Problem Adaptation Therapy (PATH) vs. Supportive Therapy in Treating Depressed, Cognitively Impaired Older Adults

Inclusion Criteria: * Meets Diagnostic and Statistical Manual for Mental Disorders(DSM)IV criteria for unipolar major depression * Severity of depression greater than or equal to 17 on MADRS * Disability as determined by at least 1 impairment in instrumental activities of daily living * Evidence of executive dysfunction or impairment in at least one of the following cognitive domains of Dementia Rating Scale (DRS): attention, construction, conceptualization, and memory (\[scaled score less than 7\] adjusted for age and race based on Mayo's older participants normative data) * Family member or caregiver able and willing to participate in treatment * Not currently taking antidepressants, cholinesterase inhibitors, or memantine or on a stable dosage for 8 weeks prior to study entry with no medical recommendation for change of these agents in the near future Exclusion Criteria: * High suicide risk * Axis I psychiatric disorder or substance abuse other than unipolar major depression or nonpsychotic depression * Axis II diagnosis of antisocial personality * Moderate to severe dementia: DRS total score corresponding to moderate or more severe impairment (scaled score less than or equal to 5) * Acute or severe medical illness (e.g., delirium; metastatic cancer; decompensated cardiac; liver or kidney failure; major surgery; stroke; myocardial infarction during the 3 months prior to entry) * Currently taking drugs known to cause depression (e.g., reserpine, alpha-methyl-dopa, steroi…