ProblemAdaptation Therapy for Older AdultsWithMajor Depression and Cognitive Impairment A Randomized Clinical Trial

IMPORTANCE Problem adaptation therapy (PATH) is a treatment for older adults with major depression, cognitive impairment (frommild cognitive deficits to moderate dementia), and disability. Antidepressants have limited efficacy in this population and psychosocial interventions are inadequately investigated. OBJECTIVE To test the efficacy of 12-week PATH vs supportive therapy for cognitively impaired patients (ST-CI) in reducing depression and disability in 74 older adults with major depression, cognitive impairment, and disability. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial at theWeill Cornell Institute of Geriatric Psychiatry from April 1, 2006, to September 31, 2011. Interventions were administered at the participants ’ homes. Participants included 74 older individuals (age65 years) with major depression and cognitive impairment to the level of moderate dementia. They were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry and were randomly assigned to 12 weekly sessions of PATH or ST-CI (14.8 % attrition rate). INTERVENTIONS Home-delivered PATH vs home-delivered ST-CI. Problem adaptation therap