Journal of Geriatric Psychiatry and Neurology最新文献

ObjectiveThis systematic review aims to evaluate recent evidence on interventions for sleep disturbances in dementia, a major clinical concern, with limited pharmacological and non-pharmacological strategies examined in controlled trials.MethodsWe included eight RCTs (N = 666 participants; 2020 - January 2025) in people with dementia and sleep disturbances. Records were identified via MEDLINE, screened using PRISMA-guidelines, and non-randomized or non-intervention studies were excluded. Risk-of-bias was assessed with Cochrane RoB2, and effect sizes (Cohen's d) were calculated in R.ResultsZ-drugs indicated small-large benefits, with eszopiclone significantly improving sleep efficiency and latency. Orexin receptor antagonists indicated mixed evidence, with low-dose lemborexant (2.5 mg) most favorable, meeting benchmarks for nocturnal awakenings. Circadian modulation light therapy was associated with reduced nocturnal awakenings in small trials, while relaxation-based music therapy indicated little to no effect. Social stimulation with PARO indicated increased sleep time and large positive effects on sleep efficiency, despite missing clinical benchmarks.ConclusionsEvidence is limited by sparse reporting and few trials per intervention. Z-drug eszopiclone, low-dose ORA lemborexant, and social stimulation PARO show the most favorable profile across outcomes and benchmarks, but pharmacological options require careful risk-benefit consideration. Non-pharmacological approaches appear safer but under-researched. Future trials should standardize outcomes and tailor strategies to patient needs. No external funding. The review was registered in INPLASY: https://doi.org/10.37766/inplasy2025.1.0097.

IntroductionNeuropsychiatric symptoms are often considered late manifestations of dementia and can be neglected during early clinical assessments. Besides visual hallucinations, less is known about other neuropsychiatric symptoms in mild dementia with Lewy bodies (DLB). We aimed to 1) describe neuropsychiatric symptoms and associated caregiver distress in mild DLB; 2) describe neuropsychiatric symptoms stratified by dementia stage within the included participants.MethodsIndividuals with probable DLB and their caregivers underwent clinical and neuropsychiatric assessments. Clinical Dementia Rating Global Score (CDR-G) of 0.5 (denoting "very mild dementia") was used to stratify the participants into earlier and later stage subgroups. The Neuropsychiatric Inventory (NPI) was used to assess neuropsychiatric symptoms. Median regression was used to estimate the difference in symptom severity and caregiver distress between the subgroups.ResultsFifty participants (age 73.5 ± 5.7 years, 43 males, median mini mental state exam (MMSE) 26 [IQR 23 - 27], median CDR 0.5 [IQR 0.5 - 1]) were enrolled. Twenty-six had earlier and 24, later stage dementia. Neuropsychiatric symptoms were common across both subgroups (96.2% and 95.8% prevalence respectively), with apathy, anxiety and depression being most prevalent (≥50% prevalence). Overall symptom severity was similar between the subgroups, although caregivers of the later stage subgroup reported more distress.ConclusionNeuropsychiatric symptom, especially apathy, anxiety and depression, are extremely common in mild DLB. Assessment of neuropsychiatric symptoms is therefore an essential part of clinical care in DLB, starting from initial presentation. Future studies should consider factors other than symptom severity that contribute to caregiver distress.

BackgroundThis study evaluated the diagnostic value and factorial structure of the Subjective Cognitive Decline Questionnaire (SCD-Q) and the Cognitive Failures Questionnaire (CFQ) in the context of early detection of cognitive decline in a memory clinic setting.MethodsA total of 128 patients were included (AD/MCI: n = 50; non-AD dementia: n = 10; mixed dementia: n = 16; subjective cognitive decline [SCD]: n = 21). Participants completed the modified SCD-Q17 and CFQ and underwent standardized cognitive assessment. Principal component and cluster analyses, regression models, and ROC analyses were used to examine psychometric properties and diagnostic performance.ResultsThe SCD-Q17 correlated with objective cognition (CERAD: r = -0.29 to -0.35, P = 0.023-0.005) and differentiated SCD from mixed dementia (AUC = 0.71). The CFQ primarily reflected executive and attentional failures and showed moderate discrimination for non-AD dementia (SCD vs NADD: AUC = 0.67). Cluster analyses identified 2 profiles (impaired vs unimpaired) for both instruments (κ = 0.47). PCA indicated a more redundant structure for the SCD-Q17, whereas the CFQ showed a broader multidimensional structure.ConclusionsRelative to CERAD performance, both questionnaires distinguished cognitively impaired from unimpaired individuals, but neither provided sufficient precision to classify specific clinical entities.

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.

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.

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.

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.