International psychogeriatrics最新文献

Objective: To identify changes in regional cerebral blood flow (CBF) associated with psychosis in patients with Alzheimer's disease (AD) through arterial spin labeling (ASL) magnetic resonance imaging (MRI).

Methods: Sixty patients with AD, whose diagnoses were supported by amyloid PET, were recruited. A set of neuropsychological tests was used to evaluate cognitive function and neuropsychiatric symptoms. All participants were assigned to either the AD with psychosis (AD-P) group or the AD without psychosis (AD-NP) group according to their hallucination and delusion scores on the Neuropsychiatric Inventory (NPI). Regional CBF was measured using pseudocontinuous ASL MRI in the resting state.

Results: Compared with AD-NP patients, AD-P patients achieved lower scores on the Mini-Mental State Examination (MMSE) and on the cognitive domains of memory and visuospatial function; they also exhibited worse performance in terms of daily function. Compared with the AD-NP group, the AD-P group exhibited significantly lower global CBF. After the global values normalized, relatively lower CBFs were detected in the left middle temporal gyrus, right supramarginal gyrus and bilateral precuneus in patients with AD-P. Lower CBF in the precuneus was correlated with both cognitive impairment and hallucinations.

Conclusion: Psychosis was associated with more severe cognitive impairment and lower CBF in regions of the temporal and parietal lobes, particularly the precuneus, in AD patients.

Aim: The objective is to study the prevalence of potentially inappropriate medications (PIMs) and analyze the relationship between PIM regimens and therapeutic adherence to antidepressant treatment in older adults diagnosed with depression within a Spanish population cohort.

Methods: This retrospective, population-based cohort study used real-world data from older patients diagnosed with depression in the Canary Islands, Spain between 2013 and 2021. The prevalence of PIMs was determined using sets of criteria developed in the USA (Beers), Ireland (STOPP) and Germany (PRISCUS). Multivariate logistic regression models were performed to assess factors associated with PIM prescriptions and treatment adherence, including sociodemographic, clinical, and lifestyle variables RESULTS: Among the 12,272 patients over 65 years of age undergoing antidepressant treatment for late-life depression, the prevalence of PIM use ranged between 73 % and 89 %. A protective effect of increasing age and male sex was found. Patients with a higher number of psychiatric and nursing comorbidities showed a higher risk of receiving a PIM. A consistent trend was observed, the risk of non-adherence to treatment increases with the number of PIMs received.

Conclusion: The findings here indicate a worrying prevalence of PIM prescription in this population. A higher risk of receiving a PIM was observed in comparatively younger older adults, women, and those with psychiatric or nursing comorbidities, with potential implications for treatment adherence. However, these results should be interpreted with caution. Further research is needed to clarify the relationship between adherence and PIM.

Background: As populations age and families become more dispersed, opportunities for meaningful intergenerational contact are diminishing. Intergenerational programmes (IGPs) aim to bridge this divide by bringing younger and older people together through structured activities. While health and social outcomes have been examined in the literature, the impacts of IGPs on the quality of intergenerational relationships remains less clearly understood.

Objectives: This scoping review aimed to map existing evidence on non-familial IGPs designed to improve intergenerational relationships and to evaluate their impacts on relationship outcomes between younger and older participants.

Methods: A comprehensive search of eight electronic databases and reference lists was conducted up to 2024. Studies were eligible if they had (1) included programmes based on structured interactions between younger and older participants and (2) reported at least one relationship-focused outcome (e.g., attitudes, perceptions, or communication). Two reviewers independently screened and charted data. Given heterogeneity in study designs and outcomes, a narrative synthesis was conducted.

Results: Of the 18,480 retrieved records, 69 studies were included. Seven types of IGPs were identified, though fewer than half explicitly reported theoretical underpinnings for their programme design. Most interventions were delivered in community or educational settings and used structured, small-group formats that facilitated emotional exchange and mutual learning. Reported outcomes included more positive intergenerational attitudes and improved perceptions of relationship quality.

Conclusions: IGPs demonstrate a promising potential in strengthening intergenerational relationships, particularly through a structured, small-group approach. Future research should incorporate theory-informed designs, apply standardised measures of relationship quality, and report implementation processes. Embedding IGPs into routine services and evaluating long-term outcomes are essential for sustainability and scalability.

Introduction: Previously, nabilone showed a medium effect size for treating agitation in moderate-to-severe Alzheimer's disease (AD), but response varied. These post hoc analyses aimed to identify a group of clinical characteristics that predicted treatment response.

Methods: Data from a double-blind, placebo-controlled crossover trial in AD agitation were used. Nineteen clinical characteristics were categorized (presence/absence) and evaluated for relation to agitation response (change on Cohen-Mansfield Agitation Inventory (CMAI)). Characteristics with a ≥ 8 point response difference between categories were included in a multivariable analysis model to calculate individual predicted response. Linear mixed-effects models with Satterthwaite's approximation evaluated the impact of treatment on the relationship between predicted and observed responses.

Results: Thirty-nine participants (77 % male, mean [SD] age 87 [10.2], standardized Mini-Mental State Exam (sMMSE) 6.5 [6.8]) were enrolled. Variable selection identified five characteristics related to greater nabilone efficacy: higher pain (Pain Assessment in Advanced Dementia score ≥3) (difference [SE] in CMAI response = -18.8 [3.2]), greater appetite and eating disorders (-16.4 [5.5]), greater apathy (-14.0 [5.5]), less cognitive impairment (sMMSE greater than 10) (-16.5 [4.2]) and no concomitant cholinesterase inhibitors (-13.9 [4.4]). For those with a predicted response in the top tertile based on those five characteristics, 82 % responded, compared with 40 % in the lowest tertile. A treatment-by-tertile interaction (F(2,29) = 8.48, p = 0.001) indicated observed treatment response varied across tertiles.

Conclusion: A reliable clinical profile of persons with AD related agitation likely to respond to nabilone may be established with additional research.

Objectives: Older adults residing in care homes will eventually require holistic end-of-life care (EoLC) that addresses not only physical symptoms but also psychological, social, spiritual and information needs. This study evaluated the Integrated Residential Home EoLC Support Teams (IRHEST) Program, an interdisciplinary service model to enhance EoLC in residential care settings.

Design: A single-arm, non-randomized, pre-post intervention multisite trial.

Setting: EoLC services in Residential Care Homes for the Elderly (RCHEs) in Hong Kong from 2022 to 2024.

Participants: Older adults (n = 567) with a prognosis of 12 months or less, residing in RCHEs, and their caregivers.

Intervention: IRHEST employs specialized nurses and social workers to provide case supervision, direct services and staff training to enhance EoLC at participating RCHEs.

Measurement: Patient physical symptoms, psychosocial distresses and information needs were assessed at baseline (T0), one month (T1) and three months (T2) after intake. Caregiver psychological distress and information needs were assessed at baseline and two months post-intervention (T3).

Results: Pre-post evaluations revealed significant reductions in physical symptoms, psychosocial-spiritual distresses and information insufficiency of patients in the first three months of service. Among caregivers, there were significant reductions in psychological distress and information needs. Patients with dementia had lower physical symptoms distress at baseline, and their improvements in the first three months of service were comparable to other patients.

Conclusion: The Program may be an effective and scalable intervention in addressing patients' physical, psychosocial, spiritual and information needs, as well as psychological distress and information needs among caregivers in residential care settings.

Background: Evacuation from one's home in later life can disrupt daily structure and emotional stability, increasing vulnerability to depression.

Objectives: To examine whether a healthy lifestyle and self-compassion function as protective factors against depressive symptoms in older adults, and to test whether evacuation status moderates these relationships.

Methods: A cross-sectional study was conducted among 360 older adults (mean age = 72.3), approximately half of whom were evacuees temporarily relocated from their homes. Participants completed questionnaires examining standardized measures of depressive symptoms (GDS-15), healthy lifestyle (sleep, physical activity, and nutrition; WHO STEPS items), and self-compassion (SCS-SF). Mediation-moderation analyses using PROCESS bootstrapping examined indirect and conditional effects while controlling for sociodemographic covariates.

Results: A healthier lifestyle was significantly associated with fewer depressive symptoms (p < .001). Self-compassion partially mediated this relationship, with a stronger indirect effect among evacuees. Education and gender also predicted depression, whereas age and marital status did not.

Conclusions: Healthy lifestyle was associated with fewer depressive symptoms, and self-compassion partially accounted for this association, with a stronger indirect effect among evacuees.

Background: In Apathy in Dementia Methylphenidate Trial 2 (ADMET2), apathy in Alzheimer's disease improved with methylphenidate (MPH) in a randomized, placebo-controlled trial, though response varied. Here we evaluated serum biomarkers for their association with apathy and with treatment response.

Methods: All ADMET2 participants with available blood samples were included. Markers of inflammation [interleukin (IL)-6, IL-10, Tumor Necrosis Factor (TNF)], oxidative stress [lipid hydroperoxide (LPH), 4-hydroxynonenal (4-HNE), 8-isoprostane (8-ISO)] and neuronal injury [neurofilament light (NfL), S100B] were assessed and values log-transformed. Neuropsychiatric Inventory-apathy (NPI-A) measured apathy. Least Absolute Shrinkage and Selection Operator (LASSO) regression was performed for feature selection of baseline markers predicting NPI-A at Month-6 (M6). Univariate analyses examined individual biomarker effects and multivariable models evaluated their combined effects. Treatment interactions, baseline and change in biomarker levels in treatment responders (≥4 change in NPI-A) and remitters (M6 NPI-A=0) were explored.

Results: In the ADMET2 biomarker subset (n = 44, MPH:21, age:75 years, MMSE:20.2), higher baseline TNF was associated with higher M6 NPI-A [B(SE)= 6.86 (1.71), p = .0003], and multivariable models found lower baseline TNF [B(SE)= 8.28(1.61), p < .001] and higher baseline S100B [B(SE)= -6.41(1.95), p = .002] were associated with lower M6 NPI-A. Exploratory analyses suggested that higher baseline NfL significantly interacted with treatment to predict lower M6 NPI-A [B(SE)= -8.36(4.21), p = .05], only when adjusting for cognition. MPH remitters had lower baseline TNF [B(SE)= -0.27(0.10), p = .02], higher baseline NfL [B(SE)= 0.33(0.14), p = .03], and a greater decrease in IL-6 [B(SE)= -0.44 (0.17), p = .02].

Conclusions: Inflammatory and neuronal injury biomarkers may have prognostic value and may potentially inform treatment response and remission outcomes in apathy. Apathy in Dementia Methylphenidate Trial 2 (ADMET2), NCT02346201, https://clinicaltrials.gov/study/NCT02346201.

Objectives: People with young-onset dementia (YOD), defined as symptom onset before the age of 65, have mortality rates five to eight times higher than those of the general population of similar age. However, survival studies focused on individuals living in the community rather than those residing in nursing homes. This study aimed to estimate survival rates, its determinants, and causes of death in nursing home residents with YOD.

Design: Survival data from the BEYOnD (2005-2018) and Care4Youngdem (2016-2021) cohort studies.

Setting: YOD special care units of 20 nursing homes in the Netherlands.

Participants: Nursing home residents with YOD (N = 385).

Methods: Kaplan-Meier estimates were used to determine survival times. Cox regression analysis examined factors associated with mortality, including age, sex, dementia type, and cardiovascular and pulmonary diseases. Hazard ratios were pooled using a random-effects meta-analysis.

Results: Median survival after diagnosis was 8.9 years (95 % CI 7.8-10.1) in BEYOnD and 7.9 years (95 % CI 6.9-9.0) in Care4Youngdem. Median survival after admission was 6.3 (95 % CI 5.3-7.2) and 5.0 (95 % CI 4.4-5.6) years, respectively. In the pooled model, higher age at diagnosis (HR 1.06 per year increment) and male sex (HR 1.36) were significantly associated with higher mortality; dementia type and comorbidities were not. Cachexia or dehydration was the most frequent cause of death (35.3 %).

Conclusions and implications: Nursing home residents with YOD have long survival times, in particular women and those diagnosed at younger ages. Our results highlight important considerations for prognostication and organizing long-term care.

Trial registration: NL-OMON23226 (Registry: OMON).