Mercedes Florido-Santiago, Luis M. Pérez-Belmonte, José P. Lara, Mercedes Millán-Gómez, Miguel A. Pérez-Velasco, Julio Osuna-Sánchez, Natalia García-Casares, Ricardo Gómez-Huelgas, Encarnación Blanco-Reina, Miguel A. Barbancho
Objectives
To assess the incidence of both Mild and Major Neurocognitive Disorders (NCD), according to the DSM-5 criteria, after cardiac surgery (off-pump an on-pump procedures) and to propose some risk associated factors.
Methods
Prospective and sequential study. Patients (n = 70, 65.9 years old, mean age) were evaluated for cognitive function (Neuronorma Battery) and daily life activities (Barthel Index and Bayer-Activities of Daily Living Scale) before surgery and at 1, 6, 12, and 48 months postoperatively. Off-pump (n = 36) and on-pump (n = 34) patients groups were compared. DSM-5 criteria for Mild NCD and Major NCD were applied. Independent associated risk factors were described.
Results
A 40.8% (off-pump) and 39.3% (on-pump) of patients met DSM-5 criteria for Mild NCD 48 months after cardiac surgery and a further 7.1% (on-pump) of them, for Major NCD. Clinical factors were associated with Mild NCD and both clinical and surgical factors, were associated with Major NCD.
Conclusion
A relevant incidence of long-term Mild NCD and Major NCD has been described 48 months after cardiac surgery, more intense in the on-pump group of patients. Assessment (identifying those with higher risk), prevention and treatment strategies for these patients should be provided. The DSM-5 criteria to classify NCD could be applied to characterize any cognitive decline due to any disease or surgical procedure.
目的：根据DSM-5标准，评估心脏手术后（无泵和有泵手术）轻度和重度神经认知障碍（NCD）的发生率，并提出一些风险相关因素。方法：前瞻性、序贯性研究。患者（70例，年龄65.9岁，平均年龄）在手术前及术后1、6、12、48个月进行认知功能（神经正常值电池）和日常生活活动（Barthel指数和Bayer-Activities of daily Living Scale）评估。停泵组（n = 36）与开泵组（n = 34）进行比较。采用DSM-5轻度非传染性疾病和重度非传染性疾病的诊断标准。描述了独立的相关危险因素。结果：心脏手术后48个月，40.8%（非体外泵）和39.3%（非体外泵）的患者符合DSM-5轻度非传染性疾病的标准，7.1%（非体外泵）的患者符合严重非传染性疾病的标准。临床因素与轻度非传染性疾病相关，临床和手术因素均与重度非传染性疾病相关。结论：心脏手术后48个月，长期轻度非传染性疾病和严重非传染性疾病的发生率相关，在非泵组患者中发生率更高。应提供这些患者的评估（识别高风险患者）、预防和治疗策略。DSM-5对非传染性疾病的分类标准可以用于描述任何疾病或外科手术导致的认知能力下降。
{"title":"Assessment of Long-Term Mild and Major Neurocognitive Disorders 48 Months After Cardiac Surgery","authors":"Mercedes Florido-Santiago, Luis M. Pérez-Belmonte, José P. Lara, Mercedes Millán-Gómez, Miguel A. Pérez-Velasco, Julio Osuna-Sánchez, Natalia García-Casares, Ricardo Gómez-Huelgas, Encarnación Blanco-Reina, Miguel A. Barbancho","doi":"10.1002/gps.70175","DOIUrl":"10.1002/gps.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the incidence of both Mild and Major Neurocognitive Disorders (NCD), according to the DSM-5 criteria, after cardiac surgery (off-pump an on-pump procedures) and to propose some risk associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective and sequential study. Patients (<i>n</i> = 70, 65.9 years old, mean age) were evaluated for cognitive function (Neuronorma Battery) and daily life activities (Barthel Index and Bayer-Activities of Daily Living Scale) before surgery and at 1, 6, 12, and 48 months postoperatively. Off-pump (<i>n</i> = 36) and on-pump (<i>n</i> = 34) patients groups were compared. DSM-5 criteria for Mild NCD and Major NCD were applied. Independent associated risk factors were described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A 40.8% (off-pump) and 39.3% (on-pump) of patients met DSM-5 criteria for Mild NCD 48 months after cardiac surgery and a further 7.1% (on-pump) of them, for Major NCD. Clinical factors were associated with Mild NCD and both clinical and surgical factors, were associated with Major NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A relevant incidence of long-term Mild NCD and Major NCD has been described 48 months after cardiac surgery, more intense in the on-pump group of patients. Assessment (identifying those with higher risk), prevention and treatment strategies for these patients should be provided. The DSM-5 criteria to classify NCD could be applied to characterize any cognitive decline due to any disease or surgical procedure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 11","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12626111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540700","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}
With the increased demand for care services, understanding how the association between caregiving and subjective well-being varies at different ages becomes a crucial policy concern. This study examined the longitudinal associations between informal caregiving (and different caregiver types) and selected subjective well-being outcomes. Furthermore, gender and household wealth heterogeneity were explored.
Methods
Based on the China Health and Retirement Longitudinal Study data, we used growth curve models to examine how the association between informal caregiving and subjective well-being varies across age.
Results
Overall, caregivers reported higher life satisfaction at age 60 compared to non-caregivers, although the positive association between caregiving and life satisfaction becomes weaker and even turns negative as people age. In contrast, caregivers consistently had lower health-related quality of life (HRQoL) than non-caregivers. When examining different caregiving types, grandparent caregivers initially had higher life satisfaction at age 60 than non-caregivers, but this advantage became less evident with age. Adult child caregivers generally showed higher life satisfaction than non-caregivers, whereas spousal caregivers consistently reported lower life satisfaction. Regarding HRQoL, there were no significant differences between adult child caregivers, grandparent caregivers, and non-caregivers, but spousal caregivers had significantly lower HRQoL than their non-caregiving counterparts. Furthermore, the relationship between caregiving and subjective well-being was influenced by both gender and household wealth.
Conclusions
The relationship between informal caregiving and subjective well-being is dynamic, and different types of caregivers display distinct age-related patterns. These findings can provide practical policy recommendations for policymakers to structure and improve sustainable informal care systems.
{"title":"Association of Caregiver Types With General and Health-Related Indicators of Subjective Well-Being in a Longitudinal Cohort of Middle-Aged and Older Adults in China","authors":"Qing Su, Cheng Cheng","doi":"10.1002/gps.70176","DOIUrl":"10.1002/gps.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>With the increased demand for care services, understanding how the association between caregiving and subjective well-being varies at different ages becomes a crucial policy concern. This study examined the longitudinal associations between informal caregiving (and different caregiver types) and selected subjective well-being outcomes. Furthermore, gender and household wealth heterogeneity were explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Based on the China Health and Retirement Longitudinal Study data, we used growth curve models to examine how the association between informal caregiving and subjective well-being varies across age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, caregivers reported higher life satisfaction at age 60 compared to non-caregivers, although the positive association between caregiving and life satisfaction becomes weaker and even turns negative as people age. In contrast, caregivers consistently had lower health-related quality of life (HRQoL) than non-caregivers. When examining different caregiving types, grandparent caregivers initially had higher life satisfaction at age 60 than non-caregivers, but this advantage became less evident with age. Adult child caregivers generally showed higher life satisfaction than non-caregivers, whereas spousal caregivers consistently reported lower life satisfaction. Regarding HRQoL, there were no significant differences between adult child caregivers, grandparent caregivers, and non-caregivers, but spousal caregivers had significantly lower HRQoL than their non-caregiving counterparts. Furthermore, the relationship between caregiving and subjective well-being was influenced by both gender and household wealth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The relationship between informal caregiving and subjective well-being is dynamic, and different types of caregivers display distinct age-related patterns. These findings can provide practical policy recommendations for policymakers to structure and improve sustainable informal care systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 11","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oscar H. Del Brutto, Robertino M. Mera, Mark J. Sedler, Denisse A. Rumbea, Emilio E. Arias, José Gutierrez, Víctor J. Del Brutto
Objectives
Both physical and cognitive impairments contribute to disability. However, their relative impact on functional decline among older adults in low-resource settings has not been adequately studied. This study aims to explore the role of these factors on functionality.
Methods
Following a population-based, cross-sectional design, older adults living in rural Ecuador underwent a handgrip strength (HGS) test for physical performance, the Montreal Cognitive Assessment (MoCA) to evaluate cognitive performance, and a Functional Assessment Questionnaire (FAQ) assessed functionality. A generalized structural equation modeling (GSEM) approach was utilized to evaluate a predefined set of causal assumptions and integrate hypothesized latent constructs, providing a comprehensive explanation of the relationships among multiple interconnected variables and their association with dysfunctionality.
Results
We included 603 individuals (mean age: 67.5 ± 7 years; 54% women). According to the GSEM approach, a 10% rise in HGS (2.4 kg) was associated with a 3.68% improvement in functionality (p < 0.001), whereas a 10% increase in MoCA scores resulted in a 2.06% improvement in functionality (p < 0.001). One standard deviation (SD) in HGS comprised 18% of the distribution, which yielded a 6.5% shift in functionality. Similarly, one SD difference in MoCA scores accounted for 19% of the distribution, and a 3.91% change in functionality.
Conclusions
Both physical and cognitive impairments significantly contribute to decreased functionality. However, physical performance exerts a greater influence on functional independence than cognitive performance. These findings highlight the importance of a holistic approach to interventions aimed at enhancing quality of life in older adults residing in low-resource rural settings.
{"title":"Physical Versus Cognitive Impairment in Stroke-Free Older Adults Living in Rural Settings: Relative Contributions to Decreased Functionality","authors":"Oscar H. Del Brutto, Robertino M. Mera, Mark J. Sedler, Denisse A. Rumbea, Emilio E. Arias, José Gutierrez, Víctor J. Del Brutto","doi":"10.1002/gps.70173","DOIUrl":"https://doi.org/10.1002/gps.70173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Both physical and cognitive impairments contribute to disability. However, their relative impact on functional decline among older adults in low-resource settings has not been adequately studied. This study aims to explore the role of these factors on functionality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following a population-based, cross-sectional design, older adults living in rural Ecuador underwent a handgrip strength (HGS) test for physical performance, the Montreal Cognitive Assessment (MoCA) to evaluate cognitive performance, and a Functional Assessment Questionnaire (FAQ) assessed functionality. A generalized structural equation modeling (GSEM) approach was utilized to evaluate a predefined set of causal assumptions and integrate hypothesized latent constructs, providing a comprehensive explanation of the relationships among multiple interconnected variables and their association with dysfunctionality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 603 individuals (mean age: 67.5 ± 7 years; 54% women). According to the GSEM approach, a 10% rise in HGS (2.4 kg) was associated with a 3.68% improvement in functionality (<i>p</i> < 0.001), whereas a 10% increase in MoCA scores resulted in a 2.06% improvement in functionality (<i>p</i> < 0.001). One standard deviation (SD) in HGS comprised 18% of the distribution, which yielded a 6.5% shift in functionality. Similarly, one SD difference in MoCA scores accounted for 19% of the distribution, and a 3.91% change in functionality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both physical and cognitive impairments significantly contribute to decreased functionality. However, physical performance exerts a greater influence on functional independence than cognitive performance. These findings highlight the importance of a holistic approach to interventions aimed at enhancing quality of life in older adults residing in low-resource rural settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 11","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145406878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although studies have reported an association between attending religious services and diminished mental health issues, the underlying mechanisms have not been thoroughly explored. Additionally, longitudinal evidence supporting this association is limited. This study aimed to examine whether psychological well-being mediates the longitudinal association between religious attendance and mental health issues.
Methods
A total of 2767 older adults (baseline mean age = 75.02 years, 57.9% female) from the National Health and Aging Trends Study (NHATS) were included in the analysis. Respondents' religious attendance, psychological well-being, and depressive and anxiety symptoms were measured annually across 7 years. Based on descriptive statistics, a longitudinal mediation analysis within a Bayesian framework was conducted.
Results
Results indicated that, controlling for sociodemographic variables and autoregressive effects, attending religious services was significantly and longitudinally associated with improved psychological well-being (β = 0.13, 95% CI: [0.10, 0.17]), which, in turn, significantly predicted subsequent reductions in depressive and anxiety symptoms (β = −0.30, 95% CI: [–0.33, −0.28]). On average, psychological well-being accounted for 26.7% of the total effect of religious attendance on mental health issues.
Conclusions
Hence, supporting older adults who wish to attend religious services may be linked to better psychological well-being and mental health.
{"title":"Religious Attendance, Psychological Well-Being, and Mental Health Issues Among Older Adults: A Seven-Year Longitudinal Study in the United States","authors":"Zhiya Hua","doi":"10.1002/gps.70171","DOIUrl":"https://doi.org/10.1002/gps.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although studies have reported an association between attending religious services and diminished mental health issues, the underlying mechanisms have not been thoroughly explored. Additionally, longitudinal evidence supporting this association is limited. This study aimed to examine whether psychological well-being mediates the longitudinal association between religious attendance and mental health issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 2767 older adults (baseline mean age = 75.02 years, 57.9% female) from the National Health and Aging Trends Study (NHATS) were included in the analysis. Respondents' religious attendance, psychological well-being, and depressive and anxiety symptoms were measured annually across 7 years. Based on descriptive statistics, a longitudinal mediation analysis within a Bayesian framework was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results indicated that, controlling for sociodemographic variables and autoregressive effects, attending religious services was significantly and longitudinally associated with improved psychological well-being (<i>β</i> = 0.13, 95% CI: [0.10, 0.17]), which, in turn, significantly predicted subsequent reductions in depressive and anxiety symptoms (<i>β</i> = −0.30, 95% CI: [–0.33, −0.28]). On average, psychological well-being accounted for 26.7% of the total effect of religious attendance on mental health issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hence, supporting older adults who wish to attend religious services may be linked to better psychological well-being and mental health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 11","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine Pennington, Harriet Ball, Peter Connelly, Elizabeth Coulthard, Gordon Duncan, Chineze Ivenso, Tobias Langheinrich, Vivek Pattan, Terence Quinn, Karen Ritchie, Craig Ritchie, Tom Russ
Objectives
Altered insight into cognitive symptoms and diagnosis is a common feature of neurodegeneration, and can adversely impact on quality of life and ability to access medical care. Affected individuals can lose awareness of their symptoms and therefore decline to engage with medical assessment and treatment. Assessing insight is difficult, and there is a lack of short, easily administered clinical assessment tools. The aim of this study was to develop and evaluate the feasibility of a novel insight assessment questionnaire (The Clinical Insight Questionnaire, CLIQ) which can be independently completed by adults with a range of cognitive abilities.
Methods
A discrepancy score approach was used to evaluate insight. A novel questionnaire targeting the domains of memory, personality and social behaviour, executive function, language, and activities of daily living was devised using the Delphi approach and public feedback. Participant and informant mirror versions of each item were written. The discrepancy between participant and informant scores provides an overall insight score. 12 UK based experts in cognitive disorder diagnosis and assessment were invited to review potential questionnaire items, as was a PPI group. A feasibility study was conducted where people with mild memory or thinking symptoms and an informant completed the questionnaire and the Montreal Cognitive Assessment.
Results
Following an iterative process using the expert Delphi group and public feedback, 20 final questionnaire items were selected from an initial pool of 30 items. 21 people with mild cognitive symptoms but no formally diagnosed cognitive disorder (median MoCA score 24.5) participated in feasibility testing. The mean discrepancy score was 1.14, close to the ideal score of zero. No participants found the assessment upsetting or too long, and 81% rated the questions as easy to understand.
Conclusions
The Clinical Insight Questionnaire (CLIQ) is a novel clinical tool for the assessment of insight in people with mild to moderate neurodegeneration. In feasibility testing it was quick and easy for people with mild cognitive symptoms and informants to self-complete. Initial feasibility testing showed very promising findings for usability and acceptability, and a full validation study is now in progress.
{"title":"Development of the Clinical Insight Questionnaire: A Novel Clinical Tool for the Assessment of Insight Into Cognitive Symptoms and Everyday Functioning in People With Neurodegeneration","authors":"Catherine Pennington, Harriet Ball, Peter Connelly, Elizabeth Coulthard, Gordon Duncan, Chineze Ivenso, Tobias Langheinrich, Vivek Pattan, Terence Quinn, Karen Ritchie, Craig Ritchie, Tom Russ","doi":"10.1002/gps.70165","DOIUrl":"https://doi.org/10.1002/gps.70165","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Altered insight into cognitive symptoms and diagnosis is a common feature of neurodegeneration, and can adversely impact on quality of life and ability to access medical care. Affected individuals can lose awareness of their symptoms and therefore decline to engage with medical assessment and treatment. Assessing insight is difficult, and there is a lack of short, easily administered clinical assessment tools. The aim of this study was to develop and evaluate the feasibility of a novel insight assessment questionnaire (The Clinical Insight Questionnaire, CLIQ) which can be independently completed by adults with a range of cognitive abilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A discrepancy score approach was used to evaluate insight. A novel questionnaire targeting the domains of memory, personality and social behaviour, executive function, language, and activities of daily living was devised using the Delphi approach and public feedback. Participant and informant mirror versions of each item were written. The discrepancy between participant and informant scores provides an overall insight score. 12 UK based experts in cognitive disorder diagnosis and assessment were invited to review potential questionnaire items, as was a PPI group. A feasibility study was conducted where people with mild memory or thinking symptoms and an informant completed the questionnaire and the Montreal Cognitive Assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following an iterative process using the expert Delphi group and public feedback, 20 final questionnaire items were selected from an initial pool of 30 items. 21 people with mild cognitive symptoms but no formally diagnosed cognitive disorder (median MoCA score 24.5) participated in feasibility testing. The mean discrepancy score was 1.14, close to the ideal score of zero. No participants found the assessment upsetting or too long, and 81% rated the questions as easy to understand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Clinical Insight Questionnaire (CLIQ) is a novel clinical tool for the assessment of insight in people with mild to moderate neurodegeneration. In feasibility testing it was quick and easy for people with mild cognitive symptoms and informants to self-complete. Initial feasibility testing showed very promising findings for usability and acceptability, and a full validation study is now in progress.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 11","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375154","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}
Owen Skoda, Miguel Conant, Vincent Couture, Marie-Andrée Bruneau, Marie-France Forget, Quoc Dinh Nguyen, Philippe Desmarais
Objectives
Neuropsychiatric symptoms (NPS) are common and burdensome manifestations of neurocognitive disorders but the characterization of their natural evolution over time is limited. We conducted a systematic review and meta-analysis to describe the longitudinal progression and heterogeneity of NPS across Alzheimer's disease (AD), Lewy body dementia (LBD), and frontotemporal dementia (FTD).
Methods
We systematically reviewed observational longitudinal studies published between 2000 and 2024 assessing the prevalence or severity of NPS at ≥ 2 time points using validated instruments. Random-effects meta-analyses were performed to pool changes in prevalence (risk difference) and severity (standardized mean difference [SMD]) at short-term (< 12 months), mid-term (12 to < 24 months), and long-term (≥ 24 months) follow-up. Heterogeneity and publication bias were also assessed. Subgroup analyses were conducted by type of neurocognitive disorder.
Results
We included 26 studies comprising 5509 participants. Apathy was the most prevalent NPS at baseline (45%), followed by irritability (35%) and depression (35%). Over time, most NPS demonstrated progressive increases in prevalence, with agitation (+16%) and apathy (+15%) emerging most frequently at long-term follow-up. Severity of most NPS remained stable, except for apathy and aberrant motor behavior, which increased significantly, and sleep disturbances, which improved. Global NPS burden increased significantly at long-term (SMD +2.04). Heterogeneity of trajectories was notably high and varied across symptoms and disorders. Subgroup analyses in AD confirmed increases in apathy, delusions, and hallucinations over time.
Conclusions
NPS exhibit distinct and heterogeneous longitudinal patterns in neurocognitive disorders. Greater understanding of these trajectories may inform clinical management, prognostication, and the timing of interventions.
{"title":"Natural Evolution and Heterogeneity of Neuropsychiatric Symptoms Across Neurocognitive Disorders: A Systematic Review and Meta-Analysis of Longitudinal Studies","authors":"Owen Skoda, Miguel Conant, Vincent Couture, Marie-Andrée Bruneau, Marie-France Forget, Quoc Dinh Nguyen, Philippe Desmarais","doi":"10.1002/gps.70169","DOIUrl":"10.1002/gps.70169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Neuropsychiatric symptoms (NPS) are common and burdensome manifestations of neurocognitive disorders but the characterization of their natural evolution over time is limited. We conducted a systematic review and meta-analysis to describe the longitudinal progression and heterogeneity of NPS across Alzheimer's disease (AD), Lewy body dementia (LBD), and frontotemporal dementia (FTD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically reviewed observational longitudinal studies published between 2000 and 2024 assessing the prevalence or severity of NPS at ≥ 2 time points using validated instruments. Random-effects meta-analyses were performed to pool changes in prevalence (risk difference) and severity (standardized mean difference [SMD]) at short-term (< 12 months), mid-term (12 to < 24 months), and long-term (≥ 24 months) follow-up. Heterogeneity and publication bias were also assessed. Subgroup analyses were conducted by type of neurocognitive disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 26 studies comprising 5509 participants. Apathy was the most prevalent NPS at baseline (45%), followed by irritability (35%) and depression (35%). Over time, most NPS demonstrated progressive increases in prevalence, with agitation (+16%) and apathy (+15%) emerging most frequently at long-term follow-up. Severity of most NPS remained stable, except for apathy and aberrant motor behavior, which increased significantly, and sleep disturbances, which improved. Global NPS burden increased significantly at long-term (SMD +2.04). Heterogeneity of trajectories was notably high and varied across symptoms and disorders. Subgroup analyses in AD confirmed increases in apathy, delusions, and hallucinations over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NPS exhibit distinct and heterogeneous longitudinal patterns in neurocognitive disorders. Greater understanding of these trajectories may inform clinical management, prognostication, and the timing of interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess awareness, perceptions, stigma, attitudes, and help-seeking behavior related to Alzheimer's disease (AD) among older adults in Nigeria.
Methods
This 12-month community-based cross-sectional study (May 2024–April 2025) was conducted across 12 purposively selected urban and rural communities, representing Nigeria's six geopolitical zones. A total of 744 older adults (≥ 60 years; mean age = 70.3) were recruited using a multistage sampling technique. Data were collected using the Alzheimer's Disease Assessment Questionnaire (ADAQ), a validated instrument covering sociodemographic characteristics, AD awareness, perceptions, stigma, attitudes, help-seeking behavior, and diagnostic care barriers. Descriptive statistics and chi-square (χ2) tests were conducted using SPSS v22.0, with significance set at p ≤ 0.05.
Results
Overall, 64.9% of respondents were aware of AD, although 66.8% held negative perceptions. High perceived stigma (62.1%) and undesirable attitudes (71.4%) were common. Only 26.2% reported appropriate help-seeking behavior. Key barriers to AD diagnostic care included lack of specialists (85.8%), high costs (84.3%), and limited access to services (80.9%). Significant associations were found between AD awareness and age (χ2 = 6.432, p = 0.011), gender (χ2 = 3.833, p = 0.020), marital status (χ2 = 2.319, p = 0.032), living arrangement (χ2 = 1.377, p = 0.010), and income (χ2 = 2.363, p = 0.031), but not with education (χ2 = 1.765, p = 0.163) or religion (χ2 = 3.832, p = 0.521).
Conclusion
Despite moderate awareness, perceptions and attitudes toward AD among older Nigerian adults remain largely unfavorable. Stigma and structural barriers continue to impede timely diagnosis and care. Community-targeted interventions are essential to improve AD literacy and health-seeking behaviors in this population.
目的：评估尼日利亚老年人对阿尔茨海默病（AD）的认识、认知、耻辱感、态度和求助行为。方法：这项为期12个月的社区横断面研究（2024年5月至2025年4月）在12个有目的地选择的城市和农村社区进行，代表尼日利亚的六个地缘政治区域。采用多阶段抽样技术，共招募744名老年人（≥60岁，平均年龄= 70.3）。使用阿尔茨海默病评估问卷（ADAQ）收集数据，这是一种经过验证的工具，涵盖社会人口学特征、阿尔茨海默病意识、认知、污名、态度、寻求帮助行为和诊断护理障碍。采用SPSS v22.0进行描述性统计和χ2检验，p≤0.05为显著性。结果：总体而言，64.9%的受访者知道AD，尽管66.8%的受访者持负面看法。较高的污名感（62.1%）和不良态度（71.4%）较为常见。只有26.2%的人有适当的求助行为。阿尔茨海默病诊断护理的主要障碍包括缺乏专家（85.8%）、费用高（84.3%）和获得服务有限（80.9%）。AD知知度与年龄（χ2 = 6.432, p = 0.011）、性别（χ2 = 3.833, p = 0.020）、婚姻状况（χ2 = 2.319, p = 0.032）、生活方式（χ2 = 1.377, p = 0.010）、收入（χ2 = 2.363, p = 0.031）有显著相关性，与教育程度（χ2 = 1.765, p = 0.163）、宗教信仰（χ2 = 3.832, p = 0.521）无显著相关性。结论：尽管意识适度，但尼日利亚老年人对阿尔茨海默病的看法和态度在很大程度上仍不乐观。耻辱感和结构性障碍继续阻碍及时诊断和护理。以社区为目标的干预措施对于提高这一人群的阿尔茨海默病知识和寻求健康行为至关重要。
{"title":"Awareness, Perceptions, Stigma, Attitudes, and Help-Seeking Behavior Regarding Alzheimer's Disease Among Older Adults in Nigeria: A Community-Based Cross-Sectional Study","authors":"Uchenna Cosmas Ugwu, Osmond Chukwuemeka Ene","doi":"10.1002/gps.70170","DOIUrl":"10.1002/gps.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess awareness, perceptions, stigma, attitudes, and help-seeking behavior related to Alzheimer's disease (AD) among older adults in Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This 12-month community-based cross-sectional study (May 2024–April 2025) was conducted across 12 purposively selected urban and rural communities, representing Nigeria's six geopolitical zones. A total of 744 older adults (≥ 60 years; mean age = 70.3) were recruited using a multistage sampling technique. Data were collected using the Alzheimer's Disease Assessment Questionnaire (ADAQ), a validated instrument covering sociodemographic characteristics, AD awareness, perceptions, stigma, attitudes, help-seeking behavior, and diagnostic care barriers. Descriptive statistics and chi-square (χ<sup>2</sup>) tests were conducted using SPSS v22.0, with significance set at <i>p</i> ≤ 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 64.9% of respondents were aware of AD, although 66.8% held negative perceptions. High perceived stigma (62.1%) and undesirable attitudes (71.4%) were common. Only 26.2% reported appropriate help-seeking behavior. Key barriers to AD diagnostic care included lack of specialists (85.8%), high costs (84.3%), and limited access to services (80.9%). Significant associations were found between AD awareness and age (<i>χ</i><sup>2</sup> = 6.432, <i>p</i> = 0.011), gender (<i>χ</i><sup>2</sup> = 3.833, <i>p</i> = 0.020), marital status (<i>χ</i><sup>2</sup> = 2.319, <i>p</i> = 0.032), living arrangement (<i>χ</i><sup>2</sup> = 1.377, <i>p</i> = 0.010), and income (<i>χ</i><sup>2</sup> = 2.363, <i>p</i> = 0.031), but not with education (<i>χ</i><sup>2</sup> = 1.765, <i>p</i> = 0.163) or religion (<i>χ</i><sup>2</sup> = 3.832, <i>p</i> = 0.521).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite moderate awareness, perceptions and attitudes toward AD among older Nigerian adults remain largely unfavorable. Stigma and structural barriers continue to impede timely diagnosis and care. Community-targeted interventions are essential to improve AD literacy and health-seeking behaviors in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although late-life depression is common, there has previously not been a comprehensive review of chronic depression (CD) in older adults. This systematic review summarizes prevalence rates, potential risk factors, and consequences of CD in later life.
Methods
This preregistered review (PROSPERO: CRD42025649324) searched MEDLINE, Web of Science, CINAHL and PsycINFO from inception to February 2025. Observational studies reporting the prevalence of CD in older adults (mean age 60+) were included. Study quality was assessed using the Joanna Briggs Institutes Critical Appraisal Tool. Random-effects models were used to estimate pooled prevalence across subgroups and meta-regression analyses were used to explore sources of heterogeneity.
Results
A total of 39 articles (38 studies) met the inclusion criteria; 20 articles (27 data points) were included in meta-analysis for point prevalence. Overall point prevalence was 4.02% [2.88%–5.35%], with estimates varying by assessment method: 2.30% [1.47%–3.31%] using DSM-IV/DSM-III-R, 7.12% [2.31%–14.22%] using DSM-III/ICD-10% and 5.52% [3.80%–7.54%] using rating scales. Prevalence varied also by region and was higher for women. Consistent risk factors included less physical activity and higher impairment in daily life. Evidence on consequences was sparse.
Conclusions
Approximately 4% of adults aged 60+ meet criteria for CD. Estimates vary substantially by method and region, and potential risk factors and outcomes remain poorly understood. Future studies should target underrepresented subgroups - such as the oldest old, the institutionalized and physically and cognitively impaired individuals—using both dimensional and categorical assessment. CD in late life appears often unrecognized, untreated and underresearched.
{"title":"Prevalence and Associated Factors of Chronic Depression Among Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression","authors":"M. W. Stratmann, H.-H. König, A. Hajek","doi":"10.1002/gps.70160","DOIUrl":"10.1002/gps.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although late-life depression is common, there has previously not been a comprehensive review of chronic depression (CD) in older adults. This systematic review summarizes prevalence rates, potential risk factors, and consequences of CD in later life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This preregistered review (PROSPERO: CRD42025649324) searched MEDLINE, Web of Science, CINAHL and PsycINFO from inception to February 2025. Observational studies reporting the prevalence of CD in older adults (mean age 60+) were included. Study quality was assessed using the Joanna Briggs Institutes Critical Appraisal Tool. Random-effects models were used to estimate pooled prevalence across subgroups and meta-regression analyses were used to explore sources of heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 articles (38 studies) met the inclusion criteria; 20 articles (27 data points) were included in meta-analysis for point prevalence. Overall point prevalence was 4.02% [2.88%–5.35%], with estimates varying by assessment method: 2.30% [1.47%–3.31%] using DSM-IV/DSM-III-R, 7.12% [2.31%–14.22%] using DSM-III/ICD-10% and 5.52% [3.80%–7.54%] using rating scales. Prevalence varied also by region and was higher for women. Consistent risk factors included less physical activity and higher impairment in daily life. Evidence on consequences was sparse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Approximately 4% of adults aged 60+ meet criteria for CD. Estimates vary substantially by method and region, and potential risk factors and outcomes remain poorly understood. Future studies should target underrepresented subgroups - such as the oldest old, the institutionalized and physically and cognitively impaired individuals—using both dimensional and categorical assessment. CD in late life appears often unrecognized, untreated and underresearched.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312137","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}
{"title":"Critical Appraisal of Sex Differences in White Matter Burden and Neuropsychiatric Symptoms in Older Adults","authors":"Brijesh Sathian, Javed Iqbal, Hanadi Al Hamad","doi":"10.1002/gps.70166","DOIUrl":"10.1002/gps.70166","url":null,"abstract":"","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laiss Bertola, Fabiana da Mata, Ari Alex Ramos, Carolina Godoy, Fernanda Menezes de Faria, Rosa Lucchetta, Haliton Alves de Oliveira Junior, Cleusa Pinheiro Ferri
Background and Objectives
In low- and middle-income countries (LMICs), family caregivers provide most of the support for people with dementia (PWD), yet little is known about how caregiver needs relate to unmet needs of PWD – especially in Latin America. This study explored that relationship in Brazilian caregiver-PWD dyads.
Methods
140 Brazilian dyads underwent in-home interviews, with assessments including a comprehensive needs of care instrument, caregiver burden, mental health, and caregiving experience, as well as PWD symptoms and demographics.
Results
All dyads had at least one unmet need. A combined model incorporating predictors from both PWD and caregivers indicated that PLWD having lower education, being male, and exhibiting more neuropsychiatric symptoms are associated with more unmet needs. Additionally, caregiver-related factors such as being male, having fewer years of caregiving experience, and having more unmet needs of their own were also linked to greater unmet needs in PWD.
Discussion and Implications
Caregiver well-being significantly affects the quality of dementia care. Caregivers' unmet needs likely reflect both their personal limitations and broader care challenges. Addressing both caregiver and PWD needs through targeted support strategies is essential for improving dementia care in LMICs, and especially in culturally and economically diverse settings.
{"title":"Unmet Needs in Dementia Care: The Predictive Role of Caregiver Challenges","authors":"Laiss Bertola, Fabiana da Mata, Ari Alex Ramos, Carolina Godoy, Fernanda Menezes de Faria, Rosa Lucchetta, Haliton Alves de Oliveira Junior, Cleusa Pinheiro Ferri","doi":"10.1002/gps.70164","DOIUrl":"10.1002/gps.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>In low- and middle-income countries (LMICs), family caregivers provide most of the support for people with dementia (PWD), yet little is known about how caregiver needs relate to unmet needs of PWD <sup>–</sup> especially in Latin America. This study explored that relationship in Brazilian caregiver-PWD dyads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>140 Brazilian dyads underwent in-home interviews, with assessments including a comprehensive needs of care instrument, caregiver burden, mental health, and caregiving experience, as well as PWD symptoms and demographics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All dyads had at least one unmet need. A combined model incorporating predictors from both PWD and caregivers indicated that PLWD having lower education, being male, and exhibiting more neuropsychiatric symptoms are associated with more unmet needs. Additionally, caregiver-related factors such as being male, having fewer years of caregiving experience, and having more unmet needs of their own were also linked to greater unmet needs in PWD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Implications</h3>\u0000 \u0000 <p>Caregiver well-being significantly affects the quality of dementia care. Caregivers' unmet needs likely reflect both their personal limitations and broader care challenges. Addressing both caregiver and PWD needs through targeted support strategies is essential for improving dementia care in LMICs, and especially in culturally and economically diverse settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300124","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}
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