Mardien Leoniek Oudega

Background: Depressive symptoms are common among older adults and can significantly impact their quality of life. However, many older adults face barriers to accessing psychological treatment. Internet-based cognitive behavioral therapy (iCBT) is a promising alternative to face-to-face treatments, but its feasibility among older adults has been less extensively studied than in adult populations. Objective: This study evaluated the feasibility of guided iCBT for adults aged 55 years and older with mild to moderate depressive symptoms recruited from the general population. Methods: This study is a feasibility study with a single-group, pretest-posttest design (n=21), in which all participants received guided iCBT for 8 weeks. Assessments were conducted at baseline (T0) and after the intervention (T1). The primary outcome was feasibility, conceptualized as satisfaction, usability, engagement, and uptake of iCBT. Secondary outcome measures included depression severity, working alliance, and technical alliance. Results: Participants were mostly highly educated (13/21, 61.9%), female (18/21, 85.7%), had an average age of 59.85 (SD 4.19; range 55-68) years, and reported moderate digital literacy. Feasibility outcomes indicated high satisfaction and engagement and moderate usability. Working alliance was rated as good by both participants and coaches, and technical alliance was rated as moderate by the participants. There was a nonsignificant modest decrease in depressive symptoms (Cohen d=0.47). Of the 20 participants who started the intervention, all completed the first 2 modules, but completion declined across the remaining 6 modules, with only 1 (5%) participant completing all modules. Conclusions: This study found that guided iCBT has the potential to be a feasible option for older adults experiencing depressive symptoms, with participants reporting generally positive satisfaction, moderate engagement, and a moderate therapeutic bond with their coaches. However, below-average usability ratings and a moderate technical alliance suggest that some aspects of the platform require improvement. Future research should focus on improving usability and adherence, as well as testing the intervention in a larger and more diverse population.

BACKGROUND Depressive symptoms are common among older adults and can significantly impact their quality of life. However, many older adults face barriers to accessing psychological treatment. Internet-based cognitive behavioral therapy (iCBT) is a promising alternative to face-to-face treatments, but its feasibility among older adults has been less extensively studied than in adult populations. OBJECTIVE This study evaluated the feasibility of guided iCBT for adults aged 55 years and older with mild to moderate depressive symptoms recruited from the general population. METHODS This study is a feasibility study with a single-group, pretest-posttest design (n=21), in which all participants received guided iCBT for 8 weeks. Assessments were conducted at baseline (T0) and after the intervention (T1). The primary outcome was feasibility, conceptualized as satisfaction, usability, engagement, and uptake of iCBT. Secondary outcome measures included depression severity, working alliance, and technical alliance. RESULTS Participants were mostly highly educated (13/21, 61.9%), female (18/21, 85.7%), had an average age of 59.85 (SD 4.19; range 55-68) years, and reported moderate digital literacy. Feasibility outcomes indicated high satisfaction and engagement and moderate usability. Working alliance was rated as good by both participants and coaches, and technical alliance was rated as moderate by the participants. There was a nonsignificant modest decrease in depressive symptoms (Cohen d=0.47). Of the 20 participants who started the intervention, all completed the first 2 modules, but completion declined across the remaining 6 modules, with only 1 (5%) participant completing all modules. CONCLUSIONS This study found that guided iCBT has the potential to be a feasible option for older adults experiencing depressive symptoms, with participants reporting generally positive satisfaction, moderate engagement, and a moderate therapeutic bond with their coaches. However, below-average usability ratings and a moderate technical alliance suggest that some aspects of the platform require improvement. Future research should focus on improving usability and adherence, as well as testing the intervention in a larger and more diverse population.

This study aimed to identify trajectories of core depressive symptoms and insomnia symptoms in depressed older adults, their prevalence and association, and predictors of unfavorable trajectories. We examined 6-year follow-up data of 329 depressed older adults from the Netherlands Study of Depression in Older persons. Core depressive symptoms and insomnia symptoms were assessed with the Inventory of Depressive Symptomatology. We applied growth mixture modeling to identify classes of participants with similar trajectories of core depressive symptoms and insomnia symptoms. The association between core depressive and insomnia symptom trajectories and predictors of these trajectories were examined. We identified three core depressive symptom trajectories: low and declining (40.4%), moderate and declining (37.4%), and high and stable (22.2%); and four insomnia symptom trajectories: moderate and declining (13.7%), low and increasing (7.6%), moderate and stable (55.6%), and high and stable (23.1%). Participants with favorable core depressive symptom trajectories often had unfavorable insomnia symptom trajectories. Older age, chronic diseases, and functional limitations predicted unfavorable core depressive symptom trajectories. Functional limitations predicted unfavorable insomnia symptom trajectories. Trajectories of core depressive and insomnia symptoms in depressed older adults were partly associated, but insomnia symptoms often persisted despite improving core depressive symptoms, highlighting the importance of different targeted interventions.

Introduction: Unipolar and bipolar mood disorders in older adults are accompanied by cognitive impairment, including executive dysfunction, with a severe impact on daily life. Up and till now, strategies to improve cognitive functioning in late-life mood disorders (LLMD) are sparse. Therefore, we aimed to assess the efficacy of adaptive, computerized cognitive training (CT) on executive and subjective cognitive functioning in LLMD.Methods: In this double-blind, randomized controlled study we enrolled patients over the age of 50 with partly remitted LLMD. Over 8 weeks, patients participated in 24 45-minute sessions of computerized multi-domain training (CT) or an active control condition (ACC) (nonspecific cognitive activity). The primary outcome was executive functioning based on the interference score on the STROOP task (not incorporated in the training). Secondary outcomes were subjective cognitive functioning, depressive symptoms and quality of life. Outcomes were assessed before and after training (T1) and at a 3-month follow-up (T2) and analyzed with linear mixed-model analyses.Results: Thirty-eight patients were included in the study, 22 in the experimental CT and 16 in the ACC. Mean age was 67.3 years and 52.6% was female. Linear mixed-model analyses showed small within-group effect sizes, corresponding to no statistically significant improvement of executive functioning or depression severity in either group. In both groups we did observe an improvement on subjective cognitive functioning over time. From T0 to T1 the mean score of the Cognitive Functioning Questionnaire (CFQ) of the CT group decreased from 52.7 to 46.8 points (p=0.003) and the mean CFQ score of the ACC group decreased from 52.7 to 45.7 points (p<0.001). This effect remained in both groups at follow-up (T2); respectively p=0.002 and p<0.001.The patients in the AAC also showed an improvement of quality of life directly after the training (T1); i.e. the mean quality of life scores improved from 53 to 57 points (p=0.011), but this effect did not remain at follow-up.Conclusions: This study shows no beneficial effect of an 8-week computerized CT on the primary outcome, i.e, executive functioning. Subjective cognitive functioning did improve in both groups, indicating that frequent cognitive training is advantageous. Future studies with more intensive training could be designed to explore this result further.Clinical trial registration: clinicaltrials.gov, identifier NCT04006756.

Background: Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce, and little is known about their feasibility and effectiveness. Objective: To present the design of 2 studies aiming to assess the feasibility of internet-based cognitive behavioral treatment for older adults with depression. We will assess the feasibility of an online, guided version of the Moodbuster platform among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in a specialized mental health care outpatient clinic. Methods: A single-group, pretest-posttest design will be applied in both settings. The primary outcome of the studies will be feasibility in terms of (1) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8), (2) usability (measured with the System Usability Scale), and (3) engagement (measured with the Twente Engagement with eHealth Technologies Scale). Secondary outcomes include (1) the severity of depressive symptoms (measured with the 8-item Patient Health Questionnaire depression scale), (2) participant and therapist experience with the digital technology (measured with qualitative interviews), (3) the working alliance between patients and practitioners (from both perspectives; measured with the Working Alliance Inventory–Short Revised questionnaire), (4) the technical alliance between patients and the platform (measured with the Working Alliance Inventory for Online Interventions–Short Form questionnaire), and (5) uptake, in terms of attempted and completed modules. A total of 30 older adults with mild to moderate depressive symptoms (Geriatric Depression Scale 15 score between 5 and 11) will be recruited from the general population. A total of 15 older adults with moderate to severe depressive symptoms (Geriatric Depression Scale 15 score between 8 and 15) will be recruited from a specialized mental health care outpatient clinic. A mixed methods approach combining quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be further explored with individual semistructured interviews and synthesized descriptively. Descriptive statistics (reported as means and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a 2-tailed, paired-sample t test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis. Results: The studies were funded in October 2019. Recruitment started in September 2022. Conclusions: The results of these pilot studies will show whether this platform is feasible for use by the older adult population in a blended, guided format in the 2 settings and will represent the first exploration of the size of the effect of Moodbuster in terms of decreased depressive symptoms. International Registered Report Identifier (IRRID): PRR1-10.2196/41445

Background: Memory clinics and their practising professionals may hide a treasure of clinical experience and knowledge. In addition, neuroscientists are seeking a way to bring their scientific results swiftly to clinical practice.Objective: To optimize patient care in Dutch memory clinics (>100) by stimulating and facilitating its members to learn together, innovate and share knowledge and experience.Methods: In November 2016 the Dutch Memory clinic Network (Nederlands Geheugenpoli Netwerk, NGN) was initiated after consulting the four national academic Alzheimer clinics (Amsterdam, Rotterdam, Maastricht, Nijmegen) and the Dutch Alzheimer Association (Alzheimer Nederland). The primary goal ‐ sharing knowledge – is achieved by: 1) Maintaining the NGN Website with information on educational opportunities, ongoing clinical research, guidelines, list of associated memory clinics, etc., 2) Sending out newsletters (4 times a year), 3) Organizing yearly conferences on various topics relevant to memory clinic professionals and researchers, 4) Facilitating professionals to discuss complex patients via the Siilo groups app (a protected messenger, to be used only by care professionals, checked through a national registration number: BIG).Results: Of >100 memory clinics 77 listed themselves at the website (Fig 1). In the last nine months the website generated >4000 pageviews. Topics that are most frequently visited on the website are educational podcasts on trending topics in the field of dementia presented by clinicians several times a year. The newsletter topics vary: ‘ current research projects’, reports of recent relevant conferences, agenda of relevant conferences for memory clinics. Currently we have 430 subscribers for the newsletter. For the conference the number of attendants has increased over the past four years from 90 in 2016 till 220 in 2019. The Siilo groups app started November 2019, and currently counts 30 participants, increasing every month. Complex patients are discussed as well as news on memory clinics in the media.Conclusion: With the growing number of page views, newsletter‐subscribers, attendants at the conference and members of the Siilo groups app, the NGN serves the dense network of memory clinic professionals in the Netherlands, with the ultimate goal to improve patient care for cognitively impaired patients.