The objective of this study was to investigate the cost of care for patients with a primary diagnosis of dementia in Swiss hospitals under the new TARPSY reimbursement system.
Methods
We used a dataset of the Swiss hospital reimbursement system TARPSY from 2016 to 2019, including all relevant remuneration variables at the patient level, to investigate hospital costs. Costs were analyzed by geographic location and hospital type. Homogeneity coefficients were used to analyze case cost homogeneity.
Results
We identified 7090 cases in the TARPSY database who were treated in Swiss hospitals under the primary diagnosis of dementia from 2016 to 2019. Of these, 6747 cases were included in our analysis. The total case costs and daily costs increased from 2016 to 2019, whereas the length of stay decreased. The average total case cost in 2019 was CHF 34,917 (σ = 32,926), corresponding to a daily cost of CHF 946 (σ = 373.44). Patients were treated for an average of 39.7 (σ = 32.40) days. In 2019, the total costs billed according to TARPSY for 57,939 days of hospital care for dementia as the primary diagnosis were CHF 51.3 million. The case costs differed by region and hospital type. Overall, cost homogeneity for total case cost as a proxy for the quality of the cost calculation was “satisfactory, sufficient” and did not show a clear trend towards improvement during the introduction of TARPSY.
Discussion
Our analysis provides reliable, case-level cost data for dementia hospital treatment in Switzerland. The total cost of dementia treatment in psychiatric hospitals appears to be much lower than previous estimates had indicated. When correcting for changes in accounting practices, total case costs only increased modestly from 2016 to 2019.
{"title":"Cost of Psychiatric Inpatient Treatment for Dementia in Switzerland: A Case-Level Analysis of Billing Data","authors":"Elena Bleibtreu, Florian Riese","doi":"10.1002/gps.70122","DOIUrl":"https://doi.org/10.1002/gps.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to investigate the cost of care for patients with a primary diagnosis of dementia in Swiss hospitals under the new TARPSY reimbursement system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a dataset of the Swiss hospital reimbursement system TARPSY from 2016 to 2019, including all relevant remuneration variables at the patient level, to investigate hospital costs. Costs were analyzed by geographic location and hospital type. Homogeneity coefficients were used to analyze case cost homogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 7090 cases in the TARPSY database who were treated in Swiss hospitals under the primary diagnosis of dementia from 2016 to 2019. Of these, 6747 cases were included in our analysis. The total case costs and daily costs increased from 2016 to 2019, whereas the length of stay decreased. The average total case cost in 2019 was CHF 34,917 (<i>σ</i> = 32,926), corresponding to a daily cost of CHF 946 (<i>σ</i> = 373.44). Patients were treated for an average of 39.7 (<i>σ</i> = 32.40) days. In 2019, the total costs billed according to TARPSY for 57,939 days of hospital care for dementia as the primary diagnosis were CHF 51.3 million. The case costs differed by region and hospital type. Overall, cost homogeneity for total case cost as a proxy for the quality of the cost calculation was “satisfactory, sufficient” and did not show a clear trend towards improvement during the introduction of TARPSY.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our analysis provides reliable, case-level cost data for dementia hospital treatment in Switzerland. The total cost of dementia treatment in psychiatric hospitals appears to be much lower than previous estimates had indicated. When correcting for changes in accounting practices, total case costs only increased modestly from 2016 to 2019.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558301","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}
Jem Bhatt, Sara Evans-Lacko, Katrina Scior, Rob Saunders
Objective
A robust psychometric instrument is imperative to measure the devastating impact of self-stigma in dementia to adequately inform policy and practice. Our objective was to evaluate the psychometric properties of the Stigma Impact Scale in a global sample of people with dementia.
Method
Data were analysed from the World Alzheimer Report including 710 participants in 42 countries who completed the SIS. Detailed psychometric analyses of the SIS included estimating reliability, convergent validity with the Warwick-Edinburgh mental Well-being Scale (WEMWBS) and the Dementia Quality of Life instrument (DQoL), the factor structure of the measure (through both exploratory and confirmatory factor analysis).
Results
The SIS and its subscales had ‘good’ to ‘excellent’ internal consistency (Cronbach's Alpha: 0.883–0.943). However, convergent validity correlations were not in the predicted direction; no significant correlations were noted between the SIS and the WEMWBS and DQoL. Factor analysis suggested marginal improvements in global fit indices for the observed model compared to the theoretical model, though none met the thresholds for acceptable fit. The final proposed model had three factors: rejection and secrecy, loneliness and belonging and perceived social isolation. Most SIS items were strongly endorsed by participants.
Conclusion
The SIS is the most robustly tested instrument measuring self-stigma in dementia. The SIS has good to excellent reliability and relevance to the target population, however future work is required to improve the factor structure of the scale. Further the results of the validity testing pose a number of theoretical and empirical questions for future research.
{"title":"An International Validation of the Stigma Impact Scale With People With Dementia","authors":"Jem Bhatt, Sara Evans-Lacko, Katrina Scior, Rob Saunders","doi":"10.1002/gps.70123","DOIUrl":"https://doi.org/10.1002/gps.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>A robust psychometric instrument is imperative to measure the devastating impact of self-stigma in dementia to adequately inform policy and practice. Our objective was to evaluate the psychometric properties of the Stigma Impact Scale in a global sample of people with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data were analysed from the World Alzheimer Report including 710 participants in 42 countries who completed the SIS. Detailed psychometric analyses of the SIS included estimating reliability, convergent validity with the Warwick-Edinburgh mental Well-being Scale (WEMWBS) and the Dementia Quality of Life instrument (DQoL), the factor structure of the measure (through both exploratory and confirmatory factor analysis).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The SIS and its subscales had ‘good’ to ‘excellent’ internal consistency (Cronbach's Alpha: 0.883–0.943). However, convergent validity correlations were not in the predicted direction; no significant correlations were noted between the SIS and the WEMWBS and DQoL. Factor analysis suggested marginal improvements in global fit indices for the observed model compared to the theoretical model, though none met the thresholds for acceptable fit. The final proposed model had three factors: rejection and secrecy, loneliness and belonging and perceived social isolation. Most SIS items were strongly endorsed by participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The SIS is the most robustly tested instrument measuring self-stigma in dementia. The SIS has good to excellent reliability and relevance to the target population, however future work is required to improve the factor structure of the scale. Further the results of the validity testing pose a number of theoretical and empirical questions for future research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550883","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}
Kathryn A. Wyman-Chick, Ella A. B. Chrenka, Joseph P. M. Kane, Matthew J. Barrett, Michael J. Miller, John T. Schousboe, Ann M. Werner, Rebecca C. Rossom
Objectives
Characterize patterns of hospitalization and emergency department (ED) visits in early-stage dementia with Lewy bodies (DLB).
Methods
We analyzed electronic health records and claims data from a U.S. healthcare system up to 3 years before/after initial diagnosis of DLB (n = 175), Alzheimer's disease (AD, n = 2478), or vascular dementia (VD, n = 513). Controls were randomly matched 3:1 with the DLB group on sex/age (n = 525). Generalized linear models were used to compare rates and types of utilization between diagnosis group with adjustment for patient characteristics.
Results
Patients with DLB had significantly greater rates of hospitalization and ED visits compared to patients with AD (Incidence Rate Ratio (IRR): 1.46, 95% CI 1.24, 1.73, IRR: 1.46, 95% CI 1.29, 1.77, respectively) and controls (IRR: 1.77, 95% CI 1.46, 2.14, IRR: 2.21, 95% CI 1.82, 2.69, respectively) and ED visits compared to those with VD (IRR: 1.24, 95% CI 1.03, 1.50). Patients with DLB were over 50% more likely to have a hospitalization associated with falls compared to those with AD and VD (OR: 1.75, 95% CI 1.16, 2.62 OR: 1.56, 95% CI: 1.01, 2.48, respectively). Compared to patients with AD, DLB patients were found to have 2.9-time higher likelihood of experiencing at least one hospitalization (Odds Ratio: 2.89. 95% CI: 1.17, 6.45).
Conclusions
Patients with DLB were substantially more likely to utilize ED services than patients with AD, VD, or controls, and more likely to experience hospitalizations compared to AD and control groups. Fall prevention and psychiatric treatment may be particularly important in reducing hospitalizations in early-stage DLB.
目的探讨早期伴路易体痴呆（DLB）的住院和急诊（ED）就诊模式。方法：我们分析了DLB （n = 175）、阿尔茨海默病（AD, n = 2478）或血管性痴呆（VD, n = 513）初诊前后3年美国医疗保健系统的电子健康记录和索赔数据。对照组与DLB组按性别/年龄按3:1随机配对（n = 525）。采用广义线性模型比较诊断组之间的使用率和类型，调整患者特征。结果与AD患者相比，DLB患者的住院率和ED就诊率显著高于AD患者（发病率比（IRR）： 1.46, 95% CI 1.24, 1.73, IRR: 1.46, 95% CI 1.29, 1.77），对照组（IRR: 1.77, 95% CI 1.46, 2.14, IRR: 2.21, 95% CI 1.82, 2.69）和VD患者（IRR: 1.24, 95% CI 1.03, 1.50）。与AD和VD患者相比，DLB患者因跌倒住院的可能性超过50% （OR: 1.75, 95% CI 1.16, 2.62 OR: 1.56, 95% CI: 1.01, 2.48）。与AD患者相比，DLB患者至少住院一次的可能性高出2.9倍（优势比：2.89）。95% ci: 1.17, 6.45)。结论：与AD、VD或对照组相比，DLB患者更有可能利用ED服务，与AD和对照组相比，更有可能住院。预防跌倒和精神治疗对于减少早期DLB的住院治疗可能特别重要。
{"title":"Utilization Patterns and Clinical Factors Associated With Hospitalization in Early-Stage Dementia With Lewy Bodies","authors":"Kathryn A. Wyman-Chick, Ella A. B. Chrenka, Joseph P. M. Kane, Matthew J. Barrett, Michael J. Miller, John T. Schousboe, Ann M. Werner, Rebecca C. Rossom","doi":"10.1002/gps.70125","DOIUrl":"https://doi.org/10.1002/gps.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Characterize patterns of hospitalization and emergency department (ED) visits in early-stage dementia with Lewy bodies (DLB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed electronic health records and claims data from a U.S. healthcare system up to 3 years before/after initial diagnosis of DLB (<i>n</i> = 175), Alzheimer's disease (AD, <i>n</i> = 2478), or vascular dementia (VD, <i>n</i> = 513). Controls were randomly matched 3:1 with the DLB group on sex/age (<i>n</i> = 525). Generalized linear models were used to compare rates and types of utilization between diagnosis group with adjustment for patient characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with DLB had significantly greater rates of hospitalization and ED visits compared to patients with AD (Incidence Rate Ratio (IRR): 1.46, 95% CI 1.24, 1.73, IRR: 1.46, 95% CI 1.29, 1.77, respectively) and controls (IRR: 1.77, 95% CI 1.46, 2.14, IRR: 2.21, 95% CI 1.82, 2.69, respectively) and ED visits compared to those with VD (IRR: 1.24, 95% CI 1.03, 1.50). Patients with DLB were over 50% more likely to have a hospitalization associated with falls compared to those with AD and VD (OR: 1.75, 95% CI 1.16, 2.62 OR: 1.56, 95% CI: 1.01, 2.48, respectively). Compared to patients with AD, DLB patients were found to have 2.9-time higher likelihood of experiencing at least one hospitalization (Odds Ratio: 2.89. 95% CI: 1.17, 6.45).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with DLB were substantially more likely to utilize ED services than patients with AD, VD, or controls, and more likely to experience hospitalizations compared to AD and control groups. Fall prevention and psychiatric treatment may be particularly important in reducing hospitalizations in early-stage DLB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550911","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}
Ben Rattray, Joseph M. Northey, Disa J. Pryor, Allison A. M. Bielak, Kaarin J. Anstey, Nicolas Cherbuin
Objectives
Investigate whether engaging in cognitive and physical activity is associated with cognitive performance and gray matter volume. Specifically, this study investigated the role of both activity types performed in close temporal proximity to each other.
Methods
Cognitively healthy older adults (n = 155; 73–78 years; 45% female) enrolled in the PATH Through Life study with valid cognitive, MRI and physical activity (PA) measures were included in the study. PA was objectively measured with a SenseWear Armband for 7 days. PA and cognitive engagement were self-reported through a 1-week activity diary. The number of 3-h periods in which ≥ 15 min of objective moderately vigorous physical activity (MVPA) > 3METs, cognitive activity, or both occurred, were assessed. Cognitive game activity periods were also coded. Associations between activity engagement and outcome measures were assessed with hierarchical regression models while controlling for age, sex, and education.
Results
For cognitive engagement, greater activity diversity was associated with better symbol digits modalities test performance (SDMT), while a greater number of cognitive activity periods were associated with better SDMT, and digit span backward performance. Greater cognitive game periods improved model fit for several cognitive outcomes and right hippocampal volume. MVPA periods were not associated with any outcome. The number of periods in which cognitive activity and MVPA were present together was associated with better immediate recall. Periods in which cognitive games and MVPA co-existed were associated with cognitive and volumetric outcomes.
Discussion
These findings support the notion that both cognitive and physical activity are positively related to brain health. They highlight the potential importance of performing both activity types in close temporal proximity to support the aging brain.
目的探讨参与认知和体育活动是否与认知能力和灰质体积有关。具体来说，本研究调查了两种活动类型在彼此时间接近时的作用。方法认知健康老年人(n = 155；73 - 78年;45%的女性)通过有效的认知、MRI和身体活动（PA）测量纳入了PATH Through Life研究。用SenseWear臂环客观测量PA 7天。PA和认知参与是通过一周的活动日记自我报告的。客观中度剧烈体力活动(MVPA)≥15分钟的3小时次数>；评估met、认知活动或两者同时发生。认知游戏活动周期也被编码。在控制年龄、性别和教育程度的情况下，用层次回归模型评估活动参与和结果测量之间的关系。结果在认知参与方面，活动多样性越大，符号数字模态测试成绩越好；认知活动时间越长，符号数字模态测试成绩越好；更长的认知游戏时间改善了模型对几种认知结果和右海马体积的拟合。MVPA时间与任何结果无关。认知活动和MVPA同时出现的时间与更好的即时记忆有关。认知游戏和MVPA共存的时期与认知和体积结果有关。这些发现支持了认知活动和身体活动都与大脑健康呈正相关的观点。他们强调了在近时间内进行这两种活动类型对支持衰老的大脑的潜在重要性。
{"title":"The Combination of Physical Activity and Cognitive Games is Associated With Better Cognitive Performance and Gray Matter Volume in Older Adults","authors":"Ben Rattray, Joseph M. Northey, Disa J. Pryor, Allison A. M. Bielak, Kaarin J. Anstey, Nicolas Cherbuin","doi":"10.1002/gps.70121","DOIUrl":"https://doi.org/10.1002/gps.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Investigate whether engaging in cognitive and physical activity is associated with cognitive performance and gray matter volume. Specifically, this study investigated the role of both activity types performed in close temporal proximity to each other.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cognitively healthy older adults (<i>n</i> = 155; 73–78 years; 45% female) enrolled in the PATH Through Life study with valid cognitive, MRI and physical activity (PA) measures were included in the study. PA was objectively measured with a SenseWear Armband for 7 days. PA and cognitive engagement were self-reported through a 1-week activity diary. The number of 3-h periods in which ≥ 15 min of objective moderately vigorous physical activity (MVPA) > 3METs, cognitive activity, or both occurred, were assessed. Cognitive game activity periods were also coded. Associations between activity engagement and outcome measures were assessed with hierarchical regression models while controlling for age, sex, and education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For cognitive engagement, greater <i>activity diversity</i> was associated with better symbol digits modalities test performance (SDMT), while a greater number of <i>cognitive activity periods</i> were associated with better SDMT, and digit span backward performance. Greater <i>cognitive game periods</i> improved model fit for several cognitive outcomes and right hippocampal volume. <i>MVPA periods</i> were not associated with any outcome. The number of periods in which <i>cognitive activity and MVPA</i> were present together was associated with better immediate recall. Periods in which <i>cognitive games and MVPA</i> co-existed were associated with cognitive and volumetric outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings support the notion that both cognitive and physical activity are positively related to brain health. They highlight the potential importance of performing both activity types in close temporal proximity to support the aging brain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550912","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}
To systematically review research evidence on the effectiveness of dementia education and training for health and social care students.
Methods
We searched electronic databases for primary research studies (published between 2015 and 2024), evaluating dementia training for health and social care students. We assessed risk of bias using the Mixed Methods Appraisal Tool, prioritising studies scoring 4+ (higher quality) that reported significant findings on primary outcomes from controlled intervention trials. We reported outcomes using Kirkpatrick's framework. We consulted professional stakeholders in a focus group regarding how findings might inform practice.
Results
17/35 included studies were rated 4+ on the MMAT; only one met our criteria for priority evidence. An experiential programme for medical students, ‘Time for Dementia’, which combined skill-learning and reflective sessions with visits to people with dementia, was found to improve Kirkpatrick Level 2 (learning) outcomes, attitudes and knowledge over 2 years of participation; this was supported from findings from qualitative studies. Asynchronous, self-directed learning did not improve learning outcomes, relative to standard training. Though almost all training programmes incorporated lived experience, no patient reported outcomes were used to evaluate the impact of training. Nine focus group attendees agreed that the evidence reflected their experiences that consistent support, combined with skills-based and reflective sessions, optimised student learning from initial patient-focused encounters.
Conclusions
Effective interventions increased confidence and enjoyment of dementia care encounters, and increased interest in careers in dementia specialities. Mandating evidence-based dementia skills programmes across specialities could ensure that students learn the skills and competencies required to be part of an effective future workforce and drive important improvements in care quality. Evidence based approaches to enhancing dementia education in training could include experiential learning modules in early years of medical school training and allied health and care professional training, using evidence-based approaches to teach communication skills and other essential dementia care skills within clinical placements, and providing dedicated supervision to support their implementation. Future research could usefully consider patient perspect
{"title":"Dementia Education and Training for the Multidisciplinary Student Healthcare Workforce: A Systematic Review","authors":"Malvika Muralidhar, Saskia Delray, Claudia Cooper, Sedigheh Zabihi, Sube Banerjee, Clarissa Giebel, Karen Harrison Dening, Yvonne Birks, Charlotte Kenten, Madeleine Walpert","doi":"10.1002/gps.70119","DOIUrl":"https://doi.org/10.1002/gps.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To systematically review research evidence on the effectiveness of dementia education and training for health and social care students.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched electronic databases for primary research studies (published between 2015 and 2024), evaluating dementia training for health and social care students. We assessed risk of bias using the Mixed Methods Appraisal Tool, prioritising studies scoring 4+ (higher quality) that reported significant findings on primary outcomes from controlled intervention trials. We reported outcomes using Kirkpatrick's framework. We consulted professional stakeholders in a focus group regarding how findings might inform practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>17/35 included studies were rated 4+ on the MMAT; only one met our criteria for priority evidence. An experiential programme for medical students, ‘Time for Dementia’, which combined skill-learning and reflective sessions with visits to people with dementia, was found to improve Kirkpatrick Level 2 (learning) outcomes, attitudes and knowledge over 2 years of participation; this was supported from findings from qualitative studies. Asynchronous, self-directed learning did not improve learning outcomes, relative to standard training. Though almost all training programmes incorporated lived experience, no patient reported outcomes were used to evaluate the impact of training. Nine focus group attendees agreed that the evidence reflected their experiences that consistent support, combined with skills-based and reflective sessions, optimised student learning from initial patient-focused encounters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Effective interventions increased confidence and enjoyment of dementia care encounters, and increased interest in careers in dementia specialities. Mandating evidence-based dementia skills programmes across specialities could ensure that students learn the skills and competencies required to be part of an effective future workforce and drive important improvements in care quality. Evidence based approaches to enhancing dementia education in training could include experiential learning modules in early years of medical school training and allied health and care professional training, using evidence-based approaches to teach communication skills and other essential dementia care skills within clinical placements, and providing dedicated supervision to support their implementation. Future research could usefully consider patient perspect","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524619","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}
Amber John, Roopal Desai, David Bartres-Faz, Dorina Cadar, Darya Gaysina, Aida Suarez Gonzalez, Natalie L. Marchant, Emily Willroth, Marcus Richards, Rob Saunders, Joshua Stott
Objectives
Previous research investigating associations between life satisfaction and risk of Alzheimer's disease (AD) has been mixed. This association may differ depending on genetic risk for AD. The aim of this study was to test interactions between life satisfaction and genetic predisposition on the future incidence of AD diagnosis.
Methods
Data were used from 66,668 participants aged 60+ from the UK Biobank. Participants attended an assessment centre at baseline, and data were linked to hospital admissions data and death records up to 14 years later. Cox proportional hazards models were used to test interactions between life satisfaction and a polygenic risk score (PRS) for AD on incident AD diagnosis. Models were also run stratified by genetic risk for AD.
Results
Models adjusted for age, sex, ethnicity, deprivation, education, and depression showed main effects of both life satisfaction (OR = 0.78, 95% CI = 0.68–0.90, p = 0.001) and the AD PRS (OR = 2.26, 95% CI = 2.12–2.40, p < 0.001) on incident AD. There was a significant interaction between the two (OR = 1.21, 95% CI = 1.09–1.35, p < 0.001). Stratified models showed that life satisfaction was associated with lower incident AD in the low, but not in the high genetic risk group (low: OR = 0.56, 95% CI = 0.42–0.75, p < 0.001; high: OR = 0.88, 95% CI = 0.75–1.04, p = 0.13).
Conclusions
Results show that genetic risk for AD modified the relationship between life satisfaction and the risk of AD. This suggests that genetic risk may weaken associations between life satisfaction and AD risk. The findings clarify the mixed results of previous research on this topic and may contribute to more tailored approaches to the prevention of AD in the future.
目的以往调查生活满意度与阿尔茨海默病（AD）风险之间关系的研究结果不一。这种关联可能因阿尔茨海默病的遗传风险而异。本研究的目的是测试生活满意度和遗传易感性对未来AD诊断发病率的相互作用。方法数据来自英国生物银行（UK Biobank）的66,668名60岁以上的参与者。参与者在基线时参加了一个评估中心，数据与14年后的住院数据和死亡记录相关联。使用Cox比例风险模型来检验生活满意度与AD多基因风险评分（PRS）在AD偶发诊断中的相互作用。模型也按照AD的遗传风险分层运行。结果调整了年龄、性别、种族、贫困、教育程度和抑郁的模型显示，生活满意度（OR = 0.78, 95% CI = 0.68-0.90, p = 0.001）和AD PRS (OR = 2.26, 95% CI = 2.12-2.40, p <；0.001)。两者之间存在显著的交互作用(OR = 1.21, 95% CI = 1.09-1.35, p <；0.001)。分层模型显示，生活满意度与低遗传风险组的低AD发生率相关，但与高遗传风险组无关(低：OR = 0.56, 95% CI = 0.42-0.75, p <；0.001;高：OR = 0.88, 95% CI = 0.75-1.04, p = 0.13)。结论AD的遗传风险改变了生活满意度与AD风险之间的关系。这表明遗传风险可能会削弱生活满意度和AD风险之间的联系。这些发现澄清了之前关于这一主题的研究结果，并可能有助于未来更有针对性地预防阿尔茨海默病。
{"title":"Understanding Interactions Between Life Satisfaction and Genetic Predisposition on Risk of Alzheimer's Disease up to 14 Years Later: Findings From the UK Biobank","authors":"Amber John, Roopal Desai, David Bartres-Faz, Dorina Cadar, Darya Gaysina, Aida Suarez Gonzalez, Natalie L. Marchant, Emily Willroth, Marcus Richards, Rob Saunders, Joshua Stott","doi":"10.1002/gps.70120","DOIUrl":"https://doi.org/10.1002/gps.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Previous research investigating associations between life satisfaction and risk of Alzheimer's disease (AD) has been mixed. This association may differ depending on genetic risk for AD. The aim of this study was to test interactions between life satisfaction and genetic predisposition on the future incidence of AD diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were used from 66,668 participants aged 60+ from the UK Biobank. Participants attended an assessment centre at baseline, and data were linked to hospital admissions data and death records up to 14 years later. Cox proportional hazards models were used to test interactions between life satisfaction and a polygenic risk score (PRS) for AD on incident AD diagnosis. Models were also run stratified by genetic risk for AD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Models adjusted for age, sex, ethnicity, deprivation, education, and depression showed main effects of both life satisfaction (OR = 0.78, 95% CI = 0.68–0.90, <i>p</i> = 0.001) and the AD PRS (OR = 2.26, 95% CI = 2.12–2.40, <i>p</i> < 0.001) on incident AD. There was a significant interaction between the two (OR = 1.21, 95% CI = 1.09–1.35, <i>p</i> < 0.001). Stratified models showed that life satisfaction was associated with lower incident AD in the low, but not in the high genetic risk group (low: OR = 0.56, 95% CI = 0.42–0.75, <i>p</i> < 0.001; high: OR = 0.88, 95% CI = 0.75–1.04, <i>p</i> = 0.13).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results show that genetic risk for AD modified the relationship between life satisfaction and the risk of AD. This suggests that genetic risk may weaken associations between life satisfaction and AD risk. The findings clarify the mixed results of previous research on this topic and may contribute to more tailored approaches to the prevention of AD in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515011","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}
Chih-Ming Cheng, Jia-Shyun Jeng, Mu-Hong Chen, Wen-Han Chang, Mu-N Liu, Wei-Chen Lin, Shih-Jen Tsai, Ya-Mei Bai, Tung-Ping Su, Cheng-Ta Li
Background
Older treatment-resistant depression (TRD) patients with transportation concerns may struggle to complete 30–36 repetitive transcranial magnetic stimulation (rTMS) sessions. Uninsured rTMS medical costs may be another issue in certain nations. 2-Week prolonged intermittent theta-burst stimulation (iTBS1800) to the left-sided dorsolateral prefrontal cortex (DLPFC) demonstrated similar antidepressant efficacy to standard rTMS or iTBS in adults with TRD. However, no study has yet confirmed the antidepressant effect of iTBS1800 in geriatric TRD patients.
Methods
We analyzed chart data from May 2018 to September 2022 to identify TRD patients aged ≥ 50 years who received self-pay TMS treatments at a single medical center in Taiwan. All patients had major depressive disorder and had failed at least one prior antidepressant treatment. The Hamilton Depression Rating Scale (HDRS-17) was evaluated before and after TMS stimulation.
Results
97 older patients with TRD (mean ± SD, age, 62.81 ± 7.89; 69.1%% female) was identified. Approximately 70% of patients reported anxious depression and prior antidepressant failures (≥ 3). The average number of self-pay TMS sessions was 11.71 ± 3.15) (range:10–30). Patients receiving iTBS1800 demonstrated a greatly higher remission rate than those receiving 10 Hz rTMS (29.5% vs 13.2%, respectively, p = 0.048), particularly in patients with mild and moderate depression. Age was not a clinically significant determinant of remission following TMS therapy.
Conclusion
Left-sided DLPFC iTBS1800 may be a feasible option for treating older patients with TRD due to its favorable effect and shorter treatment period, which may be ideal for patients with transportation, budgetary and vacation restrictions. More study is needed to compare the antidepressant efficacy of iTBS1800 to other TMS protocols in older patients with TRD.
有交通问题的老年难治性抑郁症（TRD）患者可能难以完成30-36个重复经颅磁刺激（rTMS）疗程。在某些国家，未投保的rTMS医疗费用可能是另一个问题。在成人TRD患者中，对左侧背外侧前额叶皮层（DLPFC）进行2周延长的间歇性theta-burst刺激（iTBS1800）显示出与标准rTMS或iTBS相似的抗抑郁效果。然而，尚无研究证实iTBS1800对老年TRD患者的抗抑郁作用。方法分析2018年5月至2022年9月的图表数据，以确定在台湾单一医疗中心接受自费经颅磁刺激治疗的年龄≥50岁的TRD患者。所有患者均患有重度抑郁症，且既往至少有一次抗抑郁药物治疗失败。在经颅磁刺激前后分别评估汉密尔顿抑郁评定量表（HDRS-17）。结果老年TRD患者97例(平均±SD，年龄62.81±7.89；69.1%为女性)。大约70%的患者报告焦虑性抑郁和既往抗抑郁失败（≥3）。平均自费TMS次数为11.71±3.15次（范围：10 ~ 30次）。接受iTBS1800治疗的患者的缓解率大大高于接受10 Hz rTMS治疗的患者（分别为29.5% vs 13.2%, p = 0.048），特别是在轻度和中度抑郁症患者中。年龄不是经颅磁刺激治疗后缓解的临床显著决定因素。结论左侧DLPFC iTBS1800治疗老年TRD效果好，治疗时间短，适合交通、预算、假期受限的患者，是治疗老年TRD的可行选择。iTBS1800与其他经颅磁刺激方案在老年TRD患者中的抗抑郁疗效比较需要更多的研究。
{"title":"Real-World Effectiveness and Tolerability of Prolonged Intermittent Theta Burst Stimulation in Older Adults With Treatment-Resistant Depression","authors":"Chih-Ming Cheng, Jia-Shyun Jeng, Mu-Hong Chen, Wen-Han Chang, Mu-N Liu, Wei-Chen Lin, Shih-Jen Tsai, Ya-Mei Bai, Tung-Ping Su, Cheng-Ta Li","doi":"10.1002/gps.70111","DOIUrl":"https://doi.org/10.1002/gps.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older treatment-resistant depression (TRD) patients with transportation concerns may struggle to complete 30–36 repetitive transcranial magnetic stimulation (rTMS) sessions. Uninsured rTMS medical costs may be another issue in certain nations. 2-Week prolonged intermittent theta-burst stimulation (iTBS1800) to the left-sided dorsolateral prefrontal cortex (DLPFC) demonstrated similar antidepressant efficacy to standard rTMS or iTBS in adults with TRD. However, no study has yet confirmed the antidepressant effect of iTBS1800 in geriatric TRD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed chart data from May 2018 to September 2022 to identify TRD patients aged ≥ 50 years who received self-pay TMS treatments at a single medical center in Taiwan. All patients had major depressive disorder and had failed at least one prior antidepressant treatment. The Hamilton Depression Rating Scale (HDRS-17) was evaluated before and after TMS stimulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>97 older patients with TRD (mean ± SD, age, 62.81 ± 7.89; 69.1%% female) was identified. Approximately 70% of patients reported anxious depression and prior antidepressant failures (≥ 3). The average number of self-pay TMS sessions was 11.71 ± 3.15) (range:10–30). Patients receiving iTBS1800 demonstrated a greatly higher remission rate than those receiving 10 Hz rTMS (29.5% vs 13.2%, respectively, <i>p</i> = 0.048), particularly in patients with mild and moderate depression. Age was not a clinically significant determinant of remission following TMS therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Left-sided DLPFC iTBS1800 may be a feasible option for treating older patients with TRD due to its favorable effect and shorter treatment period, which may be ideal for patients with transportation, budgetary and vacation restrictions. More study is needed to compare the antidepressant efficacy of iTBS1800 to other TMS protocols in older patients with TRD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273169","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}
We aimed to examine association patterns of white matter hyperintensities (WMH) with neuropsychiatric symptoms (NPS) in men versus women.
Methods
We performed a cross-sectional analysis of data acquired from the National Alzheimer's Coordinating Center database. Cognitively unimpaired participants aged ≥ 50 years with data on WMH severity were studied. Using Cardiovascular Health Study scores, WMH were coded as no to mild (score: 0–4), moderate (score: 5–6) or extensive (score: 7–8). NPS were quantified on the Neuropsychiatric Inventory Questionnaire. For the purposes of the main analysis, participants were dichotomized for presence of each NPS (0: absent; 1: present). Adjusted binary logistic regression models estimated the odds of having each of 12 NPS by sex-WMH status. To confirm the validity of our findings, the correlations between NPS severity and WMH burden were also separately explored in men and women.
Results
Among 4617 participants with normal cognition, there were 1502 men and 2685 women with no to mild WMH changes, 102 men and 274 women with moderate WMH changes and 19 men and 35 women with extensive WMH changes. Greater WMH burden (especially extensive changes) was related to increased odds of lability symptoms (agitation, disinhibition, irritability) and apathy in men but not women. Elation and appetite disorders followed the same trend but failed to achieve statistical significance. The exploratory analysis revealed positive correlations between these symptoms' severity with WMH burden in men but not in women.
Conclusions
WMH burden was differentially associated with NPS in older men versus women with normal cognition.
{"title":"Neuropsychiatric Symptoms and White Matter Hyperintensities in Older Cognitively Unimpaired Men Versus Women","authors":"Ioannis Liampas, Daniil Tsirelis, Silvia Demiri, Vasileios Siokas, Antonia Tsika, Elli Zoupa, Polyxeni Stamati, Lambros Messinis, Grigorios Nasios, Efthimios Dardiotis","doi":"10.1002/gps.70107","DOIUrl":"https://doi.org/10.1002/gps.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to examine association patterns of white matter hyperintensities (WMH) with neuropsychiatric symptoms (NPS) in men versus women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cross-sectional analysis of data acquired from the National Alzheimer's Coordinating Center database. Cognitively unimpaired participants aged ≥ 50 years with data on WMH severity were studied. Using Cardiovascular Health Study scores, WMH were coded as no to mild (score: 0–4), moderate (score: 5–6) or extensive (score: 7–8). NPS were quantified on the Neuropsychiatric Inventory Questionnaire. For the purposes of the main analysis, participants were dichotomized for presence of each NPS (0: absent; 1: present). Adjusted binary logistic regression models estimated the odds of having each of 12 NPS by sex-WMH status. To confirm the validity of our findings, the correlations between NPS severity and WMH burden were also separately explored in men and women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4617 participants with normal cognition, there were 1502 men and 2685 women with no to mild WMH changes, 102 men and 274 women with moderate WMH changes and 19 men and 35 women with extensive WMH changes. Greater WMH burden (especially extensive changes) was related to increased odds of lability symptoms (agitation, disinhibition, irritability) and apathy in men but not women. Elation and appetite disorders followed the same trend but failed to achieve statistical significance. The exploratory analysis revealed positive correlations between these symptoms' severity with WMH burden in men but not in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>WMH burden was differentially associated with NPS in older men versus women with normal cognition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256089","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}
Supa Pengpid, Karl Peltzer, André Hajek, Razak M. Gyasi
Objectives
Few studies have assessed the prevalence and correlates of major depressive disorder (MDD) and depressive symptoms among the oldest-old (≥ 80 years) in low- and middle-income countries. Using national data from India, the study's objective was to determine the prevalence of MDD and depressive symptoms, as well as the characteristics that are related to them, among people aged 80 and beyond.
Methods
Data from the nationally representative cross-sectional 2017-2018 Longitudinal Aging Study in India (LASI) were analyzed. The analytical sample consisted of 3163 community-dwelling people aged 80 and older (proxy interviews were excluded). MDD and depressive symptoms were evaluated using established measures. Multiple logistic regressions were used (with demographic, health, and social-related explanatory factors).
Results
The prevalence of depressive symptoms was 34.8% and MDD 10.3%. Regressions found that higher food insecurity (Adjusted Odds Ratio-AOR: 1.22, 95% Confidence Interval-CI: 1.03–1.44), lower subjective economic status (AOR: 0.90, 95% CI: 0.82–0.98), lower self-rated health status (AOR: 0.78, 95% CI: 0.66–0.93), lower life satisfaction (AOR: 0.66, 95% CI: 0.56–0.78), higher functional disability (AOR: 1.18, 95% CI: 1.06–1.32), physical inactivity (AOR: 1.57, 95% CI: 1.09–2.28), and higher perceived discrimination (AOR: 1.49, 95% CI: 1.35–1.64) increased the odds of depressive symptoms, and higher food insecurity (AOR: 1.31, CI: 1.02–1.68), lower self-rated health status (AOR: 0.65, 95% CI: 0.50–0.85), higher functional disability (AOR: 1.23, 95% CI: 1.08–1.40), and higher perceived discrimination (AOR: 1.23, 95% CI: 1.06–1.42) increased the odds of MDD.
Conclusions
Depression was prevalent among the oldest-old in India. Appropriate intervention strategies should be applied to prevent MMD among the oldest-old in India.
{"title":"Prevalence and Associated Factors of Depressive Symptoms and Major Depressive Disorder Among the Oldest-Old in India","authors":"Supa Pengpid, Karl Peltzer, André Hajek, Razak M. Gyasi","doi":"10.1002/gps.70112","DOIUrl":"https://doi.org/10.1002/gps.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Few studies have assessed the prevalence and correlates of major depressive disorder (MDD) and depressive symptoms among the oldest-old (≥ 80 years) in low- and middle-income countries. Using national data from India, the study's objective was to determine the prevalence of MDD and depressive symptoms, as well as the characteristics that are related to them, among people aged 80 and beyond.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the nationally representative cross-sectional 2017-2018 Longitudinal Aging Study in India (LASI) were analyzed. The analytical sample consisted of 3163 community-dwelling people aged 80 and older (proxy interviews were excluded). MDD and depressive symptoms were evaluated using established measures. Multiple logistic regressions were used (with demographic, health, and social-related explanatory factors).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of depressive symptoms was 34.8% and MDD 10.3%. Regressions found that higher food insecurity (Adjusted Odds Ratio-AOR: 1.22, 95% Confidence Interval-CI: 1.03–1.44), lower subjective economic status (AOR: 0.90, 95% CI: 0.82–0.98), lower self-rated health status (AOR: 0.78, 95% CI: 0.66–0.93), lower life satisfaction (AOR: 0.66, 95% CI: 0.56–0.78), higher functional disability (AOR: 1.18, 95% CI: 1.06–1.32), physical inactivity (AOR: 1.57, 95% CI: 1.09–2.28), and higher perceived discrimination (AOR: 1.49, 95% CI: 1.35–1.64) increased the odds of depressive symptoms, and higher food insecurity (AOR: 1.31, CI: 1.02–1.68), lower self-rated health status (AOR: 0.65, 95% CI: 0.50–0.85), higher functional disability (AOR: 1.23, 95% CI: 1.08–1.40), and higher perceived discrimination (AOR: 1.23, 95% CI: 1.06–1.42) increased the odds of MDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Depression was prevalent among the oldest-old in India. Appropriate intervention strategies should be applied to prevent MMD among the oldest-old in India.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244688","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}
Matthew P. Janicki, Philip McCallion, Nancy Jokinen, Frode Kibsgaard Larsen, Kathyrn P. Service, Dawna T. Mughal, Karen Watchman, Tiziano Gomiero, Seth M. Keller
Objectives
The second International Summit on Intellectual Disability and Dementia, held in 2023, highlighted the unique challenges of diagnosing dementia in older autistic adults, particularly those with intellectual disabilities, due to the complex interplay of cognitive, communicative, and behavioral factors. This article addresses key diagnostic issues and post-diagnostic considerations for this population.
Method
A consensus report was developed by the Summit's Autism/Dementia Working Group through background reviews, expert discussions at the Summit, and iterative draft revisions, incorporating feedback from internal and external stakeholders. Key issues were extracted from the report and abridged for this manuscript.
Results
Diagnostic challenges stem from overlapping symptoms of co-occurring neurodevelopmental and psychiatric conditions, rendering standard dementia tools insufficient. Comprehensive evaluations tailored to autism-related traits, sensory sensitivities, and alternative communication methods are essential. Building diagnostic capacity among clinicians and fostering multidisciplinary collaboration are critical. Longitudinal assessments, initiated before dementia symptoms appear, facilitate early detection of subtle changes. Emerging biomarkers and neuroimaging techniques show promise and should be incorporated where feasible. Accommodations, such as virtual assessments in familiar settings, can enhance diagnostic accuracy by reducing anxiety. Creating transition processes from diagnostics to post-diagnostic supports will aid in mitigating challenges and enhance life quality when dementia is a factor.
Conclusions
Research and clinician education are urgently needed to improve diagnostic approaches and streamline the transition from diagnosis to tailored post-diagnostic support. An integrated framework of comprehensive efforts is vital for our better understanding of age-associated neuropathological diagnostics and enabling long-term well-being of older autistic adults with dementia.
{"title":"Autism, Diagnostics, and Dementia: A Consensus Report From the 2nd International Summit on Intellectual Disabilities and Dementia","authors":"Matthew P. Janicki, Philip McCallion, Nancy Jokinen, Frode Kibsgaard Larsen, Kathyrn P. Service, Dawna T. Mughal, Karen Watchman, Tiziano Gomiero, Seth M. Keller","doi":"10.1002/gps.70110","DOIUrl":"https://doi.org/10.1002/gps.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The second International Summit on Intellectual Disability and Dementia, held in 2023, highlighted the unique challenges of diagnosing dementia in older autistic adults, particularly those with intellectual disabilities, due to the complex interplay of cognitive, communicative, and behavioral factors. This article addresses key diagnostic issues and post-diagnostic considerations for this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A consensus report was developed by the Summit's Autism/Dementia Working Group through background reviews, expert discussions at the Summit, and iterative draft revisions, incorporating feedback from internal and external stakeholders. Key issues were extracted from the report and abridged for this manuscript.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Diagnostic challenges stem from overlapping symptoms of co-occurring neurodevelopmental and psychiatric conditions, rendering standard dementia tools insufficient. Comprehensive evaluations tailored to autism-related traits, sensory sensitivities, and alternative communication methods are essential. Building diagnostic capacity among clinicians and fostering multidisciplinary collaboration are critical. Longitudinal assessments, initiated before dementia symptoms appear, facilitate early detection of subtle changes. Emerging biomarkers and neuroimaging techniques show promise and should be incorporated where feasible. Accommodations, such as virtual assessments in familiar settings, can enhance diagnostic accuracy by reducing anxiety. Creating transition processes from diagnostics to post-diagnostic supports will aid in mitigating challenges and enhance life quality when dementia is a factor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Research and clinician education are urgently needed to improve diagnostic approaches and streamline the transition from diagnosis to tailored post-diagnostic support. An integrated framework of comprehensive efforts is vital for our better understanding of age-associated neuropathological diagnostics and enabling long-term well-being of older autistic adults with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232278","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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