International Journal of Geriatric Psychiatry最新文献_第10页

Does Frailty Predict Cognitive and Functional Deficits After Nine Years? 虚弱是否预示着九年后的认知和功能缺陷？

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-30 DOI: 10.1002/gps.70104

Beatriz Raz Franco de Santana, Daniela de Assumpção, Flávia Silva Arbex Borim, Ivan Aprahamian, Ligiana Pires Corona, Samila Sathler Tavares Batistoni, Deusivania Vieira da Silva Falcão, Meire Cachioni, Ruth Caldeira de Melo, Anita Liberalesso Neri, Monica Sanches Yassuda

Objectives

To identify the variables at baseline, including physical frailty, that might predict cognitive and functional deficits in a 9-year follow-up.

Methods

This investigation included participants from the FIBRA study in Campinas city and Ermelino Matarazzo, subdistrict of São Paulo city, with complete data collected at baseline and follow-up for the variables sex, age, education, frailty phenotype, number of chronic diseases, and tobacco and alcohol use. Of the initial 1284 participants at baseline, 98 that exhibited cognitive impairment were excluded. At follow-up, 451 participants were located and reinterviewed and 85 scored below the cut-off on the Mini-Mental State Exam (MMSE), of which 45 also presented functional deficit.

Results

The follow-up subsample comprised predominantly participants that were female (68.1%), aged 65–74 years (71.6%), and had low education (0–4 years of education, 75.6%). At baseline, 35.5% were non-frail, 57.0% pre-frail and 7.5% frail, whereas at follow-up, 29.4% were non-frail, 62.3% pre-frail and 8.3% frail. Logistic regression showed that age and education but not frailty at baseline were associated with cognitive and functional deficits at follow-up.

Conclusions

Higher age and lower education at baseline were predictors of cognitive and functional deficits after 9 years, whereas frailty was not. Further longitudinal studies should be conducted to elucidate the factors predicting cognitive and functional decline in low-and middle-income countries.

目的确定基线变量，包括身体虚弱，在9年随访中可能预测认知和功能缺陷。方法本研究纳入了来自圣保罗市Campinas市和Ermelino Matarazzo街道的FIBRA研究的参与者，在基线和随访时收集了性别、年龄、教育程度、脆弱表型、慢性病数量和烟酒使用等变量的完整数据。在最初的1284名基线参与者中，98名表现出认知障碍的参与者被排除在外。在随访中，451名参与者被定位并重新访谈，其中85人在迷你精神状态测试（MMSE）中得分低于临界值，其中45人也表现出功能缺陷。结果随访子样本主要为女性（68.1%），年龄在65-74岁（71.6%），受教育程度低（0-4年，75.6%）。基线时，35.5%为非虚弱，57.0%为虚弱前期，7.5%为虚弱，而随访时，29.4%为非虚弱，62.3%为虚弱前期，8.3%为虚弱。逻辑回归显示，年龄和教育程度与随访时的认知和功能缺陷有关，而基线时的虚弱程度与随访时的认知和功能缺陷无关。结论：较高的年龄和较低的基线教育水平是9年后认知和功能缺陷的预测因素，而虚弱不是预测因素。应该进行进一步的纵向研究，以阐明预测中低收入国家认知和功能衰退的因素。

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引用次数: 0

Differentiating Treatment-Resistant Depression With and Without Parkinsonism in the Elderly From a Psychiatric Perspective by 99mTc-TRODAT-1 SPECT Imaging 99mTc-TRODAT-1 SPECT成像从精神病学角度鉴别老年难治性抑郁症伴与不伴帕金森病

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-30 DOI: 10.1002/gps.70102

Tung-Ping Su, Chiu-Jung Huang, Wei-Chung Mao, Yu-Hsien Chiu, Ren-Shyan Liu, Li-Fen Chen

<div> <section> <h3> Objectives</h3> <p>Late-life depression often overlaps with neurodegenerative diseases leading to diagnostic and treatment challenges for neuropsychiatrists. This study aimed to differentiate elderly treatment-resistant depression (TRD) comorbid with parkinsonism from elderly TRD without Parkinsonism as well as elderly healthy controls using striatum dopamine transporter (DAT) imaging by <sup>99m</sup>Tc TRODAT-1 SPECT.</p> </section> <section> <h3> Methods</h3> <p>Three groups were enrolled, including patients with TRD, patients with TRD comorbid with parkinsonism, and healthy controls. To obtain the DAT availability, the specific uptake ratios of the bilateral striatum were evaluated. Linear regression analyses were performed to evaluate the relationship between age and DAT level in the subregions of the striatum. Machine learning was applied to categorize the three groups with 10-fold cross-validation.</p> </section> <section> <h3> Results</h3> <p>The study enrolled 32 patients with TRD (<span></span><math> <semantics> <mrow> <mn>66.15</mn> <mo>±</mo> <mn>6.82</mn> </mrow> <annotation> $66.15pm 6.82$</annotation> </semantics></math>), 36 TRD patients with parkinsonism (<span></span><math> <semantics> <mrow> <mn>70.27</mn> <mo>±</mo> <mn>5.63</mn> </mrow> <annotation> $70.27pm 5.63$</annotation> </semantics></math>), and 74 healthy elderly (<span></span><math> <semantics> <mrow> <mn>66.95</mn> <mo>±</mo> <mn>10.59</mn> </mrow> <annotation> $66.95pm 10.59$</annotation> </semantics></math>). A normative DAT concentration by age was established, providing a reference for clinical use. DAT levels differed among groups (all pairwise <i>p</i> < 0.01), with healthy controls exhibiting the highest levels, followed by patients with TRD, and then TRD patients with parkinsonism. Further, the Fine k-NN classifier emerged as the top performer to achieve 85.7% accuracy.</p> </section> <section> <h3> Conclusions</h3> <p>Besides clinical assessment, dopaminergic as

目的老年抑郁症常与神经退行性疾病重叠，给神经精神病学家的诊断和治疗带来挑战。本研究旨在利用99mTc TRODAT-1 SPECT纹状体多巴胺转运体（DAT）成像技术，区分老年帕金森病伴发的难治性抑郁症（TRD）与非帕金森病的老年抑郁症（TRD）以及老年健康对照。方法将TRD患者、TRD合并帕金森病患者和健康对照组分为3组。为了获得数据的有效性，评估了双侧纹状体的特定摄取比率。采用线性回归分析来评估纹状体亚区年龄与DAT水平之间的关系。应用机器学习对三组进行10倍交叉验证分类。结果32例TRD患者（66.15±6.82美元66.15pm 6.82美元），TRD帕金森患者36例（70.27±5.63美元70.27pm 5.63美元）；健康老年人74例（66.95±10.59$ 66.95pm 10.59$）。建立了按年龄划分的标准DAT浓度，为临床使用提供参考。各组间DAT水平存在差异(p <；0.01)，健康对照最高，TRD患者次之，TRD合并帕金森患者次之。此外，Fine k-NN分类器表现最佳，准确率达到85.7%。结论除临床评价外，多巴胺能评价可作为老年帕金森与TRD的鉴别指标。TRD中较低的DAT可用性表明TRD可能是帕金森病的前驱症状。精神科医生应考虑老年人、抑郁症患者的共病性神经退行性疾病，并使用临床评估、神经学检查和脑成像进行早期帕金森病筛查。

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引用次数: 0

The Relationship Between Caregiver Burden With Insomnia and Malnutrition in Caregivers of Older Hospitalized Patients 老年住院患者照顾者失眠负担与营养不良的关系

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-28 DOI: 10.1002/gps.70106

Nisa Ozen Aydin, Irem Tanriverdi, Ozge Pasin, Betul Sumbul Sekerci, Lee Smith, André Hajek, Pinar Soysal

Objectives

The aim of this study was to investigate among caregivers of older hospitalized patients, the relationship between caregiver burden, caregivers' nutrition, and the two most common sleep disorders—excessive daytime sleepiness and insomnia—as well as the interplay between these factors.

Method

The study universe consisted of informal caregivers of older inpatients at an university hospital in Turkiye. The sample included 100 caregivers selected through purposive sampling between March 2024-/January 2025. Data were collected on personal information, caregiver burden (assessed using the Multidimensional Caregiver Burden Inventory [MCBI]), nutritional status (evaluated using the Mini Nutritional Assessment Test [MNA] and the Healthy Eating Attitude Scale), sleep status (assessed using the Epworth Sleepiness Scale and the Insomnia Severity Index [ISI]), and muscle strength (measured by a handgrip dynamometer).

Result

A total of 100 caregivers (79% female, with a mean age of 50.5 years). Females comprised 61% of the patient population, and the mean age was 78.5 years. A significant positive correlation was found between the MCBI score and caregiving duration, ISI score, and patient age (p < 0.005). In contrast, the MCBI score showed a significant negative correlation with the MNA score and muscle strength (p ≤ 0.005). The adjusted linear regression analysis revealed that the MNA score had a significant negative effect on MCBI, while the ISI score had a significant positive effect.

Conclusion

In the present study caregiver burden was associated with poor nutrition and sleep disturbances. Thus, reducing caregiver burden may improve insomnia and malnutrition. Moreover, addressing sleep and nutrition problems in caregivers suffering from insomnia or malnutrition may contribute to a reduction in overall caregiver burden.

目的探讨老年住院患者护理人员负担、营养状况与两种最常见的睡眠障碍日间过度嗜睡和失眠症之间的关系及其相互作用。方法研究对象为土耳其某大学医院老年住院患者的非正式护理人员。样本包括2024年3月至2025年1月期间通过有目的抽样选择的100名护理人员。收集的数据包括个人信息、照顾者负担（使用多维照顾者负担量表[MCBI]评估）、营养状况（使用迷你营养评估测试[MNA]和健康饮食态度量表评估）、睡眠状况（使用爱普沃斯嗜睡量表和失眠严重程度指数[ISI]评估）和肌肉力量（通过握力计测量）。结果共100名护理人员，女性79%，平均年龄50.5岁。女性占患者总数的61%，平均年龄为78.5岁。MCBI评分与护理时间、ISI评分和患者年龄呈显著正相关(p <；0.005)。MCBI评分与MNA评分和肌力呈显著负相关（p≤0.005）。调整后的线性回归分析显示，MNA评分对MCBI有显著的负向影响，而ISI评分对MCBI有显著的正向影响。结论在本研究中，照顾者负担与营养不良和睡眠障碍有关。因此，减轻照顾者负担可能改善失眠和营养不良。此外，解决患有失眠或营养不良的照顾者的睡眠和营养问题可能有助于减轻照顾者的总体负担。

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引用次数: 0

Changes in the Emergency Department Visits Among the Older Adults With Dementia Before, and After the Nationwide Social Distancing Measures: An Interrupted Time Series Analysis 在全国社会距离措施之前和之后，老年痴呆症患者急诊室就诊的变化：中断时间序列分析

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-21 DOI: 10.1002/gps.70100

Jeongmin Moon, Kyung-Shin Lee, Ho Kyung Sung, Seonji Kim

Objectives

Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions in social interactions and raising concerns about unforeseen impacts on vulnerable populations, particularly older individuals with dementia. This study examines the impact of extended social isolation on dementia patients receiving emergency care.

Methods

We conducted a nationwide study of emergency department (ED) visits among dementia patients aged 65+ during various phases of pandemic-related social distancing. Segmented quasi-Poisson regression models were used to determine changes in ED visits during and after social distancing compared to pre-social distancing.

Results

From 2017 to 2022, there were 203,772 ED visits by patients with dementia among older patients. The proportion of ED visits by patients with dementia decreased from 17% pre-pandemic to 15% during social isolation. Interrupted time series analysis revealed a decline in ED visits during social distancing (step change: 0.849, 95% confidence interval [CI] 0.804–0.897; slope change: 1.000, 95% CI 0.996–1.003) followed by a rebound after restrictions were lifted (step change: 1.076, 95% CI 1.024–1.131; slope change: 1.009, 95% CI 0.994–1.025). However, monthly admission and mortality rates increased during social distancing.

Conclusion

This study observed a decline in ED visits by patients with dementia among older patients during social distancing, followed by a rebound after restrictions were lifted. However, the social distancing period was associated with increased hospitalization and mortality. These findings underscore the importance of maintaining healthcare accessibility for vulnerable older adults.

众所周知，社会孤立是痴呆症的一个危险因素，尤其是在老年人中。最近的全球卫生危机，加上社交距离延长，导致社会交往前所未有的中断，并引发了对弱势群体，特别是老年痴呆症患者的不可预见影响的担忧。本研究探讨延长社会隔离对接受紧急护理的痴呆症患者的影响。方法我们在全国范围内对65岁以上痴呆症患者在大流行相关社交距离的各个阶段的急诊就诊情况进行了研究。使用分段准泊松回归模型来确定在社交距离期间和之后与社交距离前相比，急诊科就诊的变化。结果2017 - 2022年，老年痴呆患者ED就诊203772人次。痴呆症患者的急诊科就诊比例从大流行前的17%下降到社会隔离期间的15%。中断时间序列分析显示，社交距离期间急诊科就诊人数下降(阶跃变化：0.849,95%可信区间[CI] 0.804-0.897；斜率变化：1.000,95% CI 0.996-1.003)，限制解除后出现反弹(阶跃变化：1.076,95% CI 1.024-1.131；斜率变化：1.009,95% CI 0.994-1.025)。然而，在保持社交距离期间，月入院率和死亡率有所上升。本研究发现，在保持社交距离期间，老年痴呆症患者的急诊科就诊人数有所下降，而在限制解除后，就诊人数又出现反弹。然而，社交距离期与住院率和死亡率增加有关。这些发现强调了为脆弱的老年人保持医疗可及性的重要性。

{"title":"Changes in the Emergency Department Visits Among the Older Adults With Dementia Before, and After the Nationwide Social Distancing Measures: An Interrupted Time Series Analysis","authors":"Jeongmin Moon, Kyung-Shin Lee, Ho Kyung Sung, Seonji Kim","doi":"10.1002/gps.70100","DOIUrl":"https://doi.org/10.1002/gps.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions in social interactions and raising concerns about unforeseen impacts on vulnerable populations, particularly older individuals with dementia. This study examines the impact of extended social isolation on dementia patients receiving emergency care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide study of emergency department (ED) visits among dementia patients aged 65+ during various phases of pandemic-related social distancing. Segmented quasi-Poisson regression models were used to determine changes in ED visits during and after social distancing compared to pre-social distancing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2017 to 2022, there were 203,772 ED visits by patients with dementia among older patients. The proportion of ED visits by patients with dementia decreased from 17% pre-pandemic to 15% during social isolation. Interrupted time series analysis revealed a decline in ED visits during social distancing (step change: 0.849, 95% confidence interval [CI] 0.804–0.897; slope change: 1.000, 95% CI 0.996–1.003) followed by a rebound after restrictions were lifted (step change: 1.076, 95% CI 1.024–1.131; slope change: 1.009, 95% CI 0.994–1.025). However, monthly admission and mortality rates increased during social distancing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study observed a decline in ED visits by patients with dementia among older patients during social distancing, followed by a rebound after restrictions were lifted. However, the social distancing period was associated with increased hospitalization and mortality. These findings underscore the importance of maintaining healthcare accessibility for vulnerable older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Conceptualising the Role of Dementia Champions Across Health and Social Care: A Qualitative Study Informed by Theory of Change (The DemChamp Study) 概念化痴呆症捍卫者在健康和社会护理中的作用：一项由变化理论提供信息的定性研究（DemChamp研究）

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-21 DOI: 10.1002/gps.70101

Tiffeny James, Monica Leverton, Kritika Samsi, Christina Newton

Objectives

People who work in health and social care frequently come into contact with people living with dementia, highlighting the need for a dementia aware and competent workforce. Some health and care services have implemented ‘Dementia Champions’ (DCs) to address this, but the role is rarely seen in domiciliary homecare services. We aim to conceptualise the DC role across health and social care to learn how it is implemented in practice and consider how it can be applied to homecare.

Methods

We conducted 30 semi-structured interviews with health and social care workers who either work as DCs or have experience/knowledge of working with them. We used framework analysis to analyse the data, informed by a Theory of Change (ToC) approach which involved identifying the ‘inputs’ involved in the role (tasks and responsibilities); and the short, medium, and long-term mechanisms required to implement, embed, and maintain the role.

Results

We identified key tasks and responsibilities of a DC which varied between and within sectors and services. The was a lack of role clarity and rarely a role description, which was considered a barrier to the role's success. The DC role is typically voluntary with no remuneration and performed on top of existing roles with no protected time for specific DC tasks. DCs typically take on the role due to a passion for good dementia care and a desire to make a difference, meaning feedback and feeling valued were important. The DC role provides an opportunity for career development, which was considered essential to retaining DCs, and health and social care workers generally. We present these findings as five themes which map onto our ToC framework to explore how the DC role is implemented, embedded, and maintained in practice.

Conclusions

Across all services, there is need for role clarity, with a DC role description at the outset to set out the tasks, responsibilities, and boundaries of the role. The DC role needs protected time for workers to implement it and undertake training. We will use these findings to develop and refine our ToC framework to reflect its applicability for the homecare sector.

从事卫生和社会护理工作的人员经常与痴呆症患者接触，这突出表明需要一支认识到痴呆症的称职工作队伍。为了解决这一问题，一些保健和护理服务机构实施了“痴呆症捍卫者”（DCs），但在居家护理服务中很少看到这一角色。我们的目标是概念化DC在健康和社会护理中的作用，了解它在实践中是如何实施的，并考虑如何将其应用于家庭护理。方法：我们对30名卫生和社会护理工作者进行了半结构化访谈，这些工作者要么是dc工作，要么是有与dc一起工作的经验/知识。我们使用框架分析来分析数据，通过变革理论（ToC）方法进行分析，该方法涉及识别角色（任务和责任）中涉及的“输入”；以及实现、嵌入和维护角色所需的短期、中期和长期机制。结果：我们确定了DC的关键任务和责任，这些任务和责任在部门和服务之间和内部有所不同。问题是角色不清晰，很少有角色描述，这被认为是角色成功的障碍。DC角色通常是自愿的，没有报酬，并且在现有角色之上执行，没有特定DC任务的保护时间。dc通常承担这一角色，是因为他们对良好的痴呆症护理充满热情，并希望有所作为，这意味着反馈和被重视的感觉很重要。DC角色提供了职业发展的机会，这被认为是留住DC以及一般保健和社会护理工作者的关键。我们将这些发现分为五个主题，并将其映射到我们的ToC框架中，以探索如何在实践中实现、嵌入和维护DC角色。在所有服务中，都需要明确角色，在开始时使用DC角色描述来设置角色的任务、职责和边界。DC角色需要保护员工的时间来实施它并进行培训。我们将利用这些发现来发展和完善我们的ToC框架，以反映其对家庭护理部门的适用性。

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引用次数: 0

Validity and Sensitivity to Change of a Self-Report Quality of Life Measure in Patients With Korsakoff's Syndrome 科萨科夫综合征患者自我报告生活质量量表变化的有效性和敏感性

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-21 DOI: 10.1002/gps.70103

Yvonne C. M. Rensen, Corrie de Waal - Gordijn, Roy P. C. Kessels

Background

Assessing (self-reported) quality of life (QoL) in patients with Korsakoff's syndrome (KS) is important to gain insight into these patients' well-being and to optimize their care in long-term care facilities. In this study, we describe the development of the QUALIKO-Self Report (QUALIKO-SR), an instrument for objectifying self-reported QoL in patients with KS. Next, we compared the QUALIKO-SR scores with the scores on the QUALIKO-Proxy Version (QUALIKO-PV) and examined changes in QoL over time. Finally, we assessed the convergent validity and investigated whether QUALIKO-SR scores were related to the severity of the cognitive impairments.

Methods

The study took place in specialized long-term care facilities providing care for patients with KS. 116 patients with alcoholic KS participated in this study. The QUALIKO-SR was developed and validated against the QUALIKO-PV, the Manchester Short Assessment of Quality of Life (MANSA-16), and the Montreal Cognitive Assessment 8.1 (MoCA).

Results

Significant differences were found between self- and proxy reported QoL on the subscales Negative Affect, Social Isolation, and Feeling at Home. No significant differences were found on the other subscales. QUALIKO-SR scores did not significantly vary over time. However, caregivers reported significant improvements in Care Relationships, Autonomy, Restless Tense Behavior, Social Isolation, and Feeling at Home over time. A significant, positive association was found between the QUALIKO-SR and the MANSA-16. No significant correlations were found between the QUALIKO-SR and the MoCA.

Conclusions

This study describes the development and validation of a self-report instrument for objectifying QoL in patients with KS living in 24-h care facilities, the QUALIKO-SR. Measuring QoL in patients with severe cognitive impairments, such as patients with KS, is complex and we advise to include both self-report and proxy-report measures in future studies as well as in clinical practice. The availability of the QUALIKO-SR and QUALIKO-PV encourages researchers and clinicians to do so in patients with KS.

评估（自我报告的）科萨科夫综合征（KS）患者的生活质量（QoL）对于深入了解这些患者的健康状况和优化他们在长期护理机构的护理非常重要。在本研究中，我们描述了qualko - self Report （QUALIKO-SR）的发展，这是一种客观化KS患者自我报告生活质量的工具。接下来，我们将QUALIKO-SR分数与QUALIKO-Proxy Version （QUALIKO-PV）分数进行比较，并检查生活质量随时间的变化。最后，我们评估了趋同效度，并研究了QUALIKO-SR评分是否与认知障碍的严重程度相关。方法本研究在专门为KS患者提供护理的长期护理机构中进行。116例酒精性KS患者参与了本研究。根据QUALIKO-PV、曼彻斯特生活质量短期评估（MANSA-16）和蒙特利尔认知评估8.1 （MoCA）开发并验证了QUALIKO-SR。结果自我和代理报告的生活质量在消极情绪、社会孤立和家的感觉三项量表上存在显著差异。在其他量表上没有发现显著差异。QUALIKO-SR评分随时间变化不显著。然而，护理人员报告说，随着时间的推移，他们在护理关系、自主性、不安紧张行为、社会隔离和家的感觉方面有了显著的改善。在QUALIKO-SR和MANSA-16之间发现了显著的正相关。QUALIKO-SR与MoCA之间无显著相关。本研究描述了一种自我报告工具的开发和验证，用于客观化生活在24小时护理机构的KS患者的生活质量，即QUALIKO-SR。测量严重认知障碍患者（如KS患者）的生活质量是复杂的，我们建议在未来的研究和临床实践中同时采用自我报告和代理报告的测量方法。QUALIKO-SR和QUALIKO-PV的可用性鼓励研究人员和临床医生在KS患者中这样做。

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引用次数: 0

Clozapine Treatment in Patients With a Neurocognitive Disorder 氯氮平治疗神经认知障碍

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-19 DOI: 10.1002/gps.70099

A. Triest, Rob M. Kok

Objectives

Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder.

Methods

A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files.

Results

We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi² = 14.47, df = 2, p < 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration.

Conclusion

Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.

目的：痴呆症的行为和心理症状通常通过药物和非药物干预相结合来治疗，但效果通常是中等的，而且许多患者对治疗有抵抗性。我们的目的是评估神经认知障碍患者使用氯氮平治疗的适应症、反应、副作用、氯氮平停药的频率、停药的原因和停药的时间。方法回顾性队列研究，纳入荷兰一家精神病院老年科2011年至2020年间接受氯氮平治疗的所有神经认知障碍患者。临床总体印象改善量表（CGI-I）用于评估治疗反应，基于患者电子档案中的临床记录。还从患者档案中提取了有关氯氮平停药的副作用和变量。结果我们纳入了81例住院患者，他们开始使用氯氮平并有严重的神经认知障碍。27例患者出现临床相关阳性治疗反应（CGI-I评分1-2）。与伴有神经认知障碍的谵妄患者相比，无谵妄患者的预后有统计学意义上的显著改善(Chi2 = 14.47, df = 2, p <；0.0001)。81例患者中仅有79例出现不良反应，2例出现严重不良反应。11例患者因副反应主要停药，7例患者无疗效，5例患者副反应合并无疗效。氯氮平的中位剂量仅为50mg /天，较高的剂量是较短治疗时间的显著预测因子。结论氯氮平对无谵妄叠加的神经认知障碍合并BPSD患者可能是一种安全有效的干预手段。低剂量氯氮平可能是重度难治性BPSD的一种治疗选择。

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引用次数: 0

Prevalence of Dementia in European, Chinese and Indian/Fijian-Indian Populations in Aotearoa New Zealand: A Protocol 新西兰奥特罗阿地区欧洲人、中国人和印度人/斐济-印度人痴呆症患病率：一项议定书

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-19 DOI: 10.1002/gps.70089

Sarah Cullum, Xiaojing Wu, Claudia Rivera-Rodriguez, Rita Krishnamurthi, Jackie Broadbent, Susan Yates, Adrian Martinez-Ruiz, Lynette Tippett, Nick Garrett, Oliver Menzies, Braden Te Ao, Joanna Hikaka, Fuafiva Fa'alau, Etuini Ma'u, Emme Chacko, Amy Chan, Makarena Dudley, Richard Faull, Mathew Croucher, Ngaire Kerse, Gary Cheung

Objectives

Aotearoa New Zealand (NZ) is a bicultural nation (Māori and European) with a growing population of Asian and Pacific peoples. Recent analysis of national routinely collected data suggests dementia prevalence is higher in Māori and Pacific peoples when compared with European and Asian, and that inequities in dementia care for Māori, Asian, and Pacific people with dementia exist. A population-based dementia prevalence study is needed to confirm these findings. The aim of this protocol is to describe a dementia prevalence study focussing on the European, Chinese and Indian populations in NZ. The findings will be compared to a separate study on Māori populations using a similar study design.

Methods

This is a cross-sectional screen-interview survey of people aged ≥ 65 from European, Chinese and Indian/Fijian-Indian backgrounds in sampled meshblocks within two regions of NZ. Stage 1 involves screening eligible participants at the door using the brief cognitive scale of the Community Screening Instrument for Dementia (CSI-D). Stage 2 involves interviewing random samples of screen positive and negative participants using the 10/66 dementia protocol. With a margin of error of approximately 3%, and a confidence level of 5%, a total of 485 European, 410 Chinese and 425 Indian/Fijian-Indian people will be interviewed with the 10/66 protocol. Age-standardised prevalence estimates of 10/66 dementia will be back-weighted for study design.

Conclusion

This study will provide evidence for suspected ethnic inequalities in dementia, inform new culturally appropriate dementia management strategies, and contribute to improved outcomes for people with dementia in NZ.

新西兰（NZ）是一个双文化国家（Māori和欧洲），亚洲和太平洋人民的人口不断增长。最近对国家常规收集数据的分析表明，与欧洲和亚洲相比，Māori和太平洋地区的痴呆症患病率更高，并且Māori、亚洲和太平洋地区的痴呆症患者在痴呆症护理方面存在不公平现象。需要一项基于人群的痴呆患病率研究来证实这些发现。本方案的目的是描述一项以新西兰的欧洲人、中国人和印度人为重点的痴呆症患病率研究。研究结果将与使用类似研究设计的Māori人群的单独研究进行比较。方法采用横断面屏幕访谈法，在新西兰两个地区的抽样网格块中对年龄≥65岁的欧洲人、中国人和印度/斐济-印度人进行调查。第一阶段包括使用社区痴呆症筛查工具（CSI-D）的简短认知量表在门口筛查符合条件的参与者。第二阶段包括使用10/66痴呆方案随机采访筛查阳性和阴性参与者的样本。在误差约为3%，置信水平为5%的情况下，根据10/66协议将对485名欧洲人、410名中国人和425名印度人/斐济-印度人进行采访。10/66痴呆的年龄标准化患病率估计将被反向加权用于研究设计。本研究将为痴呆症的种族不平等提供证据，为新的文化上合适的痴呆症管理策略提供信息，并有助于改善新西兰痴呆症患者的预后。

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引用次数: 0

How Disease-Modifying Therapies Challenge Dementia Care Continuity in Japan: From Promise to Paradox 疾病修饰疗法如何挑战日本痴呆症护理的连续性：从承诺到悖论

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-14 DOI: 10.1002/gps.70098

Kae Ito, Akira Hatakeyama, Tsuyoshi Okamura

Management of Alzheimer's disease has entered a new phase with the advent of disease-modifying therapies (DMTs). Anti-amyloid beta antibodies used in DMTs—such as aducanumab, lecanemab, and donanemab—differ from earlier medications in that they slow cognitive decline by reducing amyloid plaque accumulation in the brain [1]. As Belder noted, the introduction of DMTs is expected to increase the demand for clinical services, necessitating systems that ensure timely and equitable access to these therapies [2].

Despite the demonstrated efficacy of DMTs, there are concerns remain regarding their cost-effectiveness. Their adoption has been limited in the United States, and they have not yet been approved in the European Union. In contrast, the Japanese government has taken a proactive stance toward promoting the use of DMTs. Japan's universal health insurance system allows patients to access treatment with minimal out-of-pocket costs if they meet specified criteria [3]. However, implementing DMTs within this system requires careful planning to avoid disruptions and ensure equitable delivery.

Our institution was tasked with advising the Tokyo Metropolitan Government to establish a delivery system for DMTs. We initially anticipated that expanding therapeutic options would lead to earlier diagnoses, thereby increasing the number of patients requiring post-diagnostic support. However, we have encountered an unintended consequence: the implementation of DMTs is, in some cases, impeding the provision of post-diagnostic support. We share this experience with the global scientific community.

The philosophy underlying Tokyo's DMT delivery system is based on the following principles [4]: diagnosis and treatment require confirmation of amyloid pathology and the capacity to monitor and manage amyloid-related imaging abnormalities (ARIA) throughout an 18-month treatment course. Therefore, only hospitals equipped with PET and MRI scanners and staffed by certified neurologists were designated as DMT-initiating hospitals. When primary care physicians (typically based in clinics) suspect that a patient is eligible for DMT, they refer the patient to an initiating hospital. In Tokyo, medical centers for dementia (MCDs), government-certified hubs for dementia care, serves as either DMT-initiating hospitals or as collaborating hospitals that support DMT-initiating institutions.

With the increasing number of patients starting DMTs, hospitals have exceeded their capacity. Consequently, patients are transferred after 6 months to less-equipped “DMT-continuing clinics,” usually smaller institutions or clinics. These continuing clinics take over day-to-day care while DMT-initiating hospitals remain responsible for periodic MRIs, cognitive assessments, and managing serious side effects, such as ARIA. Thus, a two-tiered system (Figure 1) was established to balance the need for specialized care with unive

随着疾病修饰疗法（dmt）的出现，阿尔茨海默病的治疗进入了一个新的阶段。用于dmts的抗淀粉样抗体，如aducanumab、lecanemab和donanemab，不同于早期的药物，它们通过减少大脑中淀粉样斑块的积累来减缓认知能力下降。正如Belder所指出的那样，dmt的引入预计将增加对临床服务的需求，因此需要确保及时和公平获得这些疗法的系统。尽管证明了dmt的有效性，但仍然存在对其成本效益的担忧。它们在美国的应用受到限制，在欧盟也尚未获得批准。与此相反，日本政府对推广dmt的使用采取了积极的态度。日本的全民健康保险制度允许患者以最低的自付费用获得治疗，只要他们符合特定的标准。然而，在该系统内实施dmt需要仔细规划，以避免中断并确保公平交付。我们机构的任务是为东京都政府提供建议，建立一个dmt的交付系统。我们最初预计，扩大治疗选择将导致早期诊断，从而增加需要诊断后支持的患者数量。然而，我们遇到了一个意想不到的后果：在某些情况下，dmt的实施阻碍了诊断后支持的提供。我们与全球科学界分享这一经验。东京DMT给药系统的基本理念是基于以下原则：诊断和治疗需要在整个18个月的治疗过程中确认淀粉样蛋白病理和监测和管理淀粉样蛋白相关成像异常（ARIA）的能力。因此，只有配备PET和MRI扫描仪并配备有认证神经科医生的医院才被指定为dmt启动医院。当初级保健医生（通常在诊所）怀疑患者有资格接受DMT时，他们会将患者转介到初始医院。在东京，痴呆症医疗中心（mcd），政府认证的痴呆症护理中心，要么作为dmt启动医院，要么作为支持dmt启动机构的合作医院。随着接受dmt治疗的患者越来越多，医院已经超出了能力范围。因此，患者在6个月后被转移到设备较差的“dmt继续诊所”，通常是较小的机构或诊所。这些持续的诊所接管日常护理，而启动dmt的医院仍然负责定期核磁共振成像、认知评估和管理严重的副作用，如ARIA。因此，建立了一个双层系统（图1），以平衡对专业护理的需求和普遍可及性。虽然初级保健医生不直接参与DMT的管理，但他们与患者及其家属保持着长期的关系。这些医生能够很好地通过考虑患者的生活史、家庭动态和合并症来支持共同决策，这些因素对整体生活质量至关重要。这种以患者为中心，以康复为导向的支持是有效的诊断后护理的核心。然而，一旦患者开始DMT，他们的痴呆症护理往往会转移到实施DMT的医疗机构，常常打断初级保健医生参与诊断后支持。此外，由于发起dmt的医院也是负责诊断后支持的mcd，因此患者在初始治疗阶段就得到了这种支持。然而，我们对一些继续使用dmt的诊所的工作人员的采访显示，他们有意避免提供诊断后的支持。这种不情愿源于担心破坏现有的医患关系。在缺乏全科医生制度的日本，病人可以自由地向任何医疗机构咨询。在关系紧密的地方医疗社区，更换初级保健提供者有时被视为“偷走病人”，导致一些临床医生避免提供支持性护理，因为这可能会吸引病人离开原来的医生。因此，诊断后支持的不连续性经常发生在患者转移到dmt继续诊所后。目前尚不清楚这种情况是普遍存在还是仅限于某些地区。然而，必须强调这一矛盾：旨在确保安全、公平使用dmt的提供系统可能在不经意间造成诊断后支持方面的差距。这一发现值得在痴呆症护理系统改革的背景下进行更广泛的讨论。该研究得到了东京都老年学研究所研究伦理委员会的批准（R24-121）。作者声明无利益冲突。

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引用次数: 0

Incidence and Risk Factors of Postoperative Delirium in Elderly Patients Following Hip Fracture Surgery: A Nationwide Retrospective Cohort Study in Taiwan 老年髋部骨折术后谵妄的发生率及危险因素：台湾一项全国性的回顾性队列研究

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-12 DOI: 10.1002/gps.70094

Chien-An Shih, Deng-Chi Yang, Wei-Ming Wang, Yi-Lin Wu, Yi-Ching Yang, Han-Chang Ku

Background

Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended hospital stays, increased mortality risk, and higher nursing costs. In postoperative hip fracture patients, delirium results in a higher complication rate, poorer functional recovery, increased readmission rates, repeat surgeries, and elevated mortality. Despite these serious consequences, the literature provides limited information on the incidence of postoperative delirium following hip fracture surgeries in Asians. Additionally, there is a lack of long-term, comprehensive nationwide population-based studies, highlighting an important area for future research. This study aims to understand the incidence and risk factors of postoperative delirium in hip fracture patients using representative population data.

Methods

We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort consisted of 118,682 patients aged 65 years or older who were diagnosed with hip fractures. The delirium incidence was observed per 1000 person-years. The Cox proportional hazards model was used to investigate the incidence of delirium among hip fracture patients.

Results

The incidence of the first episode of delirium after hip surgery in the elderly was 1.87 events per 1000 PYs. Factors associated with delirium included being female (adjusted hazard ratio [aHR]: 0.59; 95% confidence interval [CI]: 0.53–0.64), age ≥ 95 years (aHR: 3.52; 95% CI: 2.74–4.51), comorbid dementia (aHR: 2.63; 95% CI: 2.38–2.92), and ICU stay 2–3 days (aHR: 2.85; 95% CI: 1.28–6.37). The occurrence of delirium was significantly associated with an ICU stay of ≥ 4 days, dementia, as well as 30-day, 90-day, and 1-year mortality (p < 0.001).

Conclusions

This study highlights the relatively low incidence of postoperative delirium in elderly hip fracture patients in Taiwan. Key risk factors identified include advanced age, female gender, comorbid dementia, and prolonged ICU stays. These findings underscore the need for targeted prevention and early intervention strategies to improve patient outcomes.

谵妄是一种以行为和心理特征为特征的急性认知变化，如视觉和听觉幻觉、睡眠障碍和情绪混乱。它可能导致住院时间延长，死亡风险增加，护理费用增加。在髋部骨折术后患者中，谵妄导致较高的并发症发生率、较差的功能恢复、再入院率增加、重复手术和死亡率升高。尽管有这些严重的后果，文献提供的关于亚洲人髋部骨折术后谵妄发生率的信息有限。此外，缺乏长期的、全面的、基于全国人口的研究，这突出了未来研究的一个重要领域。本研究旨在通过具有代表性的人群数据了解髋部骨折患者术后谵妄的发生率及危险因素。方法采用2009年至2020年台湾全民健康保险研究数据库（NHIRD）进行回顾性队列研究。该队列包括118,682名年龄在65岁或以上的诊断为髋部骨折的患者。谵妄发生率为每1000人年。采用Cox比例风险模型调查髋部骨折患者谵妄的发生率。结果老年髋关节术后首次谵妄的发生率为1.87例/ 1000年。谵妄的相关因素包括女性(校正风险比[aHR]: 0.59；95%可信区间[CI]: 0.53-0.64)，年龄≥95岁(aHR: 3.52；95% CI: 2.74-4.51)，共病性痴呆(aHR: 2.63；95% CI: 2.38-2.92)， ICU住院2-3天(aHR: 2.85；95% ci: 1.28-6.37)。谵妄的发生与ICU住院≥4天、痴呆以及30天、90天和1年死亡率显著相关(p <；0.001)。结论台湾老年髋部骨折患者术后谵妄发生率较低。确定的主要危险因素包括高龄、女性、共病性痴呆和延长ICU住院时间。这些发现强调需要有针对性的预防和早期干预策略来改善患者的预后。

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