International psychogeriatrics最新文献

Objectives: Positive psychological characteristics may help to bolster daily functioning in older adults even in the presence of subjective or subtle objective cognitive weaknesses. The purpose of the present study was to examine which specific psychological characteristics may contribute to better functional abilities, independent of cognitive performance, among a sample of older adults with subjective cognitive decline (SCD).

Design, setting, and participants: Participants included 277 older adults recruited from the community who were enrolled in a randomized controlled trial examining the impact of training in memory support strategies and healthy lifestyle behaviors. The current study was based on baseline data prior to intervention randomization.

Measurements: Linear regression was used to assess associations between positive psychological characteristics (positive affect, life satisfaction, purpose in life, resiliency, self-management of health, and perceived competence), one negative psychological characteristic (negative affect), and functional abilities controlling for demographic variables. A final model assessed for associations between functional abilities and any of the significant characteristics identified in the linear regressions while controlling for global cognition (measured with the Modified Neuropsychological Test Battery composite score), depression, and demographic variables.

Results: In the individual regressions, most of the psychological characteristics were significantly associated with functional abilities. In the final model, positive and negative affect remained significantly associated with functional abilities.

Conclusions: This is one of the first studies to show that greater positive affect is associated with better functional abilities, even after controlling for objective cognitive performance. Positive affect in older adults may represent a modifiable target for intervention.

Objectives: The aim of this study was to determine whether individuals with Subjective Cognitive Decline (SCD), particularly those with a neurostructural marker of risk for AD (SCD+), exhibit differences in the functional connectivity of the Default-Mode Network (DMN) relative to controls, as this network is known to be altered in the AD continuum.

Design: Cross-sectional study.

Setting: Galicia, Northwest Spain.

Participants: The sample compromised 133 participants: 69 controls, 51 SCD and 13 SCD+.

Measurements: Seed-to-voxel analysis was conducted using four DMN ROIs. Dynamic independent component analysis of the DMN was also performed.

Results: The SCD and SCD+ groups exhibited DMN hyperconnectivity, which was more extensive in the SCD+ group. Increased anti-correlations between DMN and task-positive parietal regions were related to poorer executive scores in SCD+ and a tendency for higher DMN recurrence in SCD+.

Conclusions: Hippocampal atrophy as a SCD+ biomarker is associated with extensive DMN hyperconnectivity and increased anti-correlations between DMN and task-positive network regions.

Objectives: This study examined the cultural and psychosocial foundations of well-being among older Japanese adults by focusing on the sentiment "good to have been alive," a culturally embedded expression of life affirmation.

Methods: A cross-sectional survey was conducted among 382 community-dwelling older adults in rural Japan. The main outcome, "good to have been alive," was analyzed as an ordinal variable (1-5). Measures included generativity, perceived connections to nature, ancestors, and future generations, social support, depressive symptoms, subjective health, financial satisfaction, and life satisfaction. Ordinal logistic regression models were used to identify independent correlates.

Results: Responses were highly skewed toward life affirmation, with 84 % selecting 4 or 5. In fully adjusted models, stronger perceived connections-to nature (OR = 1.44, 95 % CI 1.03-2.00), ancestors (OR = 1.74, 95 % CI 1.09-2.78), and future generations (OR = 1.52, 95 % CI 1.01-2.30)-were independently associated with higher life affirmation. Social support (OR = 1.38, 95 % CI 1.20-1.58) and subjective health and financial satisfaction were also significant. Parallel ordinal models for life satisfaction and subjective happiness showed consistent patterns.

Conclusion: The expression "good to have been alive" reflects a multidimensional sense of well-being rooted in vertical (generational) and holistic (natural) connections. It complements global indicators by capturing culturally embedded sources of fulfillment in later life. Incorporating such expressions may enhance well-being assessment and policy design in aging societies. Further cross-cultural and qualitative research is needed to clarify how this sentiment resonates across different sociocultural contexts.

Objectives: Hippocampal volume reductions are associated with Major Depressive Disorder. Evidence of relationships between hippocampal subfield volumes and specific subsyndromal depression symptoms can add to our understanding of this mechanistic correlate.

Design: Cross-sectional correlational study.

Setting: University of Pittsburgh research facilities using 7 Tesla (7 T) MRI.

Participants: Sixty older adults (mean age=70.05; standard deviation=6.99) who had stress/strain related to family dementia caregiving and had no more than subsyndromal depression symptoms (PHQ-9 < 10 at screening).

Measurements: Hippocampal subfield volumes were obtained from 7 T MRI segmentations. Depression symptom outcomes were Center for Epidemiological Studies Scale Revised (CESD-R) total and symptom group scores (assessing symptoms of dysphoria, anhedonia, appetite changes, sleep, thinking/concentration, guilt/worthlessness, tiredness/fatigue, psychomotor disturbance, and suicidal ideation). Partial Spearman correlation coefficients, adjusted for age, sex, and intracranial volume, were used to evaluate associations of subfield volumes with depression symptoms.

Results: Of the five subregion volumes examined, only lower DG volume was statistically associated with higher total CESD-R depression total scores (Spearman r = -0.27, p = 0.04). There were medium effect size correlations of DG volumes with three of the nine symptom groups: thinking/concentration (Spearman r = 0.37, p = 0.004, q=0.04); dysphoria (Spearman r = -0.29, p = 0.02, q=0.07); and tiredness/fatigue (Spearman r = -0.29, p = 0.02, q=0.07).

Conclusions: Finding correlations of low DG volume with subsyndromal depression symptoms raises questions of whether low DG volumes contribute to the etiology and consequences of subsyndromal depression symptoms (such as risk for dementia and major depression). Future studies are needed to replicate/extend these findings and clarify the broader mechanism(s) linking DG structural characteristics with depression.

Background: Older adults comprise an especially vulnerable population with unique challenges associated with aging. Current mental health interventions for this population focus on different important components of well-being but do not combine them into one curriculum that is widely accessible to those who could benefit. We have chosen 3 pillars (mindfulness, meaning in life, and social connection) and developed a comprehensive curriculum to be shared with others by combining survey preferences from our population sample with evidence-based practices from the literature including positive psychiatry and psychotherapy.

Methods: Long-term care and subacute rehabilitation patients from 2 nursing homes in Atlanta were recruited to participate in a survey. Categorical frequency calculations were used to evaluate participant interest and logistical preferences. Ranked scores and distribution columns were used to evaluate course content.

Results: 100 participants completed the survey. 55.1 % expressed interest in attending this type of course. For class length, frequency, duration, and size, average preference was for 30 min, once a week, 2-4 weeks, and 6-10 people, respectively. Between pillars, preferences in order of priority were: meaning in life (ranked score 215), mindfulness (198), and social connection (157). The subtopics with the highest ranked scores within each pillar were: gratitude for life lived, emotional stability, and increasing opportunities for social connections.

Conclusion: Based on survey results and the literature, we have developed a psychoeducational course to promote well-being in older adult nursing home patients. A curriculum syllabus complete with course description, learning objectives, weekly topics and timelines, materials needed, notes, and handouts is included with the manuscript.

Objectives: This study evaluated the effect of music exposure on global clinical impact, arousal, and brain network connectivity in subjects with moderate to severe Alzheimer's disease (AD).

Design: This was a pilot, controlled, single-blind, randomized, cross-over study.

Setting: The University Hospital Outpatient Clinic and Imaging Center and the Veterans Administration Research Facility.

Participants: Ten participants aged between 55 and 90 years with moderate to severe AD, a Mini-Mental State Examination (MMSE) score of 5-20, and without neuropsychiatric symptoms of dementia were enrolled in the study.

Intervention: Participants were exposed to both preferred music (PM) and nature sounds (NS). A randomization program was used to determine assignment order for either PM or NS to be delivered via over-ear headphones at Visit 1. Visit 2, which occurred approximately one week later, was identical to Visit 1, but the participants who were originally exposed to PM were exposed to NS and vice versa.

Measurements: A modified version of the Alzheimer's Disease Cooperative Study Clinical Global Impression of Change (ADCS-CGIC) was the primary outcome measure and functional magnetic resonance imaging (fMRI) scans were used to evaluate brain network connectivity.

Results: There was a clinically and statistically significant positive response to music stimulation in the primary outcome measure and in the secondary outcome measure, as well as a clear differentiation in brain network connectivity when individuals were exposed to PM versus NS. There was also a strong correlation between clinical changes and brain network connectivity changes as documented by fMRI.

Conclusions: Music has the potential to be utilized as a non-invasive method to stimulate the brain of individuals with severe cognitive impairment in key functions TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov (ID: NCT05309369) by Jacobo Mintzer, MD, MBA.

Background: Dementia, is a leading cause of death internationally, affecting 55 million people. A palliative approach, emphasizing holistic and psychosocial care, is increasingly recognised as essential for addressing the complex needs of people with dementia and their carers. However, little research has explored the interface between psychosocial interventions for people with dementia near the end of life and palliative care, necessitating a synthesis to guide integrated, person-centred care.

Aim: To establish a framework of evidence-based psychosocial interventions in dementia palliative care.

Methods: We conducted a systematic review using narrative synthesis. Three electronic databases (Epistemonikos, MEDLINE and ASSIA) were searched (January 1980-May 2024), for systematic reviews, guided by the methods of Cochrane overview of reviews. This is part of a series of reviews with the focus for this manuscript on psychosocial interventions for people with dementia.

Results: Thirty-four reviews were included, published between 2009 and 2023. No reviews of interventions covered all domains of dementia palliative care. The majority focussed on neuropsychiatric symptom management and promoting wellbeing. There were no reviews which covered managing care transitions, continuity of care and care co-ordination, or information for people with dementia.

Conclusions: There is significant progress in the development and evaluation of interventions targeting behavioural and psychological symptoms of dementia (BPSD). However, a critical gap persists in addressing other essential aspects of quality of life and dementia care, with a notable gap in addressing many crucial aspects of palliative dementia care, such as care co-ordination, transitions, and carer support.

There are 182 active trials and 138 unique drugs in the current Alzheimer's disease drug development pipeline. Of these, 33 % of trials are global involving both North American and non-North American sites. Phase 3 clinical trials are more likely to have a global distribution of sites (73 %) than Phase 1 or Phase 2 trials. Considering all global trials together, 32,284 participants are needed to populate the ongoing trials; 25,628 of these are required for Phase 3 trials. From a world region perspective, 100 % of global trials include North America, 45 % involve South America or Mexico, 71 % include Europe Western Europe or Israel, 39 % include Eastern Europe or Russia, 30 % include Asia (not including Japan), 39 % include Japan, and 43 % include South Africa, Australia, or New Zealand. A total of 46 countries are participating in current global trials. Of the 46 countries, 28 % are classified as low-and-middle-income countries. There are 5361 trial sites in active global trials; of these, 50 % are in the United States and 50 % are in other global regions. Seven percent of sites are in low-and-middle income countries. Eighty-nine percent of global trials are sponsored and funded by biopharmaceutical companies. Together these observations suggest that many global regions are involved in Alzheimer's disease clinical trials. North America has a larger number of trials and trials sites than other global regions. Low- and middle-income countries are poorly represented in terms of clinical trial sites. These regions have many patients with Alzheimer's disease and are well suited to advance trial recruitment if adequate infrastructure can be developed.