Journal of Geriatric Psychiatry and Neurology最新文献

Background: Subjective cognitive decline is considered one of the earliest signs of Alzheimer's disease (AD), making early detection crucial for disease-modifying treatments to have the greatest impact. The CogScreen study, supported by the Davos Alzheimer's Collaborative Healthcare System Preparedness Program, evaluates tools for community-based screening of AD in its early stages. This study investigates subjective experiences, focusing on motivations, concerns, and potential improvements regarding digital tools used in cognitive assessments.Methods: Semi-structured qualitative interviews were conducted with a random selection of 28 participants with subjective cognitive decline or healthy controls. Interviews were transcribed and analyzed using conventional content analysis (MAXQDA, VERBI Software, 2024). Results: Analysis identified emergent themes related to the usability of digital tools, the importance of clear communication, and the desire for a more personalized research experience. Participants highlighted motivations and concerns regarding the implementation of digital assessments. Discussion: Findings support the feasibility of integrating digital assessments in aging populations and underscore the importance of addressing participants' motivations, concerns, and digital affinity when introducing innovative tools into clinical practice. Conclusion: Insights from this study contribute to future participant engagement strategies and the development of early detection methods for cognitive impairment. Trial Registration: CogScreen is registered at ClinicalTrials.gov (NCT06191952).

IntroductionWhile human longevity has increased significantly over the last 2 centuries, the time spent in good physical and cognitive health has not risen proportionately. The incidence of Alzheimer's disease (AD) increases with age, but parental longevity is often associated with better offspring health and lower AD risk. This study aimed to investigate the relationship between parental longevity and AD.MethodsWe included patients with AD and cognitively healthy subjects (over 75 years), collecting family history data, namely maternal and paternal age at death. We performed a logistic regression to evaluate the association of parental longevity and AD risk and linear regression models for the association with age of onset and CSF biomarkers, adjusting for confounders.ResultsWe analyzed 3069 participants from a Portuguese cohort, including 893 AD patients and 2176 cognitively healthy controls. Maternal longevity was inversely associated with AD risk (OR: 0.989, 95%CI = [0.982, 0.997], P = 0.005). In AD patients, higher maternal age of death was associated with an earlier disease onset (β = -0.081, 95%CI = [-0.148, -0.013], P = 0.019). No associations were found between parental longevity and CSF biomarkers.DiscussionMaternal longevity appears protective against AD risk but is linked to an earlier onset in patients. This may indicate that protective factors for AD could become detrimental once AD is triggered. These findings highlight the complex interplay of genetic, environmental, and potentially epigenetic influences on AD.

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.

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.