Journal of Geriatric Psychiatry and Neurology最新文献

BackgroundOur aim is to evaluate the intricate dynamics of gender differences in cognitive rehabilitation outcomes among older adults with MS undergoing cognitive rehabilitation using robotics plus virtual reality.MethodsThis retrospective study included 80 RRMS patients aged >60 years, matched for demographic and clinical variables and divided into two groups. The experimental group (EG, n = 40) received Lokomat Free-D training with VR integration, while the control group (CG, n = 40) underwent traditional rehabilitation. Cognitive, functional, and emotional outcomes were assessed before and after treatment.ResultsIntergroup analysis revealed significantly greater improvements in the EG compared to the CG in MoCA (P < 0.001 in males, P = 0.001 in females), FIM (P = 0.02 in females), and HRS-A (P = 0.01 in males, P = 0.005 in females). Within-group analyses showed that both males and females in the EG experienced significant improvements across all domains (P < 0.001), but in the CG, improvements were more limited, particularly in mood scores. Notably, a positive correlation between MoCA and gender was found in EG (r = 0.47; P = 0.002), suggesting stronger cognitive gains among women.ConclusionOur results provide preliminary data on the influence of gender differences on neurological rehabilitation outcomes, which should be evaluated and taken into due consideration to personalize and improve rehabilitation treatment.

IntroductionIndia's geriatric population is projected to reach 319 million by 2050, reflecting the global aging trend. Cognitive impairment significantly impacts the quality of life of older adults. Anthropometric measures serve as accessible indicators of nutritional status and body composition with potential associations with cognitive function. This study investigates the relationship between anthropometric measures and cognitive abilities using the Indian Council of Medical Research (ICMR)-Multilingual Dementia Research and Assessment (MUDRA) Toolbox among geriatric populations in Gorakhpur, Uttar Pradesh.MethodsThis cross-sectional study enrolled 1013 participants aged 60 years and above from 7 randomly selected administrative blocks in Gorakhpur. Cognitive assessment was performed using the ICMR-MUDRA Toolbox, evaluating global cognition, attention, executive functioning, episodic memory, language, and visuospatial abilities. Anthropometric measurements included height, weight, BMI, waist circumference, hip circumference, Waist-to-Hip Ratio (WHR), and Mid-Upper Arm Circumference (MUAC). Statistical analysis included Spearman rank correlation and binomial logistic regression.ResultsSignificant positive correlations were observed between MUAC and cognitive domains of the MUDRA toolbox. Conversely, WHR demonstrated significant negative correlations with the domains (P ≤ 0.05). Participants with moderate-risk WHRs had higher odds of impairment in attention/executive function (aOR = 1.79), memory (aOR = 1.69), and visuospatial function (aOR = 2.50), while high-risk WHRs were associated with greater impairment in memory (aOR = 2.18) and language (aOR = 2.21).ConclusionThis study reveals significant relationships between anthropometric measures and cognitive function in the geriatric population, with MUAC positively correlating with cognitive performance while WHR demonstrating negative correlations. The findings indicate that central obesity may be a particular risk factor for cognitive decline.

Alzheimer's Disease (AD) is the most common dementia, affecting mainly older adults, particularly over 65. Characterized by progressive cognitive decline-including deficits in memory, executive functions, and language, alongside behavioral disturbances-AD arises from complex pathophysiological mechanisms. These include neurotransmitter imbalances, cholinergic deficits, amyloid-beta (Aβ) toxicity, tau protein hyperphosphorylation, oxidative stress, synaptic dysfunction, and neuroinflammatory processes. Growing evidence highlights the protective role of microglia in AD pathology through their immune functions, phagocytic clearance of Aβ proteins, and trophic support to promote tissue repair and maintain cerebral homeostasis, as alterations in their response to Aβ are linked to an increased risk of AD. However, disruptions in homeostasis or tissue alterations may trigger microglial activation, leading to detrimental effects such as increased inflammatory activity, impaired microglial-mediated clearance, synapse loss, and neuronal damage. Astrocytes, a distinct type of glial cell with homeostatic functions, also exhibit neuroprotective effects. However, the presence of Aβ may result in astrocyte reactivity, leading to neurotoxic effects associated with disturbances of calcium levels, activation of proinflammatory pathways, gliotransmission, altered tau metabolism, and impaired clearance of Aβ. Despite substantial research, AD remains challenging to diagnose early and lacks effective treatments. Given its multifactorial nature, therapeutic approaches primarily aim to slow progression and remain limited in achieving a definitive cure. While most current strategies focus on mitigating the toxic effects of Aβ and tau proteins, growing interest has emerged in addressing neuroinflammation as a potential means to delay or prevent neurodegeneration. Targeting neuroinflammation could open new therapeutic avenues for the treatment of AD.

PurposeThis study examined relations between four late-life depression subgroups (recent, >2 years ago, chronic, no depression) and regional brain volumes using structural MRI data from the National Alzheimer's Coordinating Center (n=1,551).Data AnalysisMultiple linear regressions evaluated the effects of depression on 30 MRI biomarkers, while moderation analyses assessed how APOE ε4 and depression shape the connections between cognitive status and brain structure volumes.ResultsAfter adjusting for covariates and applying Hochberg's method, recent depression (< 2 years) was associated with reduced total cerebrum cranial volume and left frontal lobe cortical gray matter volume. Chronic depression correlated with larger right lateral ventricle volume.ConclusionThese findings suggest that recent depression is linked to brain atrophy across specific regions and ventricular enlargement. Future research should investigate age-related impacts on these associations and whether restoration of brain volume occurs after depressive symptoms subside.

BackgroundBody pain is common among older adults who often experience comorbid depressive symptoms and cognitive impairments. This study examined differences in depressive symptoms and cognitive functions between older adults distressed with body pain and those without pain and explored symptom interrelationships in the pain-distressed group.MethodsData from the 2020 China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale-10 (CESD-10). Cognitive function was evaluated using standardized measures. Network analysis identified both central and bridge symptoms in the pain group.ResultsThis study included 3938 participants of whom 1969 comprised the group distressed by body pain. Depressive symptoms were more prevalent among those with body pain (39.1%; 95% CI: 36.95%, 41.25%]) compared to controls (21.4%; 95% CI: 19.59%, 23.21%], P < 0.01). Conversely, cognitive function scores did not differ between the two groups. In the network model for the pain-distressed group, "feeling depressed" (CESD3) was the most central symptom (strength = 1.01), followed by "everything was an effort" (CESD4) (strength = 0.98) and "inability to get going" (CESD10) (strength = 0.88). "Orientation" (Bridge strength = 1.44) was the most influential bridge symptom linking depressive symptom and cognitive function communities, followed by "memory" (Bridge strength = 1.13) and "attention" (Bridge strength = 0.72).ConclusionFindings highlighted a higher prevalence of depressive symptoms among older adults with body pain compared to their pain-free peers. Results suggest interventions targeting key central and bridge symptoms warrant consideration in future treatment studies.

BackgroundDiscussing pharmaceutical treatment for dementia is challenging because of variation in disease progression, lack of curative treatments, and communication difficulties. Research in the context of dementia suggests shared decision making is limited, this study examined how dementia medications are discussed in practice.MethodsFocused video/audio ethnography of clinical appointments (n = 14), semi-structured interviews with patients/supporters (n = 23) and clinicians (n = 5) were employed to examine communication practices.ResultsTwo themes developed; Framing and understanding of information in the context of uncertainty explores how uncertainties around risks and benefits are understood. 'Not worth the risk' or 'nothing to lose' presents how patients/supporters and clinicians balance individuals' contexts/perceived risks/benefits. In the absence of certainty around potential benefits, risk often informed decision-making, particularly for frailer or more vulnerable patients.ConclusionsClinicians should be aware of their influence on decision-making and be cognisant of the way that they frame opinions, which are largely based on clinical experience. Prescribers would benefit from a standardised information source which enables them to describe the likelihood and magnitude of benefits and side effects in a universal way. Accessible information for patients and relatives about the same is also recommended. Patients and relatives make their decisions to take medications in the context of relative uncertainty about the likelihood of benefits, with risk playing a pivotal role in decision making for some.

Clinical staging may provide a valuable alternative to the limitations of categorical diagnostic models like the DSM-5 for mental disorders. However, research on the clinical utility of staging models on mental disorders is limited, particularly in comparison to the DSM-5, which hinders the implementation of staging models in clinical practice. The limitations of categorical models are even more pronounced in older adults, as personality disorders (PDs) may manifest differently later in life, potentially leading to over- or underdiagnosis when relying on the DSM-5.AimThis study compared the clinical utility of a clinical staging model (CSM) with the DSM-5 for diagnosing PDs in older adults from the perspective of clinicians.MethodThirty-four Dutch participants, including psychiatrists, geriatricians, psychologists, and psychiatric nurse practitioners (PNP), completed an online questionnaire featuring an introduction to the CSM and the assessment of 2 fictional vignettes. Each vignette represented different stages of PDs and was evaluated using both the CSM and the DSM-5. Participants rated their experiences across 6 domains for both models.ResultsThe clinicians rated the clinical utility of the CSM significantly higher than that of the DSM-5 across all domains, with 55.9% preferring the CSM, 32.8% opting for both models, and 11.8% preferring the DSM-5 in clinical practice.ConclusionsThese findings suggest that the CSM may be a valuable addition to the diagnosis of PDs in older adults. This highlights the need for further research into its clinical application and the general utility of staging models.

ObjectiveSubjective cognitive complaints (SCC) are often conceptualized as a risk factor for objective cognitive decline predominantly due to neurodegenerative diseases, however, they can be associated also with other psychiatric or somatic conditions. The study on healthy older adults aims to examine complex associations between SCC, cognitive performance, somatic, and psychiatric symptoms, using network analysis.Method154 participants older than 65 years (mean age 74.47 SD = 6.76, 58% females) were assessed with a comprehensive neuropsychological battery, including self-report measures on SCC, somatic symptoms, symptoms of anxiety, and depression. SCC were measured by the Multifactorial Memory Questionnaire (MMQ). Data were analyzed using a network analysis. Gaussian Graphical Modelling was used for network visualization.ResultsMMQ subscale Ability was negatively associated with cardiopulmonary, gastrointestinal and fatigue symptoms, whereas Satisfaction subscale was associated with pain. All subscales were associated with the measure of anxiety symptoms. Depression was negatively associated with the Satisfaction and Ability scale, the first association being stronger.ConclusionThe study provides novel insights by taking into account different aspects of SCC and analyzing mutual relationships of several variables. SCC formulated as memory failures are associated with higher levels of somatic symptoms. Negative emotions towards the memory are associated with depression symptoms. The explanation behind these complex relationships may include pathophysiological mechanisms. Differentiation between different forms of SCC may help to navigate the further diagnostic procedures in clinical practice.

ObjectivePsychosis is a significant neuropsychiatric symptom in Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI). While female APOE4 homozygotes are at the highest risk of psychosis, mechanisms underlying this association remain unclear. We investigated whether epigenetic age acceleration (EAA) is associated with psychosis in individuals with AD and MCI, and whether this association varies by sex and APOE4 status.MethodsParticipants with clinical MCI or AD were drawn from the Alzheimer's Disease Neuroimaging Initiative database. EAA was calculated from DNA methylation data using the PhenoAge epigenetic clock, with the Horvath and Hannum clocks included for comparison. Psychosis status was defined as experiencing hallucinations or delusions at any time, based on the Neuropsychiatric Inventory Questionnaire. Logistic regression models were used to assess associations between EAA and psychosis, including three-way interactions with sex and APOE4 carrier status.ResultsAmong 418 total participants (54 with psychosis, 84 female APOE4 carriers), EAA was not associated with psychosis for any of the 3 clocks utilized. However, a significant three-way interaction between sex, APOE4 carrier status, and PhenoAge EAA in predicting psychosis was observed (P = 0.013). Elevated PhenoAge EAA was associated with higher odds of psychosis in female APOE4 carriers (OR = 1.76 per 5-year, P = .025), whereas no associations were observed for other subgroups or clocks.ConclusionsPhenoAge EAA may serve as a novel biomarker of psychosis among female APOE4 carriers. These findings highlight the potential of second-generation epigenetic clocks for early risk stratification and biological investigations into psychosis in AD and MCI.

Physical frailty is associated with adverse health outcomes in older adults, including cognitive decline; however, the underlying biological and pathophysiological mechanisms linking frailty to neuropathological biomarkers remain underexplored, particularly in older adults without dementia. This study examined associations between physical frailty and cognitive performance and biomarkers based on the amyloid, tau, and neurodegeneration (ATN) framework in a sample of community-dwelling older adults without dementia. Using baseline data from a randomized controlled trial, we conducted a secondary cross-sectional analysis of 137 sedentary adults aged 60-85 years with insomnia symptoms and Montreal Cognitive Assessment scores above 17. Frailty was measured using the Johns Hopkins Frailty Assessment Tool. Cognitive performance was assessed with the CogState computerized battery, and plasma biomarkers-including amyloid beta 42/40 ratio (Aβ42/Aβ40), total tau (t-tau), and neurofilament light chain (NfL)-were quantified using Single Molecule Array (Simoa) technology in a subsample (n = 98). In adjusted models, frail participants demonstrated significantly lower global cognition, processing speed, and attention compared to robust individuals. Prefrail participants did not show significant differences in cognitive performance. For biomarkers, prefrail individuals had significantly lower Aβ42/Aβ40 ratios in unadjusted models, and frail individuals showed significantly higher NfL levels in adjusted models. No significant associations were found for t-tau. These findings suggest that physical frailty is linked to both cognitive impairment and early neurobiological changes in older adults without dementia. Incorporating frailty assessments alongside biomarker evaluation may enhance early detection of Alzheimer's-related changes and guide timely interventions to mitigate cognitive decline.