International psychogeriatrics最新文献

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.

An emerging body of work suggests that financial exploitation vulnerability (FEV) may be an early marker of Alzheimer's disease (AD). We examined how APOE e4 genotype and cognition at baseline interact to predict subsequent FEV one year later. Participants were 95 older adults without dementia aged 50 or older (M age = 69.09, SD = 7.51; 72.63 % female; 72.63 % White non-Hispanic). Participants completed two annual assessments that included comprehensive neuropsychological testing and a measure of FEV. Saliva samples for APOE genotyping were collected. Linear regression models regressed Year 2 FEV on APOE, global cognition, and their interaction. Age, sex, education, and Year 1 FEV scores were covaried. Models were re-run considering cognitive domains separately (memory, language, and attention/working memory and executive functioning). Main effects of APOE and cognition were not found. However, cognition and APOE status interacted to predict Year 2 FEV. Specifically, worse cognitive functioning predicted higher FEV only for e4 carriers. Cognitive domain analyses revealed more nuanced relationships. Findings suggest that cognition is a relevant risk factor of FEV for e4 carriers, and support the emerging idea that FEV may be an early marker of AD-related neuropathological changes.

We read with considerable interest the article by Beunders et al. (2025) titled "Physical multimorbidity is not independently associated with cognitive performance in patients with older-age bipolar disorder (OABD)" published in International Psychogeriatrics. The study addresses an important and underexplored area, highlighting the complex interplay between multimorbidity and cognition in OABD. While the authors conclude that physical multimorbidity is not independently associated with cognitive impairment after adjustment for confounders, we believe some methodological and conceptual aspects warrant further reflection.

Background: Electroconvulsive therapy (ECT) is one of the most effective options for severe psychiatric disorders. However, it is often underutilized due to stigma and fear of cognitive side effects. This is the first systematic review and meta-analysis synthesizing the currently available evidence regarding ECT exposure and dementia risk.

Methods: We included observational studies assessing the risk of developing dementia after ECT exposure or its incidence among ECT-treated patients to July 2025. Adjusted hazard ratios (HR) were pooled using a random-effects model.

Results: Six observational cohort studies encompassing 286,995 patients, predominantly with affective disorders, were included. 9124 of the patients were exposed to ECT while 277,871 patients were not treated with ECT. Follow-up durations ranged from a median of 4.9-16.9 years, and the weighted mean baseline age was ∼51 years. Meta-analysis revealed no statistically significant association between ECT exposure and the overall risk of dementia (HR = 0.98, 95 %CI [0.79, 1.21], P = 0.83, I² = 67.1 %, very low certainty). Sensitivity analysis showed a marginally lower risk after excluding one study (HR = 0.87, P = 0.045). In older adults (>50 years; 112,842 patients), ECT was associated with a significantly lower risk of dementia (HR = 0.78, 95 %CI [0.69, 0.88], P < 0.001, I²= 0 %, moderate certainty).

Conclusion: The study provides preliminary insights on the long-term cognitive safety of ECT. ECT was not associated with increased risk of dementia in patients with affective disorders and was associated with lower risk among older adults. More studies are needed to confirm our results, particularly with proper adjustment for potential confounders.

Background: Little is known about the psychosocial pathways linking social support to health-related quality of life (HRQoL) in family caregivers of people with dementia (PwD). This study aimed to explore how self-efficacy and caregiver distress mediate the relationship between social support and caregivers' HRQoL.

Methods: This study utilized baseline data from a randomized controlled trial involving 266 Chinese dementia caregivers recruited from China and Australia. Four self-report scales were used: the Chinese version of the Carers of Older People in Europe Index-Quality of Social Support, the Revised Scale for Caregiving Self-efficacy, the Revised Memory and Behavior Problem Checklist and the 12-Item Short-Form Health Survey. Structural equation modeling was conducted using AMOS 26.0 to examine the mediating roles of self-efficacy and caregiver distress in mediating the relationship between social support and HRQoL.

Results: Social support was significantly associated with HRQoL. It also indirectly predicted physical HRQoL through caregiving self-efficacy (β = 0.062) and caregiver distress (β = 0.070), accounting for 38.88 % of the total effect. Besides, social support indirectly predicted mental HRQoL through self-efficacy (β = 0.182) and caregiver distress (β = 0.041), contributing to 58.1 % of the total effect. Self-efficacy and caregiver distress functioned as sequential mediators in this association.

Conclusion: Social support was positively associated with HRQoL, both directly and indirectly, through the serial mediating role of self-efficacy and caregiver distress among family caregivers of PwD. Our findings highlight the importance of providing psychosocial interventions to improve HRQoLfor dementia caregivers.

Background: Bipolar disorder is a lifelong mental disorder. Late diagnosis increases treatment difficulty and costs, and age-related decline in liver and kidney function may affect drug metabolism and efficacy. This study assesses the global disease burden, geographical distribution, influencing factors, and future trends from 1990 to 2021.

Methods: Data from the GBD 2021 were used to evaluate age-standardized incidence, prevalence, and DALYs for bipolar disorder, and analyze influencing factors. Temporal trends were analyzed using Joinpoint regression, while future trends were projected with Bayesian Age-Period-Cohort models. Spatial distribution was assessed via cold-spot and hot-spot analyses.

Results: From 1990-2021, the incidence, prevalence, and DALYs of bipolar disorder in individuals aged 60 and older in H-SDI regions were significantly higher than those in L-SDI regions (P < 0.05), with H-SDI regions showing a declining trend, while the increase in these factors in L-SDI regions was substantially greater than in H-SDI regions (P < 0.05). Although the incidence peaks at ages 15-19, the economic burden and prevalence gradually shift towards older adults, with the peak moving from the 20-24 age group to 25-29, and a significant increase in prevalence and DALYs among individuals aged 25 and older in middle and lower SDI regions. By 2021, the spatial dimension of substance abuse and child abuse showed improvement, particularly in Australia and New Zealand, while alcohol abuse in Russia rose to 235.89. Cold-spot and hot-spot analysis highlighted the contraction of cold spots and the expansion of hot spots, especially in Central Africa and the Mediterranean region. Future projections, based on current trends and models, suggest a slight decrease in global disease burden by 2030, with a more significant reduction for males.

Conclusions: By 2021, both spatiotemporal trends show signs of deterioration, with significant regional and gender differences. Although projections indicate a decline in disease burden in the future, current focus should remain on the intergenerational impact of child abuse on mania, the accumulation of disease burden among the older adults and the phenomenon of alcoholism in high-latitude regions such as Eurasia.

Background: Depression in older adults often goes undiagnosed due to subtle symptoms. Physical performance tests, established health markers, may help assess links between mental and physical health. This study examined 7-year changes in Geriatric Depression Scale (GDS) scores in relation to physical performance, considering sex differences.

Methods: Data were from the Progetto Veneto Anziani (Italians ≥65). Baseline measures included physical performance (handgrip, gait speed, chair-stand test), GDS, and inflammatory status (assessed via fibrinogen, ESR, and WBC). Hippocampal atrophy was evaluated in 759 subjects using temporal horn and interuncal distance. After 7 years, physical performance and GDS were reassessed. Linear mixed models examined GDS changes over time relative to performance.

Results: Among 1429 participants (mean age 73.4; 794 women), handgrip, gait speed, and chair-stand test were associated with GDS at baseline, independent of inflammation. Higher gait speed (B = -4.33; 95 % CI -8.23 to -0.43; p = 0.03) and poorer chair-stand performance (B = 8.15; 95 % CI 4.84-11.46; p < 0.001) were associated with higher GDS scores over follow-up. In sex-stratified analyses, only the chair-stand test remained significant in both men (B = 7.52; p = 0.003) and women (B = 8.30; p < 0.001). In the MRI subgroup, among participants with hippocampal atrophy below the median, time interactions were significant for handgrip strength and the chair-stand test. With atrophy above the median, time interactions were not significant, but the chair-stand test showed a significant main effect (B = 11.61; p = 0.04). By sex, the chair-stand test was associated with GDS in women irrespective of atrophy status, while it did not reach significance in men with high atrophy.

Conclusions: Physical performance measures are associated with GDS scores. While this relationship warrants further exploration, monitoring physical function may serve as a valuable intervention target for improving mental health in older adults.