1 - (SYM 28) Improving Depression in the Context of Co-occurring Mild Cognitive Impairment: A Feasibility Trial of Engage, a Behavioral Intervention for Older Adults

Background: Depression is a leading risk factor for worsening cognition and conversion to dementia. However, psychotherapy for depression in the context of mild cognitive impairment (MCI) is inadequately investigated. Engage is a brief, structured behavioral treatment for late-life depression previously tested in a cognitively normal sample. This study evaluated feasibility of Engage in a sample of older adults with depression and MCI.

Method: This single-arm trial provided up to 9 sessions of Engage delivered over weekly 45-to-60-min individual sessions. Engage focuses on positive valence system dysfunction as a critical mechanism of late-life depression per NIMH Research Domain Criteria (RDoC). Engagement in meaningful, rewarding activities is its principal intervention, alongside structured assessment and strategies to overcome common barriers encountered in late-life depression. Eligible participants were community-dwelling adults 60 and older with elevated depressive symptoms (Geriatric Depression Scale [GDS-SF] ≥5) and mild cognitive impairment (Montreal Cognitive Assessment [MoCA] scores 18-25). Implementation outcomes included feasibility (recruitment, retention) and acceptability (Working Alliance Inventory). Clinical outcomes included change in the Hamilton Depression Rating Scale (HAM-D) and purported mechanism of behavioral activation (Behavioral Activation for Depression-Short Form) between pre- and post-treatment. Paired sample t-tests and Hedges’ g effect size assessed change.

Results: Of the 24 individuals screened; 8 (33%) were eligible and enrolled. Primary reasons for ineligibility were not cognitively impaired (n=12) or not depressed enough (n=2). Enrolled participants were on average 72.5 years old (range 65-82). Most participants were women (75%) and non-Hispanic White (80%); 20% identified as Asian. Treatment retention was good (n=1 enrolled participant dropped); the remainder completed at least 7 sessions and up to 9 (average: 8.57, SD = .98). HAM-D indicated a clinically significant signal (Hedges’ g >1.0). Hypothesizes mechanism of behavioral activation was engaged (BADS-SF change Hedges’ g=0.57). Working alliance was rated highly.

Discussion: Preliminary findings suggest Engage may be a feasible and acceptable intervention for depression in the context of MCI, with the potential for clinically relevant improvement in target mechanism and intended outcome. This innovation warrants further study in a larger and more diverse sample.