Depression and anxiety in memory clinic attenders and their carers: implications for evaluating the effectiveness of cognitive rehabilitation interventions

BACKGROUND: The potential of cognitive rehabilitation (CR) for people who have a diagnosis of Alzheimer's disease (AD) is increasingly being recognised. It has been suggested, however, that interventions targeting memory functioning in AD have negative effects on the well-being of participants and carers in terms of mood and perceived strain. While some 'memory training' studies do report an increase in self-report scores on scales assessing these variables, it is not clear whether the changes are attributable to the intervention. There is some overlap between CR and 'memory training', but CR is a much more individualised approach, and therefore CR intervention studies often adopt within-subjects or single case experimental designs, for which relevant comparison data are required. METHOD: Participant and carer depression and anxiety, and carer strain, were assessed at initial attendance and again by postal survey 6 months later in a consecutive series of 94 Memory Clinic referrals who received standard treatment but no specialised CR interventions. RESULTS: At the group level, there were no statistically significant changes in scores at follow up, although the participants scoring above designated cut-points were not necessarily the same individuals at the two time points. CONCLUSIONS: The study provided useful comparison data for use in evaluating the effects of cognitive rehabilitation interventions on mood and carer strain, showing that in the absence of intervention scores remain generally stable over time. Significant changes observed in intervention studies should be viewed in this context.