Cognitive behavioral therapy (CBT) is a type of psychological treatment that helps people change unhelpful thoughts and behaviors. It is widely used for anxiety, depression, and insomnia, but its effectiveness for people with Alzheimer’s disease is less clear. This article explores what CBT is, how it might help Alzheimer’s patients, what the research says, and what other treatments are available.
## What Is Cognitive Behavioral Therapy?
CBT is a structured therapy that focuses on the connection between thoughts, feelings, and behaviors. The goal is to help people identify negative thought patterns and replace them with more positive, realistic ones. For example, someone who feels anxious might learn to challenge their worries and try new ways of coping. CBT is usually delivered by a trained therapist in sessions that last several weeks.
## Alzheimer’s Disease: Symptoms and Challenges
Alzheimer’s disease is a progressive brain disorder that causes memory loss, confusion, and changes in behavior and personality. Over 90% of people with Alzheimer’s experience behavioral and psychological symptoms, such as agitation, depression, and psychosis[1]. These symptoms can be distressing for both patients and their caregivers. Managing them is a key part of care.
## Can CBT Help Alzheimer’s Patients?
There is limited direct evidence that traditional CBT is effective for the core cognitive symptoms of Alzheimer’s, such as memory loss. Most research on psychological therapies for Alzheimer’s focuses on non-cognitive symptoms like depression, anxiety, and sleep problems.
**Depression and Anxiety:** Some studies suggest that adapted forms of CBT might help with depression and anxiety in people with mild cognitive impairment or early-stage dementia. However, as Alzheimer’s progresses, it becomes harder for patients to engage in the self-reflection and homework that CBT requires. There is no strong, authoritative evidence that CBT is a first-line treatment for depression or anxiety in moderate to severe Alzheimer’s.
**Sleep Problems:** A 2025 scoping review looked at CBT for insomnia in neurodegenerative diseases, including Alzheimer’s[6]. The review found that CBT for insomnia (CBT-I) can be helpful for sleep problems in some people with neurodegenerative conditions. However, the evidence is still emerging, and more research is needed to know how well it works specifically for Alzheimer’s patients. Sleep disturbances are common in Alzheimer’s, so this could be an area where CBT has a role, but it is not yet a standard treatment.
## What Are the Main Treatments for Alzheimer’s?
**Medications:** The main drugs for Alzheimer’s are cholinesterase inhibitors (like donepezil) and memantine, which can help with memory and thinking for a time[1]. Recently, new drugs called anti-amyloid monoclonal antibodies (lecanemab and donanemab) have been approved. These drugs can slow cognitive decline in early-stage Alzheimer’s, but they are not a cure and come with risks, including brain swelling and bleeding[1][3]. They also require regular brain scans to monitor for side effects[3].
**Non-Drug Approaches:** Non-pharmacological strategies are often recommended, especially for behavioral and psychological symptoms. These include personalized activities, caregiver training, and programs like DICE (Describe, Investigate, Create, Evaluate), which focus on understanding and managing behaviors without medication[1]. Memory therapy, which includes cognitive stimulation, reminiscence therapy, and occupational therapy, can help maintain cognitive function and improve quality of life in the early stages[4].
**Caregiver Support:** Training and supporting caregivers is a critical part of Alzheimer’s care. Caregivers who learn how to manage challenging behaviors and provide stimulating activities can make a big difference in the patient’s quality of life[1].
## Challenges in Using CBT for Alzheimer’s
CBT requires the ability to recognize and change thought patterns, which becomes difficult as Alzheimer’s progresses. People with moderate to severe dementia may not be able to participate fully in traditional CBT. Therapies need to be adapted, and even then, the benefits may be limited.
## What Does the Research Say?
There is no large, authoritative study showing that CBT is a primary treatment for Alzheimer’s disease itself. Most evidence supports the use of medications and non-drug strategies for cognitive and behavioral symptoms[1][2]. For sleep problems, CBT-I shows promise, but more research is needed to confirm its effectiveness in Alzheimer’s[6]. For depression and anxiety, CBT may help in mild cases, but it is not a standard recommendation for moderate to severe dementia.
## Other Psychological Therapies
Other types of therapy, such as reminiscence therapy (discussing past experiences) and cognitive stimulation therapy (group activities to engage thinking skills), have more evidence for helping people with dementia[4]. These approaches are often easier for patients to engage with as the disease progresses.
## The Big Picture
Alzheimer’s disease is complex, and no single treatment works for everyone. The best approach is usually a combination of medications, non-drug strategies, and support for caregivers[1]. CBT may have a role in managing certain symptoms, especially in the early stages, but it is not a primary treatment for the disease itself. Ongoing research is needed to find better ways to help people with Alzheimer’s and their families.
## Sources
[1] health.ucdavis.edu/news/headlines/new-series-from-the-lancet-offers-roadmap-for-alzheimers-treatment-in-a-changing-therapeutic-landscape/2025/09
[2] pubmed.ncbi.nlm.nih.gov/40997839/
[3] ncbi.nlm.nih.gov/pmc/articles/PMC12499630/
[4] neuraleffects.com/blog/memory-therapy-for-dementia-cognitive-therapy/
[6] frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2025.1700496/full
