Journal of Geriatric Psychiatry and Neurology最新文献

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder marked by α-synuclein aggregation and dopaminergic neuron degeneration in the substantia nigra. Evidence suggests that the leukotriene (LT) pathway contributes to PD progression through oxidative stress and neuroinflammatory mechanisms. Purpose: To evaluate the efficacy and neuroprotective potential of the leukotriene receptor antagonist montelukast in the management of PD. Research Design: A narrative review synthesizing evidence from preclinical and clinical studies investigating the effects of montelukast on PD-related neuropathology. Study Sample: Studies indexed in Scopus, Cochrane, Embase, PubMed, and CENTRAL that examined the role of montelukast in PD models or populations. Data Collection and/or Analysis: Two independent reviewers conducted database searches, screened studies for relevance, and extracted data on montelukast's effects on neuroinflammation, oxidative stress, mitochondrial function, and autophagy. Results: The reviewed evidence indicates that montelukast exhibits neuroprotective activities, including attenuation of neuroinflammation, reduction of oxidative stress, improvement of mitochondrial dysfunction, and enhancement of autophagic processes. These mechanisms collectively contribute to slowing the onset and progression of PD-related neuropathology. Conclusions: Montelukast may offer therapeutic benefits in PD by modulating key pathological processes such as inflammatory signaling, oxidative damage, mitochondrial impairment, and autophagy dysregulation. Further clinical studies are warranted to validate its potential as an adjunct or novel therapeutic option.

Cognitive Stimulation Therapy is a group-based psychosocial intervention for people living with dementia with a solid evidence base. Although Cognitive Stimulation Therapy provision is expanding, its access remains limited, particularly in low- and middle-income countries. To foster dissemination of this intervention, the purpose of the current article is to conduct a systematic review to identify barriers and facilitators that different countries experienced during the adaptation and/or implementation of Cognitive Stimulation Therapy. This was done to understand both shared and context-specific difficulties during these processes. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies describing cultural adaptation and implementation of Cognitive Stimulation Therapy in different countries were included. The databases used for this research were PubMed, Science Direct and PsycInfo. Social connection, emotional support, and spirituality were key facilitators. Stigma, caregiver burden, and lack of awareness about dementia were significant barriers, highlighting the need for culturally sensitive strategies. Cultural influences across different social contexts were crucial for the adaptation and exploration of the efficacy of the program. Lack of knowledge and stigma about dementia reinforce the importance of implementing and enhancing strategies to increase dementia awareness, subsequently encouraging greater uptake of psychosocial interventions.

BackgroundMobility impairments in Parkinson's disease (PD) significantly impact individuals' physical health, independence, and psychosocial wellbeing. In this review, mobility loss is used to refer to altered or impaired mobility (eg, reduced gait, balance difficulties, freezing of gait), rather than a complete loss of mobility. These changes affect daily functioning and quality of life. Carers also experience significant burden as they manage mobility issues. Understanding the implications of mobility loss in PD is essential for improving support for both people with PD and carers. This review explores impact of mobility loss on perceived independence and psychosocial wellbeing in people with PD and carers, providing deeper insight into the broader emotional and social consequences of the condition.MethodsA systematic search of six health databases (Medline, Embase, PsycInfo, CINAHL, Scopus, Web of Science) was conducted using key terms related to mobility loss, independence, and psychosocial wellbeing in PD. Studies were included if they employed qualitative methods to explore experiences of mobility from people with PD and/or carers. The methodological quality of studies was assessed using the NICE qualitative checklist, and reporting adhered to PRISMA guidelines. A meta-ethnographic approach was used to extract key themes and construct a comprehensive understanding of the findings.ResultsFive key themes emerged: the struggle for independence and associated self-esteem, navigating personal relationships, perceived stigmatisation and social isolation, resilience and adaptation, and impact of mobility on carer wellbeing.DiscussionFindings highlight the need for comprehensive support systems that address the challenges of mobility loss in PD. Wearable technology presents a promising solution for personalised interventions. Future research should explore diverse populations of people with PD and include formal carers to develop a more holistic perspective of mobility-related challenges in PD caregiving.

BackgroundCardiovascular medications are commonly prescribed to older adults; however, their potential association with cognitive decline remains poorly understood.ObjectiveThis study aimed to systematically evaluate the relationship between cardiovascular drugs and the risk of dementia.Methods(1) A retrospective disproportionality analysis of the FDA Adverse Event Reporting System data, accessed via OpenVigil 2.1, which examined 97 cardiovascular drugs across 14 therapeutic categories in patients aged ≥60 years, and (2) a literature review of case-reports of drug-induced cognitive impairment.ResultsOf the 97 drugs analyzed, disproportionate reporting signals (indicating more frequent reporting than expected by chance) were identified for 38 (39.2%) across four types of dementia: dementia (13.4%), Alzheimer's disease (16.5%), vascular dementia (18.6%), and dementia with Lewy-bodies (6.2%). ACE inhibitors exhibited the highest signal rate (75.0%). Thirteen case-reports were identified, primarily involving statins (53.8%). Discontinuation of the drug resulted in cognitive improvement in 12/13 cases.ConclusionsThis study identifies disproportionate dementia-related adverse event reporting for nearly 40% of cardiovascular drugs examined, with ACE inhibitors and ARBs showing the highest signal rates. However, these findings are preliminary and require validation through future pharmacoepidemiological studies.

BackgroundDementia care units offer specialized inpatient psychiatric treatment for persons living with dementia (PLWD). Given increasing numbers of PLWD and limited availability of dementia care units, it is crucial to clarify how these units can be used most efficiently.MethodsThe sample included data from 75 unique inpatient psychiatric hospitalizations for PLWD. Data were collected via retrospective chart review. Mixed random and fixed effects longitudinal analyses were run to identify significant predictors of length of psychiatric hospitalization.ResultsPredictors showing significant association included a change in living environment at time of discharge; an ED send out/admission to a general medical hospital; legal pursuits; and diagnostic evaluations pursued during the psychiatric hospitalization.ConclusionsDementia care units are effective in reducing neuropsychiatric symptoms for PLWD. This study highlights avenues for optimization of this care environment to allow for the maximum number of PLWD to receive specialized dementia care treatment.

Neuropsychiatric symptoms (NPS) are very common and associated with high levels of distress, both in dementia patients and their caregivers. Especially at more advanced dementia disease stages, NPS rarely occur in isolation and the presence of two or more NPS may affect disease severity as well as the response to therapy. There is limited quantitative information on prevalence of specific symptom combinations in the general population, as well as in the populations recruited for symptom-specific investigations. We performed cross-sectional analyses of data from two longitudinal studies (Aging, Demographics, and Memory Study (ADAMS) and the National Alzheimer's Coordinating Center data (NACC)). In both studies and all Mini Mental State Examination (MMSE) strata, we observed every possible pair combination, from commonly recognized and discussed associations (e.g., hallucinations and delusions) to what might be seen as rather counter-intuitive patterns (e.g., apathy and agitation). In conclusion, prevalence of symptom pairs cannot be readily predicted based on prevalence of individual symptoms. Further, the presence of cognitive deficit and degree of cognitive impairment is associated with increased prevalence of all symptoms and symptom pairs, albeit to different degrees. The present study illustrates that, while there is the possibility of any combination of neuropsychiatric symptoms presenting during the course of dementia, their co-occurrence cannot be readily predicted based on the prevalence of individual symptoms. Thus, our study results serve as a source of reference information to inform the design and recruitment strategies for future clinical studies and epidemiological research on neuropsychiatric symptoms in people with dementia.

BackgroundThis study assessed the prevalence, characteristics, and contributing factors of violent behaviors in patients with frontotemporal dementia (FTD) as reported by their caregivers.MethodsA nationwide survey was conducted in France targeting caregivers of FTD patients. The survey was disseminated online between July and September 2022 through the French FTD association communications channels. It collected data on the frequency, types and targets of violent behaviors, and associated behavioral and psychological symptoms of dementia (BPSD). Associations between violent behaviors, BPSD, and demographic factors were explored.Results167 answers were analyzed. Violent behaviors were reported in 56.29% of patients with FTD, predominantly verbal (83.2%), often directed at caregivers (68.1%). Factors associated with violence included higher proxy NPI, delusions, agitation/aggression, and irritability scores. Violent behaviors were underreported, with only 48.8% of caregivers having disclosed them to health professionals.ConclusionsViolent behaviors in patients suffering from FTD appear often underreported. Systematic screening during medical appointments is recommended to ensure early intervention and better management.

PurposeDelirium is a common yet preventable complication of hospitalization, surgery and illness that is associated with poor outcomes. Older adults with Alzheimer's Disease and Related Dementias (ADRD) are especially vulnerable to delirium and experience greater delirium severity, yet no existing assessment tool is specifically designed to evaluate this vulnerable population. This study will validate two new delirium severity instruments, the Delirium Severity (DEL-S) rating for all older adults and the Delirium Severity Rating in ADRD (DEL-S-AD) for patients with dementia.Design/Setting and ParticipantsThe Better ASsessment of ILlness II (BASIL II) study is an innovative prospective cohort study that measures cognitive function, delirium, delirium severity, demographics, clinical and functional variables and clinical outcomes. Participants include older adults from 3 unique yet complementary clinical sites: medical inpatients, elective surgery inpatients, or skilled nursing facility residents.MethodsPerformance of DEL-S and DEL-S-AD items in older adults with cognition ranging from no impairment to moderate impairment will be determined. Analyses will include psychometric characteristics of DEL-S and DEL-S-AD items, harmonization of the two scales and validation against reference standard diagnoses.Conclusions and ImplicationsResults from this study will help accurately measure delirium severity, a critically important, graded outcome. The DEL-S-AD instrument holds broad applications in persons with and without ADRD to monitor delirium severity in clinical settings, and as an outcome measure in future clinical treatment trials and pathophysiologic studies. Ultimately, the DEL-S and DEL-S-AD have the potential to improve health care for the vulnerable, growing population of older adults with cognitive impairment worldwide.

BackgroundWe aimed to evaluate the effects of 12 weeks of resistance training (RT) on cardiovascular disease (CVD) risk factors in older women with and without history of depression.MethodsWe included 79 older women, 52 without depression and 27 with a history of depression. 79 participants formed the waitlist control group and were instructed to maintain their habitual routine. The participants were reevaluated and attended 12 weeks of RT. The Beck Anxiety Inventory (BAI) and Patient Health Questionnaire-9 (PHQ-9). The serum levels of high-sensitivity C-reactive protein (CRP), glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density cholesterol (LDL-c), and triglycerides (TG) were used as cardiovascular risk factors. The Linear Mixed Model (LMM) was used to compare between groups.ResultsThe average age of the sample was 69.3 ± 5.7 and the body mass index was 28.5 ± 4.5. The 12 weeks of RT resulted in a reduction in BAI (-3.9 [-7.1; -0.6], P < 0.05) and PHQ-9 scores (-1.4 [-3.2; -0.5] P < 0.05) in the Training group with depressive disorders. In the training group with depressive disorders, it was observed an improvement in TG (-17.1 [-43.0; -8.8]), TC (-18.6 [-35.9; -1.3]), LDL-c (-10.3 [-26.8; -6.2]), and CRP (-0.4 [-1.3; -0.5]). Similar results were found for TG, TC, and LDL-c in the Training group without depressive symptoms. No difference between RT groups was observed.ConclusionOur results suggest that RT is effective in improving CVD risk factors, anxiety, and depressive symptoms in older women with history of depression.

BackgroundSubjective memory complaints (SMC) are common in older adults and may indicate an increased risk of cognitive decline. Polypharmacy and anticholinergic burden have been associated with cognitive impairment, but their specific contribution to SMC remains unclear. The aim of this study was to investigate the association between polypharmacy, anticholinergic burden and SMC in community-dwelling older adults.MethodsThis cross-sectional study included 652 participants aged 65 years and older from geriatric outpatient clinics. SMC was assessed via a structured clinician-administered question, and cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Polypharmacy was defined as the concomitant use of five or more medications, while anticholinergic burden was determined using the Anticholinergic Burden Classification (ABC). Logistic regression models were used to examine the independent effects of polypharmacy and anticholinergic burden on SMC, adjusting for demographic variables, comorbidities and depressive symptoms.ResultsSMC was reported by 48% of participants. Polypharmacy (OR = 2.10, 95% CI: 1.43-3.08, P < 0.001) and higher anticholinergic burden (OR = 2.39, 95% CI: 1.72-3.32, P < 0.001) were independently associated with increased SMC. Chronic obstructive pulmonary disease (COPD) was also identified as a significant predictor (OR = 2.90, 95% CI: 1.41-5.98, P = 0.004).ConclusionPolypharmacy and anticholinergic burden are significant risk factors for SMC in older adults. Reducing unnecessary medication use and minimizing anticholinergic burden may help to alleviate cognitive complaints. Future longitudinal studies are needed to determine causal relationships and possible interventions.