International psychogeriatrics最新文献

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.

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.

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.

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.

Neuropsychiatric syndromes (NPS) such as agitation, psychosis, apathy, and irritability are among the most disabling features of major and mild neurocognitive disorders including Alzheimer's disease, other neurodegenerative disorders (NDD), and vascular cognitive impairment. Clinical trial methodologies for the treatment of these syndromes are evolving and the first agents to reduce NPS severity has been approved. Biomarkers are rapidly becoming available to guide clinical trial decision-making. Biomarkers can confirm the diagnosis of Alzheimer's disease and are playing a larger role in non-Alzheimer trials. The Consolidated Standards for Reporting Trials (CONSORT) specify the elements of clinical trials that must be reported when clinical trials are published. These criteria provide conventions for uniform reporting of all key aspects of a clinical trial and facilitate comparisons across trials. We describe best practices for clinical trials of NPS including research definitions of the NDD, use of biomarkers to support clinical diagnosis, research criteria for NPS, use of rating scales to define the severity of NPS at baseline and as endpoints for the clinical trial, and approaches to data analysis of specific interest in NPS trials. Standards for describing the limitations of trials and their generalizability are provided. The goal is to inform planning and reporting of NPS trials including the use of biomarkers based on CONSORT guidelines for best trial practices.

Objectives: Current treatments for cognitive and neuropsychiatric symptoms in Alzheimer's disease and related dementias (ADRD), such as cholinesterase inhibitors (CEIs) and selective serotonin reuptake inhibitors (SSRIs), show inconsistent effectiveness, necessitating a personalized therapy approach. We aimed to develop predictive models using MRI-derived brain neuroanatomical features and clinical data to forecast responses to CEIs and SSRIs in ADRD patients.

Design and setting: This was a retrospective observational analysis of electronic health records (EHRs) and MRI data conducted within Johns Hopkins Medical Systems.

Participants: Cohort 1 comprised 179 patients prescribed CEIs or SSRIs for the first time with over a year of follow-up. Cohort 2 included 1244 patients with similar criteria to explore clinical characteristics linked to MRI features affecting treatment benefits.

Measures: Medication efficacy was assessed via a Likert scale based on EMR descriptions. We quantified brain volumes across 280 anatomical areas on T1-weighted MRIs and applied an elastic net model after harmonizing volumes with the ComBat model. Predictive model efficacy was evaluated using receiver operating characteristic (ROC) analysis.

Results: Preserved volume in the nucleus basalis of Meynert correlated with better responses to both CEIs and SSRIs. Specific white matter volumes related to CEI benefits, while SSRI efficacy was linked to gray matter in the Nucleus Accumbens and frontal cortex. Area under ROC curve values were 0.82 for CEI and 0.75 for SSRI predictions. Older age and vascular factors were associated with reduced medication benefits.

Conclusions: MRI-derived neuroanatomical features effectively predict medication responses in ADRD, potentially enabling more tailored treatment strategies.

Objective: To review the effectiveness of healthcare professionals' dementia training and consider implications for policy and practice.

Design: Systematic and policy review SETTING: Healthcare services PARTICIPANTS: Healthcare professionals INTERVENTION: Training MEASUREMENTS: We searched electronic databases for primary research studies (2015-2024) evaluating dementia training for healthcare professionals. We assessed risk of bias using the Mixed Methods Appraisal Tool, prioritising studies scoring 4 + , of interventions supported by Randomised Controlled Trial evidence; reporting outcomes using Kirkpatrick's framework. To explore how evidence might translate to practice, using England as a case study, we reviewed relevant policies and consulted professional stakeholders.

Results: We reviewed 63 primary research studies. One met priority criteria; it evaluated a Train-the-Trainer (TTT), team-based reflective practice model, which improved primary care nurses' and doctors' learning, and self-reported practice over ≥ 3 months. Higher quality, controlled studies evaluated a TTT programme for hospital staff, improving client outcomes (agitation) over ≤ 5 days; an expert-led two-day interactive training for inpatient nurses that reduced role strain; and expert-led, nine-week, occupational therapy-derived training programme that improved retirement community staff strategies for client activity engagement. Sixteen policies and related documents highlighted concerns about limited implementation of the Dementia Core Skills Education and Training Framework (DCSETF). Eight focus group attendees considered time a limiting factor to evidence implementation, but valued group training to share experiences; and TTT models to enable tailoring to local contexts.

Conclusions: By increasing reach of dementia training and embedding learning in practice, Train-the-Trainer models can increase care quality and support evidence-based policy implementation.

Background: The prevalence of mild cognitive impairment (MCI) has increased among older adults in recent years, while increasing evidence highlighted residence as a critical social determinant of cognitive health. This study examined the longitudinal association between residential trajectories and MCI, and whether depressive symptoms influenced these associations.

Methods: A total of 4425 individuals aged ≥ 60 years from the China Health and Retirement Longitudinal Study (CHARLS; 2015 and 2018) were included. Participants were categorized into four residential trajectories: persistent urban residence, persistent rural residence, rural-to-urban migration, and urban-to-rural migration. Poisson regression models were used to assess these associations.

Results: During the follow-up period, 808 individuals (18.26 %) developed MCI. Individuals in rural areas were significantly associated with lower scores across all cognitive domains than those in urban areas. Compared to persistent urban residence, the risk of incident MCI was significantly higher for persistent rural residence (RR: 2.53, 95 % CI: 2.01-3.19) and urban-to-rural migration (2.09, 1.51-2.90). Rural-to-urban migration was associated with the lowest risk (1.60, 1.06-2.41). Persistent rural residence showed the highest risk of incidence MCI when combined with depressive symptoms (3.74, 2.79-5.02).

Conclusion: An individual's residential trajectory was associated with cognitive health in later life. Persistent rural residence, especially when combined with depressive symptoms, were significantly associated with higher MCI risk. Our findings underscore that older rural adults with depressive symptoms warrant further attention in public health surveillance and clinical screening efforts.