International Journal of Geriatric Psychiatry最新文献

Background: The 2020 Lancet Commission report on dementia prevention, intervention, and care, as well as its 2024 update, did not include sleep duration or sleep quality among the identified modifiable risk factors for dementia. Emerging evidence, however, supports a renewed, systematic reappraisal of the relationship between sleep parameters and cognitive impairment.

Methods: An umbrella review was conducted to comprehensively evaluate the associations between sleep duration, sleep quality, and cognitive decline. This review was registered with PROSPERO (CRD420250655199) and adhered to PRISMA guidelines, as reported in the PRIOR checklist. Major electronic databases, including PubMed, Ovid MEDLINE, PsycINFO, and Google Scholar, were systematically searched for peer-reviewed systematic reviews and meta-analyses up to the end of February 2025. Eligible reviews included observational studies (cohort, cross-sectional, or case-control) examining sleep duration or sleep quality as exposures and irreversible cognitive decline or dementia as outcomes. Quality was assessed using the CASP tool. Reviews primarily focusing on parasomnias or sleep apnea were excluded.

Results: Of 786 records identified, 13 systematic reviews met the inclusion criteria, including 11 with meta-analyses. Five reviews reported associations with long sleep duration, six with short sleep duration, and three reported no significant association with short sleep duration. Among five cohort-based reviews, three consistently supported an association between sleep duration and cognitive decline. Two of three low-bias reviews also supported this association. No low-risk or cohort-only reviews specifically examined sleep quality. Two reviews assessing both duration and quality of sleep reported increased dementia risk. Overall, pooled evidence from cohort-only and low-bias reviews supported a U-shaped association between sleep duration and cognitive impairment, with longitudinal data suggesting temporal directionality.

Conclusion: As most evidence was rated low certainty by GRADE, these findings should be considered supplementary to the 2024 Lancet Commission report. As the first rigorously conducted umbrella review, this review consolidates existing evidence and highlights the need for well-designed prospective research to clarify the independent effects of sleep duration and quality on cognition.

Background: Accessing a diagnosis and receiving adequate care and support for dementia can often be subject to various inequalities. Personal-, community-, and infrastructure-level factors can contribute to and often intersect in causing unequal health and care outcomes. With a paucity of evidence to inform solutions for dementia inequalities, the aim of this public consultation exercise was to explore potential solutions to inequalities in dementia diagnosis and care with different dementia stakeholders.

Methods: Utilising a future workshop approach, we conducted 11 in-person and remote consultation workshops to discuss experienced barriers of accessing diagnosis and care; discuss an ideal-world scenario where no barriers exist; and solutions to reach more equitable dementia diagnosis and care with people with dementia, unpaid carers, health and social care professionals, and third sector representatives. Discussions were synthesised by the research team and one public consultation group and mapped against the Dementia Inequalities model.

Results: A total of 131 different stakeholders in dementia attended 11 workshops across England. Solutions were identified across three layers of inequalities, with the majority of solutions proposed on a community and infrastructure level. Examples included link workers, a social care career pathway, Community Champions, adequate home equipment, and digital training. Some solutions require Governmental input, such as creating career pathways in the social care workforce, similar to the NHS, to train and maintain good paid carers, as well as a cross-UK national dementia strategy raising the priority of dementia and required changes.

Conclusions: Dementia inequalities could be addressed via diverse and holistic approaches. With limited evidence to date on the impact of some of the proposed solutions, future research needs to build on these recommendations and design and test suitable interventions.

Background: Elder abuse is under-researched in low-and middle-income countries (LMICs) where culture and context shape detection and reporting. This study estimated the prevalence, perpetrators and predictors of self-reported elder abuse in South Africa.

Methods: Data were collected in 2021 from 490 households in the STRIDE community-based survey across the Western Cape and Limpopo provinces. Each household included an older adult (≥ 65 years) and an informant (≥ 18 years). The adapted EAST assessed physical, emotional, sexual and financial abuse and neglect. Other measures included functional impairment (WHODAS 2.0), dementia caseness (10/66 algorithm), dementia severity (DSRS), neuropsychiatric symptoms (NPI-Q), social engagement (LSNS-6), and a novel insight into memory impairment variable comparing informant and self-ratings of memory. Logistic regression models examined demographic and health-related predictors of self-reported elder abuse.

Results: One in ten (10.4%) older adults screened positive for abuse, with most perpetrators being either a non-family member where there is a personal relationship, or family member. Financial (78%) and emotional (50%) abuse were dominant, while neglect, physical and sexual abuse were less frequent (< 6%). Functional impairment was associated with elder abuse (OR = 1.05, p < 0.01). Recall ability was not associated with reporting abuse, highlighting that cognitive limitations within the present sample did not influence disclosure.

Conclusion: Elder abuse in South Africa is prevalent and closely linked to functional dependence and financial exploitation. This is one of the first studies to examine the relationship between dementia, functional impairment and elder abuse at community level, providing critical evidence to inform prevention and support strategies in LMICs.

Objectives: Although hearing loss is a well-established risk factor for dementia, previous studies predominantly focused on peripheral hearing sensitivity, overlooking deficits in central auditory processing as measured by speech-in-noise (SIN) testing. This study aims to investigate the association between bilateral SIN hearing loss and the risk of all-cause dementia, and to examine how cognitive reserve (CR) modifies this association.

Methods: We conducted a prospective cohort study utilizing data from the UK Biobank, a large, population-based cohort. Participants were recruited between 2006 and 2010, with follow-up lasting until October 2023. The primary outcome was all-cause dementia, and secondary outcomes included some brain regions of interest. Cox proportional-hazards models were employed to estimate dementia risk and differences in brain volume associated with bilateral SIN hearing status, as well as the interaction between SIN hearing and CR.

Results: Of the 72,004 participants, both bilateral hearing loss (HR = 1.507, 95% CI: 1.349, 1.685) and unilateral hearing loss (HR = 1.181, 95% CI: 1.068, 1.305) were associated with higher dementia risk. Bilateral hearing loss was significantly associated with volume in brain regions supporting auditory, including subcortical volumes, regional gray matter volumes, accumbens, hippocampus, central opercular cortex, and heschl's gyrus. Right ear dominance was observed in unilateral mild hearing loss, whereas unilateral severe hearing loss demonstrated left ear dominance. Although dementia risk showed a dose-response relationship according to the level of SIN hearing and CR, there was no evidence that CR significantly moderated the association between SIN hearing and dementia risk.

Conclusions: Our study highlights significant disparities in dementia risk and brain volume based on bilateral hearing status, and hearing conservation strategies should consider hearing status laterality and severity to enhance prevention precision.

Background: The GBA variant confers increased risk of synuclein disorders but it is unclear what impact it has in pre-clinical groups. This study aimed to identify early psychiatric and cognitive manifestations amongst pre-clinical GBA carriers in a community cohort.

Method: This study used data from the PROTECT-UK cohort to compare 388 GBA carriers (N370S, E326K and T369M) without Parkinson's disease to age-matched controls. Neuropsychiatric symptoms (NPS) were measured with the Mild Behaviour Impairment Checklist, and cognition was measured using computerised neuropsychology.

Results: Results: GBA carriers over 70 had significantly increased NPS compared with controls (z = 2.13, p = 0.03). There was no difference between carriers and non-carriers in younger individuals but a sub-group comparison in the overall cohort showed that NPS were more severe in quartile four (Q4) of carriers compared to Q4 of controls (z = 2.39, p = 0.017), indicating an increase in NPS in this sub-group across a broader age range. No differences in cognition were seen.

Discussion: These findings suggest that NPS may be an early clinical manifestation of emerging synucleinopathy amongst individuals prior to diagnosis.

Background: Depression poses a significant global health burden yet remains widely undiagnosed and untreated, especially among South Asian populations. Despite higher prevalence rates, depression among South Asian immigrants in countries like Canada is often under-recognized due to cultural nuances. This study aims to examine patterns of mood disturbance and risk factors for depression diagnosis among South Asian and general home care clients in Ontario, Canada.

Methods: Using data from the interRAI Home Care (HC) assessments conducted between 2018 and 2022, demographic and clinical characteristics of South Asian home care clients were compared against the general home care population. Depression diagnosis and mood disturbance severity were assessed using standardized measures. Multivariate logistic regression models were employed to examine risk factors for depression diagnosis.

Results: While mood disturbance prevalence was comparable, the percentages with depression diagnosis were significantly lower 0.50 (95% CI 0.47-0.54) among South Asian home care clients compared to the general home care population. Multivariate analyses confirmed this difference even after accounting for demographic and clinical factors.

Discussion: The under-detection of depression among South Asian home care clients suggests potential issues related to cultural competence among health care providers and stigma. Systematic assessment tools like the interRAI HC can aid in identifying mental health needs. Efforts are needed to increase awareness, reduce stigma, and provide culturally appropriate mental health services for South Asian populations.

Conclusion: Depression is under-recognized among South Asian home care clients in Ontario, Canada, despite a similar prevalence of mood disturbance. Addressing cultural competence and stigma is crucial for improving the detection and treatment of depression in this population.