Impact of multicomponent, nonpharmacological care program for mild Alzheimer’s disease with anxiety and depression

doi:10.5498/wjp.123323

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Publication Name

World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Nov 19, 2026; 16(11): 123323
Published online Nov 19, 2026. doi: 10.5498/wjp.123323

Impact of multicomponent, nonpharmacological care program for mild Alzheimer’s disease with anxiety and depression

Ya-Fei Chen, Yan Zhu, Bi-Xia Li, Jin-Na Zhang

Ya-Fei Chen, Yan Zhu, Department of General Medicine, Shaoxing 7th People’s Hospital, Shaoxing 312000, Zhejiang Province, China

Bi-Xia Li, Jin-Na Zhang, Department of Psychiatry VI, Shaoxing 7th People’s Hospital, Shaoxing 312000, Zhejiang Province, China

Author contributions: Chen YF initiated research; Zhu Y, Li BX, and Zhang JN designed the experiments and conducted clinical data collection, performed postoperative follow-up and recorded the data; Chen YF conducted the collation and statistical analysis, and wrote the original manuscript and revised the paper; all authors read and approved the final manuscript.

AI contribution statement: No AI tools were used in writing, editing, or generating any part of this manuscript, including text, images, and data analysis.

Supported by Zhejiang Province Health Industry Science and Technology Plan Project, No. 2025HY1317.

Institutional review board statement: This study was approved by the Ethics Committee of Shaoxing 7th People’s Hospital (No. 2025-039-01).

Informed consent statement: The ethics committee agrees to waive informed consent.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: All data generated or analyzed during this study are included in this published article.

Corresponding author: Ya-Fei Chen, MD, Doctor, Department of General Medicine, Shaoxing 7th People’s Hospital, No. 1234 Shengli West Road, Yuecheng District, Shaoxing 312000, Zhejiang Province, China. chenyfly258@163.com

Received: May 15, 2026
Revised: June 22, 2026
Accepted: July 13, 2026
Published online: November 19, 2026
Processing time: 166 Days and 22.6 Hours

Abstract

BACKGROUND

Patients with mild Alzheimer’s disease (AD) frequently suffer from comorbid anxiety and depression, which exacerbate neuropsychiatric symptoms, reduce quality of life, and increase caregiver burden. Conventional pharmacological treatments often inadequately address these multifaceted issues.

AIM

To evaluate the impact of a multicomponent, nonpharmacological care program on the neuropsychiatric symptoms, quality of life, caregiver burden, cognitive function, and sleep quality in patients with mild AD experiencing comorbid anxiety and depression.

METHODS

A retrospective analysis was conducted on 200 individuals diagnosed with mild AD and exhibited symptoms of anxiety and depression [Geriatric Anxiety Inventory-Short Form (GAI-SF) ≥ 3; Geriatric Depression Scale-15 (GDS-15) ≥ 6]. The patients received either conventional care (donepezil 5 mg/day plus basic health education, n = 104) or a multicomponent, nonpharmacological care program (additional 24 sessions over 12 weeks including cognitive rehabilitation, occupational therapy, art/doll therapy, exercise training, and speech therapy, n = 96). Evaluations were conducted at baseline and following a 3-month period using the Neuropsychiatric Inventory (NPI), GAI-SF, GDS-15, AD Cooperative Study Activities of Daily Living (ADCS-ADL), Quality of Life-AD (QOL-AD), Zarit Caregiver Burden Interview (ZBI), Mini-Mental State Examination (MMSE), AD Assessment Scale-Cognitive Subscale (ADAS-cog), and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

At 3 months, the multicomponent group showed the following markedly superior outcomes than the conventional group: Lower NPI total symptom score (P = 0.004) and caregiver distress (P = 0.020); Lower GAI-SF (P = 0.003) and GDS-15 (P = 0.003); Higher ADCS-ADL (P < 0.001) and QOL-AD (P < 0.001); Lower ZBI (P = 0.004); Higher MMSE (P = 0.004) and lower ADAS-cog (P = 0.024); and lower PSQI (P < 0.001).

CONCLUSION

The multicomponent, nonpharmacological care program is associated with improved neuropsychiatric symptoms, anxiety, depression, quality of life, caregiver burden, cognitive function, and sleep quality in patients with mild AD experiencing anxiety and depression.

Keywords: Alzheimer’s disease; Multicomponent nonpharmacological care; Anxiety; Depression; Caregiver burden

Core Tip: This study evaluates a multicomponent nonpharmacological care program (cognitive rehabilitation, occupational therapy, art/doll therapy, exercise training, and speech therapy) in mild Alzheimer’s disease patients with comorbid anxiety and depression. Compared to conventional care, the program significantly improved neuropsychiatric symptoms, quality of life, caregiver burden, cognitive function, and sleep quality. The findings support a holistic, nondrug approach for this specific population.