International psychogeriatrics最新文献

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.

Background: Diagnostic criteria for apathy in neurocognitive disorders (DCA-NCD) have recently been updated.

Objectives: We investigated whether validated scales measuring apathy severity capture the three dimensions of the DCA-NCD (diminished initiative, diminished interest, diminished emotional expression).

Measurements: Degree of mapping ("not at all", "weakly", or "strongly") between items on two commonly used apathy scales, the Neuropsychiatric Inventory-Clinician (NPI-C) apathy and Apathy Evaluation Scale (AES), with the DCA-NCD overall and its 3 dimensions was evaluated by survey.

Design: Survey participants, either experts (n = 12, DCA-NCD authors) or scientific community members (n = 19), rated mapping for each item and mean scores were calculated. Interrater reliability between expert and scientific community members was assessed using Cohen's kappa.

Results: According to experts, 9 of 11 (81.8%) NPI-C apathy items and 6 of 18 (33.3%) AES items mapped strongly onto the DCA-NCD overall. For the scientific community group, 10 of 11 (90.9%) NPI-C apathy items and 7 of 18 (38.8%) AES items mapped strongly onto the DCA-NCD overall. The overall mean mapping scores were higher for the NPI-C apathy compared to the AES for both expert (t (11) = 3.13, p = .01) and scientific community (t (17) = 3.77, p = .002) groups. There was moderate agreement between the two groups on overall mapping for the NPI-C apathy (kappa= 0.74 (0.57, 1.00)) and AES (kappa= 0.63 (0.35, 1.00)).

Conclusions: More NPI-C apathy than AES items mapped strongly and uniquely onto the DCA-NCD and its dimensions. The NPI-C apathy may better capture the DCA-NCD and its dimensions compared with the AES.

Objectives: Quilombos are settlements founded by descendants of runaway enslaved populations in Brazil, and often present social vulnerabilities, high levels of illiteracy, and limited health access. The Quilombola population likely presents an increased risk for dementia; however, it is underrepresented in aging research. This study aimed to investigate the association between cognition and social participation, which remains unclear in underserved communities.

Methods: This cross-sectional study was conducted in 11 Quilombola rural underserved communities in Brazil. The study comprised 221 older adults (60-104 years). Participants completed a health survey and a cognitive screening. Demographics, cardiovascular risk factors, mood, cognition, and social participation were assessed. Regression models examined the association between social participation and cognition, accounting for demographics and health measures. Our models also examined the moderation role of age and sex.

Results: Higher social participation was associated with better cognition (p < 0.001) above and beyond demographics, functional capacity, mood, and a cardiovascular risk factor (waist-to-hip ratio). The social activity that mostly drove the result was attending "religious/faith services". Age and sex did not moderate the associations.

Conclusion: Our findings extend the scope of the potential protective role of social participation for cognitive health to socially vulnerable contexts. In a disadvantaged context, social participation may be a crucial aspect for promoting cognitive and brain health. We hypothesize that social participation may provide not only cognitive stimulation and emotional support, but also facilitate access to the community's needs (e.g., health services). The results are limited by the cross-sectional design and survival bias, which restrict the interpretation of causality, although they may inform future research in underserved populations.

Humanity is undergoing a profound demographic transition, with older adults representing a growing share of society. This late stage of life not only prompts profound reflections on the meaning of life and the inevitability of death, but is also associated with a higher occurrence of certain non-ordinary experiences - such as end-of-life experiences (ELEs), after-death communications (ADCs), and near-death experiences (NDEs). These experiences evoke deeper questions about death itself, the nature of dying, and the essence of who we are. This commentary emphasizes the significance of acknowledging the high prevalence of these phenomena during aging and offers a concise overview of the available evidence on the topic. It concludes by providing a perspective that is open to non-physicalist views, framing late life and dying not as a mere fading away, but as a vital and potentially transformative stage of human experience. A stage rich with meaning, transformation, and opportunities for connection for those living it, their families, healthcare professionals, and researchers.

Background: Impaired decision-making (DM) under uncertainty in mild cognitive impairment (MCI) increases financial vulnerability and suboptimal medical decision-making OBJECTIVE: This two-year longitudinal study characterized DM changes in MCI and identified modifiable cognitive correlates for functional preservation.

Methods: Fifty-two MCI and 49 cognitively normal (CN) participants underwent annual Iowa Gambling Task (IGT), modeled via Outcome-Representation Learning (ORL) to quantify reward/punishment learning rates (A_rew/A_pun), memory decay (K), and win/deck perseverance (β_F/β_P). Concurrent neuropsychological assessments measured six domains.

Results: MCI patients showed progressive failure to learn from penalties (ΔA_pun: 0.00 vs. 0.02, p = 0.047), inability to adapt choice strategies (ΔK: 0.01 vs. -0.35, p < 0.001), and accelerated loss of cognitive flexibility (Δβ_F: -0.60 vs. 0.16, p = 0.013). Network analysis identified declining social cognition (strength=1.97) and executive function (1.87) as core cognitive drivers of DM deterioration. Regression linked ∆attention to ΔA_pun (R² = 0.15, p = 0.019) and Δβ_F (R² = 0.12, p = 0.024), and ΔSocial cognition to DM-related memory system dysregulation (ΔK: R² = 0.26, p = 0.001).

Conclusions: MCI involves clinically significant DM disintegration, primarily attributable to executive-social network collapse rather than memory decline. Our findings highlight the critical role of attentional control and socioemotional processing deficits in functional impairment, suggesting that targeted interventions-such as metacognitive strategy training and emotion recognition therapy-represent promising approaches for potentially mitigating real-world functional risks.

Objective: This study aims to explore individual- and country-level factors associated with loneliness' transitions and estimate total life expectancy (TLE) and lonely life expectancy (LLE) at age 60 across 24 countries.

Design: This is a longitudinal study.

Setting: Data were drawn from five harmonized multinational cohorts.

Participants: This study included 61,511 older adults aged 60 and above MEASUREMENTS: A multistate Markov model was used to estimate the life expectancy of older adults in states of loneliness and non-loneliness, and factors associated with the state transition probabilities.

Results: Female, low education, multimorbidity, and psychological disorders were associated with higher risk of transitioning from "Not lonely" to "Lonely", while physical activity was linked to recovery. Beyond individual-level factors, high GDP, civil society participation, and accessible public transport were linked to lower loneliness risk. However, civil society participation and transport access had limited effects on mortality. TLE for older adults aged 60 was 23.14 years, with a LLE of 4.31 years. Older adults in high-GDP countries had a 1.25-year longer TLE and a 2.40-year shorter LLE. Greater civil society participation was linked to a 0.75-year increase in TLE and a 2.78-year reduction in LLE. In contrast, higher urbanization was associated with a slightly longer TLE but a higher LLE. Public transport accessibility correlated with a significantly reduced LLE by 1.97 years.

Conclusions: This study highlights the longitudinal associations between individual behaviors, socioeconomic factors and loneliness, offering valuable insights for promoting healthy aging globally.

Introduction: Psychosis is frequently observed in patients with neurodegenerative disease and may precede onset of cognitive symptoms. Additionally, the presence of psychosis in neurodegenerative disease is often associated with adverse effects including increased progression of cognitive decline and conversion to dementia, increased caregiver burden, and increased rates of placement in long-term care. Moreover, existing pharmacological treatments, which consist principally of off-label antipsychotic medications, may be associated with increased risk of harm, making management of symptoms challenging.

Objective: We review recent advances in the field of psychosis in neurodegenerative disease, including advances in clinical criteria, biomarkers (neuroimaging, pathology, and genomic and epigenomics), and treatments.

Method: Under the direction of the International Psychogeriatric Association (IPA), a task force comprised of experts in the field of psychosis in neurodegenerative disease was convened. An in-person meeting was organized in September 2024, coincident with the annual IPA Congress. The task force undertook a review of the literature in the areas of clinical care, biomarkers, and treatment, from which key recommendations for the management and future investigation of psychosis in neurodegenerative disease were derived.

Results: It was concluded that psychosis in neurodegenerative disease has a characteristic phenomenology that despite sharing some features with schizophrenia spectrum psychotic disorders, may differ in other clinically meaningful aspects. Etiopathogenesis based on biomarker, genomic, and treatment studies may differ to some extent among neurodegenerative diseases. There is emerging evidence supporting the use of prescriptive non-pharmacological (WHELD intervention) and novel pharmacological (pimavanserin, muscarinic agonists) approaches in the treatment of psychosis in neurodegenerative disease.

Conclusion: Future directions include the need for the implementation of evidence-based nonpharmacological treatments consistent with the aims of precision medicine, further investigation into novel pharmacological agents, mapping specific psychotic symptoms to specific biomarkers, and further exploration of the link between psychosis in neurodegenerative disease and other late-life psychoses.

Background: Early detection of Alzheimer's disease (AD) is crucial in the era of disease-modifying therapies (DMTs). While amyloid positron emission tomography (PET) is an important approach for detecting amyloid pathologies, the high cost and limited availability of this method have led to challenges in community-wide screening. Electroencephalography (EEG) is a low-cost, noninvasive method that may help to bridge this gap. Previous studies have suggested that certain EEG features, including phaseamplitude coupling (PAC), could reflect AD-related network abnormalities; however, it remains unclear whether PAC can serve as a reliable predictor of amyloid pathology.

Methods: We analyzed resting-state EEGs from 61 participants with mild cognitive impairment (MCI) who underwent amyloid PET scans: 28 were PET-positive, and 33 were PET-negative. We examined PAC (synchronization indices) between low-frequency (delta, theta, alpha, beta) and high-gamma (70-100 Hz) activities. A naïve Bayes classifier with a stratified 10-fold cross-validation was used to predictor amyloid PET status.

Results: Theta-high gamma PAC was lower in the PET-positive group, particularly at the posterior (P3) and occipital (O2) electrodes (p < 0.05). The classifier trained on the theta-high gamma PAC achieved a mean balanced accuracy of 64.6 % (95 % confidence interval = 0.599-0.693), which was significantly greater than chance, whereas the other bands were not predictive.

Conclusions: Theta-high gamma PAC in resting-state EEG can distinguish amyloid PET-positive patients with MCI from PET-negative patients, thereby providing a feasible, noninvasive biomarker for AD pathology. Integrating PAC analysis into routine EEG could improve the early identification of individuals who qualify for DMTs, thereby facilitating timely intervention.