International psychogeriatrics最新文献

Objectives: Dementia and sleep disturbance co-occur frequently. Previous research has focused on sleep disturbance and dementia risk, but its impact in established dementia is less clear. The aim of this study was to investigate the frequency of recorded sleep disturbance at the time of dementia diagnosis and its association with adverse outcomes.

Design & setting: Using data from a large South London healthcare provider, a retrospective cohort study was assembled.

Participants: Patients aged 55 years and older with a dementia diagnosis received between 2007 and 2018 (n = 17,235).

Measurements: Recorded sleep disturbance at the time of dementia diagnosis was ascertained using natural language processing algorithms. Multivariate Cox regression models were applied to identify associations with the following adverse outcomes: unplanned hospitalisation, emergency department attendance, mental health crisis care, mortality.

Results: The prevalence of recorded sleep disturbance at the time of dementia diagnosis was 29.0 %. After adjustment for twenty-two different potential confounders sleep disturbance was associated with significantly increased risk of all adverse outcomes (unplanned hospitalisation: adjusted hazard ratio (aHR): 1.06, 95 % confidence interval (CI): 1.01-1.10; emergency department attendance: aHR: 1.09, 95 % CI: 1.05-1.14; mental health crisis care: aHR: 1.58, CI: 1.36-1.84) apart from mortality.

Conclusion: Sleep disturbance at the time of dementia diagnosis is an indicator for a worse prognosis. Preventing and treating sleep disturbance in people with dementia could pose an opportunity to reduce adverse outcomes.

Objectives: To estimate point prevalence of apathy in older adults, examine its overlap with depression and fatigue, and explore its associations with multimorbidity and objective markers of health.

Design: Sydney Memory and Ageing Study, an Australian population-based cohort.

Setting: Community dwellings between 2005-2007.

Participants: 1,030 older adults, without dementia, aged 70-90.

Measurements: Apathy was classified using strict (=3) and standard (≥2) cutoff scores on the self-report Geriatric Depression Scale (GDS)-3A, and a validated cutoff score (>0) on the informant-report Neuropsychiatric Inventory. Depression was assessed with strict and standard cutoffs on the GDS-12D, and fatigue with the Assessment of Quality of Life-6D. Multimorbidity (≥2 chronic conditions; computed with and without cardiovascular conditions), physical performance (walking speed, sit-to-stand, lateral stability, grip strength), adiposity (BMI, waist circumference), blood pressure, cholesterol and glucose were assessed.

Results: Prevalence of apathy on the self-reported measure was 15.8 % (strict cutoff) or 48.9 % (standard). Informant-reported apathy was lower (2.9 %). Prevalence of self-reported depression was 5.9 % (strict cutoff) or 15.8 % (standard), and fatigue 9.8 %. Apathy overlapped very little with depression or fatigue (κ = .18, 95 % CI .14-.21). Apathy was associated with multimorbidity (even when excluding cardiovascular conditions), adiposity, fasting blood glucose level and physical performance, but not blood pressure or cholesterol.

Conclusions: Apathy is more common than depression or fatigue in dementia-free older adults. It does not typically co-occur with these symptoms, but is accompanied by poorer physical health, including multimorbidity and metabolic dysregulation. Apathy may be relevant for public health and an important consideration in clinical care.

Objectives: Cognitive impairment is common in bipolar disorder (BD), especially in older age (≥50 years). Underlying causes of BD-related cognitive impairment are not fully elucidated. This study investigates the association between physical multimorbidity and subjective and objective cognitive performance in patients with older age bipolar disorder (OABD).

Design: Cross-sectional design.

Setting: Dutch Older Bipolars (DOBi) dynamic cohort.

Participants: 170 outpatients with BD aged ≥ 50 years.

Measurements: Chronic physical diseases were assessed in a structured interview. Objective cognitive performance was measured with neuropsychological tests, subjective cognitive performance with the Cognitive Failures Questionnaire (CFQ). Linear regression analyses were performed between multimorbidity, defined as two or more affected physical disease domains, and 1) objective cognitive performance, 2) subjective cognitive functioning, and 3) four cognitive domain scores (attention, learning and memory, verbal fluency, executive functioning). Analyses were hierarchically adjusted for demographic, lifestyle, and psychiatric characteristics.

Results: Multimorbidity was significantly associated with a lower composite cognitive score (B=-0.205, p = 0.040), but after full adjustment statistical significance disappeared (B=-0.044, p = 0.633). Controlled for demographics only, multimorbidity was not significantly associated with higher CFQ (B=6.009, p = 0.053). Multimorbidity was associated with worse executive functioning (B=-0.279, p = 0.018), but statistical significance disappeared after full adjustment (B=-0.085, p = 0.469).

Conclusions: In OABD physical multimorbidity is not independently associated with poorer cognitive performance and subjective functioning. Rather, shared risk factors, such as demographics, psychiatric characteristics, and lifestyle factors might lead to both the presence of physical diseases and worse cognitive performance in OABD.

Late-onset depression (LOD) may indicate the prodromal phase of Lewy body disease (LBD) and is often associated with treatment resistance. However, the relationship between treatment resistance and indicative biomarkers of LBD is still unknown. This retrospective study investigated whether ¹²³I-ioflupane dopamine transporter single-photon emission computed tomography (DaT-SPECT) and ¹²³I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy can predict treatment resistance in hospitalized patients with LOD. The study included 79 inpatients diagnosed with LOD between October 2018 and September 2023 at a geriatric psychiatry ward. DaT-SPECT and MIBG cardiac scintigraphy were used to assess dopaminergic and autonomic function, respectively. Treatment resistance was defined as an inadequate response to antidepressant monotherapy, where cases require electroconvulsive therapy (ECT) analyzed as a distinct group. Logistic regression showed that DaT-SPECT abnormalities significantly predicted nonresponse to antidepressant monotherapy (OR = 4.70, p = 0.013). While oral sensory hallucinations, another clinical marker linked to dopaminergic dysfunction, did not significantly predict treatment response, MIBG cardiac scintigraphy findings enhanced predictive accuracy for severe cases requiring ECT. Additionally, the Cochran-Armitage test indicated that the likelihood of nonresponse to antidepressant monotherapy and the need for ECT increased significantly with a higher number of abnormal LBD biomarkers (z = 7.37, p = 0.007; z = 10.91, p < 0.001, respectively). These results suggest that neurodegenerative processes in the prodromal phase of LBD may contribute to treatment resistance in LOD. The combination of DaT-SPECT and MIBG cardiac scintigraphy improves early identification of treatment resistance, supporting more timely and personalized interventions for hospitalized patients with LOD.

Objective: To analyse the prevalence of depressive symptoms in centenarians, identify their predictors, and explore the role of functional dependence as a contributing factor.

Design setting, and participants: Cross-sectional baseline data from the Swiss Centenarian Study (n = 102), including community-dwelling and institutionalised participants with complete data on depressive symptoms and functional capacity.

Measurements: Functional capacity was assessed using the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Depressive symptoms were measured with the Geriatric Depression Scale - Short Form. Group differences were analysed using Chi-squared tests; relationships were examined with correlations. Multiple linear regressions identified predictors. Mediation analysis explored the interplay between functional capacity, living situation, and depressive symptoms.

Results: Functional capacity varied, with basic activities of daily living generally better preserved than instrumental activities. Almost one-fourth of participants screened positive for possible clinical depression, which was significantly more common among institutionalised centenarians (p < .05). Health conditions, anxiety, and lower functional capacity were significant predictors of depressive symptoms and together explained 24.7 % of the variance, with anxiety being the strongest predictor followed by health conditions and functional capacity. Mediation analysis showed that functional capacity mediated the relationship between living situation and depressive symptoms, highlighting its critical role in mental health.

Conclusions: A significant proportion of centenarians screened positive for depression, underscoring the need for greater attention to depressive symptoms and systematic screening. Targeted interventions promoting functional independence may play an important role to prevent depression, and strategies are needed to encourage institutionalised very old individuals to re-develop and maintain a certain level of independence.

Background: Social connections are important for the quality of life of individuals living with dementia. As dementia progresses, maintaining these connections becomes challenging: especially in nursing homes, social interactions are often reduced. Small-scale, homelike environments such as green care farms (GCFs) may provide opportunities to facilitate social interactions. However, research on the characteristics of social interactions and their effects on mood is limited in these settings. This paper explored social interactions and their impact on mood over time in individuals with dementia living in GCFs.

Methods: This observational study used ecological momentary assessments to gather repeated measurement data on individuals' experiences in everyday environments. The data were collected for a total of 151 residents living at four GCFs in the Netherlands. The residents' social interactions and mood were assessed using the Maastricht Electronic Daily Life Observation Tool (n = 4868 observations).

Results: Social interactions occurred in less than half of the observations, indicating that residents spent the other half of their day without social interactions. The most common interactions included one resident and another person (e.g., staff members or other residents); these interactions were primarily positive. Overall, having social interactions was significantly related to a higher mood. However, social interactions did not have a significant effect on subsequent mood.

Conclusions: The results highlight the importance of social interactions for residents' mood. Long-term care organizations should facilitate opportunities for meaningful social interaction to support the immediate mood and thus the well-being of residents with dementia.

Background: As a highly prevalent and disabling mental health condition among older adults, the epidemiology of depressive disorders could have evolved with global ageing. We aimed to assess the global, regional, and national burdens and trends of depressive disorders among older adults aged ≥ 55 years.

Methods: We retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 on the incidence, prevalence and disability-adjusted life-years (DALYs) of depressive disorders for older adults. Estimated annual percentage changes were calculated to quantify the temporal trends.

Results: In 2021, there were an estimated 93.1 million (95 % UI 80.4-108.5) older adults with depressive disorders globally, representing a substantial increase of 136.1 % from the 1990 estimates. The number of DALYs globally in 2021 was 14.8 million (10.3-20.1) for depressive disorders. The largest increase in DALYs was observed in High-income Asia Pacific, while the largest reduction was in Eastern Europe. In terms of risk factors, the corresponding estimated annual percentage change for intimate partner violence was -0.02 % (-0.11 to 0.07), and for childhood sexual abuse and bullying was -0.22 % (-0.30 to -0.14), from 1990 to 2021.

Conclusions: For three decades, improved health conditions had not resulted in the expected decline in depressive disorders burdens among older adults, highlighting the need for health policy attention, especially in countries with low to medium Socio-demographic Index. It is important to align funding priorities with epidemiological shifts in low- and middle-income countries to mitigate depressive disorders burdens among this population.