International psychogeriatrics最新文献

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).

Aims: With the rise in global life expectancy, interest in older adults' mental well-being is growing. Media use is currently seen as potentially contributing to well-being. The study is guided by the Stimulus-Organism-Response (S-O-R) model, positing that external stimuli are linked to internal processes and may be associated with specific outcomes. Accordingly, the study examines whether social inclusion and subjective accelerated aging mediate the association between media use and well-being in older adults.

Methods: A structured questionnaire was distributed to older adults via multiple channels. The sample included 636 Israeli participants aged 64 and older. Mediation analysis was conducted to estimate the indirect association of media use with well-being through social inclusion and subjective accelerated aging.

Results: In the mediation model, the direct association between media use and well-being was not significant. However, full mediation occurred through the proposed mediators. Media use was positively associated with social inclusion and negatively with subjective accelerated aging. Social inclusion was negatively associated with subjective accelerated aging and positively with well-being, whereas subjective accelerated aging was negatively associated with well-being.

Conclusion: The study shows that media use is associated with better older adults' well-being only by contributing to social inclusion and subjective accelerated aging. The findings strengthen the conceptualization of subjective accelerated aging as a meaningful construct. They also highlight the need to promote and strengthen digital literacy and media-based programs for adults, including integrating media use into community initiatives, which can promote a sense of inclusion, reduce subjective accelerated aging, and contribute to mental well-being.

Behavioural and psychological disturbances are common among individuals with dementia. It is unclear if the use of antidementia medicines reduces their presence. This study aimed to clarify if the introduction of antidementia medicines leads to a decline in the dispensing of antidepressants, anxiolytics and antipsychotics. We used time-series analyses to examine the association between the supply of cholinesterase inhibitors or memantine and psychotropics. Participants were males and females aged 60 years or over included in the Australian 10 % Pharmaceutical Benefits Scheme database between 2013 and 2024. The outcomes of interest were the dispensing of antidepressants, anxiolytics and antipsychotics, and the exposure the dispensing of antidementia medicines. The panel dataset included 466,210 individuals. The odds ratio of being dispensed a psychotropic in association with the supply of an antidementia medicine was 8.40 (95 %CI=8.05-8.78) for antidepressants, 1.99 (95 %CI=1.89-2.09) for anxiolytics, and 24.31 (22.54-26.22) for antipsychotics. Interrupted time-series analyses showed that the introduction of an antidementia medicine decreased the annual rate of dispensing of antidepressants (-0.7 % per year), but increased the dispensing of anxiolytics by 0.8 % per year and antipsychotics by 1.0 % per year. Contrary to our hypothesis, interrupted time series analyses showed that the supply of antidementia medicines was associated with subsequent increased rate of dispensing of psychotropic agents, particularly anxiolytics and antipsychotics. Antidementia medicines are not effective at reducing the clinical use of anxiolytics and antipsychotics.

Background: The SUPERA® Cognitive Stimulation program was tested in a randomized, single-blinded, controlled clinical trial to investigate its effectiveness in older adults without cognitive impairment or dementia.

Methods: A total of 207 participants were randomly assigned to three groups: Training Group (TG), Active Control Group (ACG), and Passive Control Group (PCG). The TG (n = 65) received the SUPERA® Cognitive Stimulation program in 72 weekly cognitive stimulation sessions over 18 months; the ACG (n = 63) received health and lifestyle education; and the PCG (n = 79) received no intervention. Participants were assessed at baseline (T0), 6 (T1), 12 (T2), 18 (T3), and 24 (T4) months (six-month follow-up). Main outcomes included a battery of cognitive performance tests. Additional outcomes included psychological symptoms, quality of life, and self-perceived cognitive functioning. Intention-to-treat (ITT) analyses using Linear Mixed Models were conducted.

Results: Main outcomes showed significant improvement in Phonemic Verbal Fluency (FAS) in the TG, with evidence of maintenance of effects at the twenty-four-month follow-up. The post-hoc analysis of the composite scores revealed significant time-group interactions favoring the TG for memory, executive function, and global cognition. Specifically, a marked time-group interaction was observed on the FAS in favor of the TG, an effect that was sustained at the six-month follow-up (T4). Furthermore, robust effects were found for subjective cognitive functioning. In this domain, the time-group interaction analysis was consistently favorable for the TG, which reported sustained gains across all follow-up assessments. These findings demonstrate the positive impact of the intervention on objective cognitive performance, and particularly on participants´ self-perceived functioning.

Conclusions: These findings suggest that an 18-month-long multicomponent SUPERA® Cognitive Stimulation program may represent an effective preventive strategy against cognitive decline among healthy older adults. However, further studies are needed to confirm long-term benefits and to explore the mechanisms underlying the reported improvements.