Effects of cognitive behavioral therapy on cognition, neuropsychiatric symptoms, and quality of life in Alzheimer's disease: a meta-analysis.

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disorder, often accompanied by cognitive decline and neuropsychiatric symptoms, which substantially impair patients' quality of life. Cognitive behavioral therapy (CBT) has shown effects in improving mood and quality of life in depression and anxiety, but systematic evidence of its application in AD is still limited. Objective: This study aims to systematically assess the efficacy of CBT interventions on global cognition, neuropsychiatric symptoms (including depression severity) and Quality of Life (QoL) in AD. Method: PubMed, Embase, Cochrane, and Web of Science databases were researched from the inception of each database to March 2025. The search strategy included MESH terms "Alzheimer Disease" and "Cognitive Behavioral Therapy", combined with the Boolean operator "AND". Randomized controlled trials involving CBT-adapted protocols were included. Data were pooled using random-effects models (Hedges' g with 95%CIs), with subgroup analyses by intervention duration. Meta-analyses were performed using Stata MP 18.0, with bias risk assessed by the Cochrane Risk of Bias tool RevMan 5.4. Result: A total of 15 randomized controlled trials (n=2,135 participants) were included. The meta-analysis showed that CBT significantly improved global cognition (MMSE: SMD = 0.67, 95%CI=0.31 to 1.02, p<0.001), though heterogeneity was high (I²=86.9%). No significant effects were observed for neuropsychiatric symptoms, or QoL. Subgroup analyses revealed medium-term interventions (8-16 weeks) reduced depressive symptoms and improved QoL, while long-term CBT (>16 weeks) enhanced cognition. Conclusions: CBT demonstrates significant benefits for global cognition in AD, with medium-term interventions effective for mood and QoL outcomes. These findings support CBT intervention as viable non-pharmacological strategies for AD management, though methodological limitations and considerable heterogeneity warrant cautious interpretation.