Imagine you’re trying to fix a leaky faucet. You could try different solutions – tightening the screws, replacing the washer, or even call a plumber. In the same way, when it comes to treating depressive symptoms in cognitive impairment, there are various options available. A recent systematic review and Bayesian network meta-analysis evaluated the effectiveness and acceptability of different treatments for depressive symptoms in cognitive impairment. The study compared the efficacy of 28 treatments and found that non-pharmacological interventions, such as aerobic exercise, behavioral training, electrical current stimulation, massage, music therapy, and reminiscence therapy, were more effective than pharmacological treatments in reducing depressive symptoms and improving cognitive impairment. Interestingly, no treatments showed a higher risk compared to a placebo. These results suggest that non-pharmacological treatments should be considered as an alternative or supplement to pharmacological treatments in clinical settings. If you’re interested in learning more about this research and the specific treatments that stood out, be sure to explore the underlying study!

BackgroundDepressive symptoms play an essential role in cognition decline, while the benefit and acceptability of treatments for depressive symptoms in cognitive impairment are still unknown.ObjectiveTo comprehensively evaluate the comparative efficacy and acceptability of treatments for depressive symptoms in cognitive impairment based on the quantitative Bayesian network meta-analysis method (NMA).MethodWe searched MEDLINE, Embase, the Cochrane Library, CINAHL, and PsycINFO from inception until August 2022 to identify randomized clinical trials (RCTs) evaluating treatments for depressive symptoms in cognitive impairment. Efficacy was evaluated by the Cornell Scale for Depression in Dementia (CSDD), the Hamilton Depression Rating Scale (HDRS), and the Geriatric Depression Scale (GDS) for depression; the Neuropsychiatric Inventory (NPI) and the Cohen–Mansfeld Agitation Inventory (CMAI) for behavior; and the Mini-Mental State Examination (MMSE) for cognition. Safety was evaluated by total adverse events (AEs), serious AEs, diarrhea, headache, and nausea.ResultsIn this study, 13,043 participants from 107 RCTs were included, involving 28 treatments and the discontinuation of antidepressants. On CSDD, aerobic exercise (MD −4.51, 95%CrI −8.60 to −0.37), aripiprazole (MD −1.85, 95%CrI −3.66 to −0.02), behavioral training (MD −1.14, 95%CrI −2.04 to −0.34), electrical current stimulation (MD −3.30, 95%CrI −5.94 to −0.73), massage (MD −12.67, 95%CrI −14.71 to −10.59), music therapy (MD −2.63, 95%CrI −4.72 to −0.58), and reminiscence therapy (MD −2.34, 95%CrI −3.51 to −1.25) significantly outperformed the placebo. On MMSE, cognitive stimulation therapy (MD 1.42, 95%CrI 0.49 to 2.39), electrical current stimulation (MD 4.08, 95%CrI 1.07 to 7.11), and reminiscence therapy (MD 1.31, 95%CrI 0.04 to 2.91) significantly outperformed the placebo. Additionally, no treatments showed a significantly higher risk than the placebo.ConclusionOur NMAs indicated that non-pharmacological interventions were more efficacious and safe than pharmacological treatments for reducing depressive symptoms as well as improving cognitive impairment. Electrical current stimulation, aerobic exercise, and reminiscence therapy could be first recommended considering their beneficial performance on both depression and cognition. Hence, non-pharmacological treatments deserve more attention and extensive application and should at least be considered as an alternative or assistance in clinical settings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021239621, identifier: CRD42021239621.

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