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Objectives: The objective of this study was to evaluate the effect of tumour necrosis factor-alpha inhibitors (TNF-αI) on Alzheimer's disease-associated pathology.Design: A literature search of PubMed, Embase, PsychINFO, Web of Science, Scopus, and the Cochrane Library databases for human and animal studies that evaluated the use of TNF-αI was performed on 26 October 2016.Results: The main outcomes assessed were cognition and behaviour, reduction in brain tissue mass, presence of plaques and tangles, and synaptic function. Risk of bias was assessed regarding blinding, statistical model, outcome reporting, and other biases. Sixteen studies were included, 13 of which were animal studies and 3 of which were human. All animal studies found that treatment with TNF-αI leads to an improvement in cognition and behaviour. None of the studies measured change in brain tissue mass. The majority of studies documented a beneficial effect in other areas, including the presence of plaques and tangles and synaptic function. The amount of data from human studies was limited. Two out of 3 studies concluded that TNF-αI are beneficial in Alzheimer's disease patients, with one being an observational study and the latter being a small pilot study, with a high risk of bias.Conclusion: It was concluded that a large-scale randomized controlled trial assessing the effectiveness of TNF-αI on humans is warranted. [ABSTRACT FROM AUTHOR]

Objectives To review the effectiveness of cognitive behavioral therapy ( CBT) for depression in older people, together with factors associated with its efficacy. Design Online literature databases and registers were searched for randomized controlled trials ( RCTs) of CBT for depression in older people. Random-effects meta-analysis and meta-regression were conducted. Setting Studies involving participants from the community and inpatient and outpatient clinical settings were included in the meta-analysis. Participants Older people with major or minor depression, dysthymia, or depressive symptoms. Measurements Evidence-based outcome measures of depression. Results Four hundred eighty-five studies were identified, of which 23 were included. At the end of the intervention, CBT was significantly more effective at reducing depressive symptoms (irrespective of whether rated by clinicians or participants) than treatment as usual ( TAU) or being on a waiting list but not than active controls. The same pattern of results was found for 6-month follow-up. At all other time-points, pooled effect sizes in favor of CBT were nonsignificant. Clinician-rated outcome measures resulted in larger effect sizes in favor of CBT than self-rated measures. No significant differences in efficacy were found between CBT and other treatment (pharmacotherapy and other psychotherapies). Meta-regression analyses revealed four factors that predicted effect sizes for comparisons between CBT and control conditions, including whether concurrent pharmacotherapy was allowed. Conclusion CBT for depression in older people is more effective than waiting list or TAU, but greater efficacy than active controls or other treatment has not been demonstrated. More high-quality RCTs comparing CBT with active controls need to be conducted before firm conclusions can be drawn about the efficacy of CBT for depression in older people. Other treatment approaches that could be contrasted with or augment CBT (e.g., pharmacotherapy) also need to be explored further. [ABSTRACT FROM AUTHOR]

Objectives To review the magnitude and duration of and factors associated with effects of cognitive behavioral therapy ( CBT) for anxiety disorders in older people. Design Electronic literature databases and the Cochrane Trials Registry were searched for articles. A systematic critical review, random-effects meta-analysis, and meta-regression of randomized controlled trials were conducted. Setting Community outpatient clinics. Participants People with diagnoses of anxiety disorders. Measurements Outcome measures of anxiety and depression. Results Twelve studies were included. CBT was significantly more effective than treatment as usual or being on a waiting list at reducing anxiety symptoms at 0-month follow-up, with the effect size being moderate, but when CBT was compared with an active control condition, the between-group difference in favor of CBT was not statistically significant, and the effect size was small. At 6- but not 3- or 12-month follow-up, CBT was significantly more effective at reducing anxiety symptoms than an active control condition, although the effect size was again small. Meta-regression analyses revealed only one factor (type of control group) to be significantly associated with the magnitude of effect sizes. Conclusion The review confirms the effectiveness of CBT for anxiety disorders in older people but is suggestive of lower efficacy in older than working-age people. The small effect sizes in favor of CBT over an active control condition illustrate the need to investigate other treatment approaches that may be used to substitute or augment CBT to increase the effectiveness of treatment of anxiety disorders in older people. [ABSTRACT FROM AUTHOR]