International psychogeriatrics最新文献

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.

Background: Depression after coronary artery bypass graft (CABG) surgery is common and associated with worse outcomes. The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study evaluates the vascular depression hypothesis, which implicates cerebrovascular disease as a contributor to late-life depression, as applied to a CABG surgery cohort.

Methods: We evaluate whether right or left middle cerebral artery (MCA) stenosis or its severity is associated with a greater risk of post-CABG depression. NOAHS was a prospective study of non-demented patients 40 years of age or older having CABG surgery. Depression was evaluated at baseline and monthly after surgery to 12 months. Transcranial Doppler (TCD) assessed intracranial atherosclerosis at baseline. We examined whether MCA stenosis predicted new-onset depression, adjusting for baseline characteristics.

Results: In our sample (n = 148, average age 66.1, 75.7 % male), 11 % had baseline depression and 26 % had mild cognitive impairment (MCI). Perceived psychosocial support was high, with a mean score of 82.7 of 100 on the Medical Outcomes Study social support survey. Excluding those with baseline depression, 13 (16 %) developed new-onset depression. New-onset depression was associated with younger age, greater baseline functional impairment, lower perceived psychosocial support, MCI status, and prior depression. MCA stenosis and its severity was not associated with new-onset depression in any model; however, lower perceived psychosocial support did predict new-onset depression.

Conclusions: We did not find an association between baseline MCA stenosis and new-onset depression after CABG. Instead, well established risk factors including lower perceived social support were more strongly associated with post-CABG depression.

Background: Adverse Childhood Experiences (ACEs) have long-term effects on health, but the mechanisms remain unclear.

Objective: To investigate the association between ACEs and health status, exploring the potential mediating roles of activities of daily living (ADL) and chronic diseases.

Participants and setting: 9575 middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: Longitudinal analysis of 4 waves (2013-2018) data. ACEs were derived from 2014 self-report life history survey. Latent growth curve modeling assessed the mediating effect of ADL and chronic diseases on the relationship between ACEs and self-rated health (SRH).

Results: Among the 9575 individuals (mean [standard deviation, SD] age, 58.12 [8.73] years; 5174 [54.04 %] were females), the average ACEs score was 2.27 (SD = 1.75). Individuals with higher ACEs reported lower baseline SRH (β = -0.156, P < .001) and greater decline over time (β = -0.075, P < .001). Mediation analysis indicated that both baseline and longitudinal changes in ADL and chronic diseases (intercept and slope) partially mediated the association between ACE and the intercept of SRH, while ADL (intercept and slope) and chronic diseases (slope) fully mediated the association between ACE and the slope of SRH.

Conclusions: ACEs were associated with poorer health status and accelerated decline, partially mediated by impaired ADL and increased chronic diseases. Interventions targeting ACE reduction, enhancing ADL, and managing chronic diseases could effectively improve the health of middle-aged and older adults.