• Montgomery Asberg Depression Scale (MADRS) [ Time Frame: Measured at Weeks 4, 8, 12, and 24 ] [ Designated as safety issue: No ]
  
• WHO Disability Assessment Schedule (WHODAS)-II [ Time Frame: Measured at Weeks 4, 8, 12, and 24 ] [ Designated as safety issue: No ]
  

• Hamilton Depression Rating Scale [ Time Frame: Measured at Weeks 4, 8, 12, and 24 ] [ Designated as safety issue: No ]
  
• Sheehan Disability Scale [ Time Frame: Measured at Weeks 4, 8, 12, and 24 ] [ Designated as safety issue: No ]
  

Depression, cognitive impairment, and disability often coexist in older adults and can lead to patient suffering and family disruption. Moreover, many depressed, cognitively impaired older adults have slow, poor, or unstable response to antidepressant drugs. Despite the need for treatments other than medication, most psychotherapy research focuses on either cognitively intact patients with limited disability or on dementia patients with pronounced disability. Thus, the available treatments do not fully address the needs of the large number of depressed elders with intermediate cognitive impairment and disability. Previous studies with cognitively impaired psychiatric populations have taught participants compensatory strategies to overcome their behavioral and cognitive limitations. This study will evaluate the effectiveness of a type of psychotherapy called problem solving therapy (PST) as well as specially tailored compensatory strategies, in treating depressed, cognitively impaired older adults.

All participants in this single-blind study will undergo initial evaluations, including a 2-hour interview to assess depression, memory, and physical functioning; questions about medical history; and a neuropsychological exam. Participants will then be randomly assigned to one of two treatment groups: PST or supportive therapy. Participants assigned to PST will receive 12 weekly PST sessions conducted at the home of the participants. During these sessions, a therapist will identify the participant's difficulties in life related to depression and physical functioning and will provide strategies to overcome these difficulties. The goal of treatment is to improve adaptive functioning in the home environment, which in turn may reduce depression and disability. The first session will last between 1 and 2 hours, and the remaining 11 sessions will last 1 hour. Participants assigned to supportive therapy will also receive 12 weekly treatment sessions with a therapist conducted at the home of the participants. During supportive therapy sessions, the therapist will help participants to express feelings and to focus on their strengths and abilities when working through difficulties and transitions. For all participants, initial assessments will be repeated at Weeks 4, 8, 12, and 24.