Journal of Geriatric Psychiatry and Neurology最新文献

Globally, the prevalence of Parkinson's disease (PD) is increasing at an unprecedented rate. Therefore, it is imperative to provide evidence on the mental well-being of individuals with PD and identify context-specific determinants in sub-Saharan Africa to inform future interventions. An explanatory sequential mixed-methods design was employed, recruiting 304 individuals with PD who were receiving follow-up treatment. The prevalence of poor mental well-being among participants was 72.5%. Psychiatric manifestations included depression with suicidal ideation, anxiety, poor sleep quality, cognitive impairment, psychotic symptoms, and emotional and behavioral changes. Stigma was significantly associated with poor mental well-being, with an adjusted odds ratio of 1.13 (95% CI: 1.07-1.203, P < 0.001). A framework illustrating the vicious cycle of PD-related stigma, discrimination, and its impact on mental well-being was developed. Routine screening and treatment of mental disorders, along with community awareness campaigns to reduce stigma, are strongly recommended.Plain language summaryParkinson's disease (PD) exerts a significant impact on mental well-being due to its disease process and associated social and economic consequences. Therefore, assessing the prevalence of poor mental well-being, identifying manifestations of mental illness, and examining context-specific determinants in sub-Saharan Africa are essential to informing current practices and future research. Findings from this study reveal that nearly three-fourths of individuals with PD experience poor mental well-being in Ethiopia. Additionally, they exhibit a range of psychiatric manifestations, including severe conditions such as hopelessness and suicidal ideation. PD-related stigma is an independent determinant of mental well-being. People with PD face significant stigma and discrimination, largely driven by societal misconceptions about the causes of the disease. Routine screening and treatment of mental disorders, alongside the integration of mental health care into routine PD management, are essential to addressing the mental health needs of individuals with PD. Community awareness initiatives on the causes of PD are critically needed to reduce stigma and promote mental well-being. Given the high burden of mental disorders and the impact of stigma and discrimination, mental health and psychosocial interventions should prioritize individuals with PD.

BackgroundIstradefylline, a selective adenosine A2A receptor antagonist, is used as an adjunct therapy to levodopa to improve motor symptoms in Parkinson's disease (PD) patients, particularly those experiencing wearing-off phenomena. This study integrates safety data on istradefylline for the treatment of PD from randomized controlled trials (RCTs) and the FDA Adverse Event Reporting System (FAERS).MethodsWe performed a systematic search of PubMed, EMBASE, Ovid, MEDLINE, and ClinicalTrials.gov for RCTs on istradefylline safety in PD patients up to September 2024. A random-effects meta-analysis estimated the Peto odds ratio (OR) with 95% confidence intervals (CIs). FAERS data were analyzed through disproportionality measures, including the proportional reporting ratio (PRR) and reporting odds ratio (ROR), with signal refinement to primary suspect cases.ResultsThe safety meta-analysis, encompassing data from 8 RCTs, reveals a significant association between istradefylline treatment and an increased risk of dyskinesia (odds ratio [OR] 1.77, 95% CI 1.32-2.36; P = 0.01), hallucinations (OR 2.08, 95% CI 1.11-3.90; P = 0.02), and nausea, when compared with placebo. In the FAERS database, 2597 patients were identified with adverse events (AEs) linked to istradefylline. Disproportionality analysis of istradefylline revealed 39 AEs strongly associated with its use, all of which were substantiated through signal refinement. The most commonly reported AEs were primarily associated with nervous system and psychiatric disorders.ConclusionThis study highlights distinct AE patterns for istradefylline in trials vs real-world data, underscoring the importance of post-marketing surveillance to detect underreported AEs and validate new safety signals effectively.

BackgroundDementia is an escalating public health challenge in the MENA region, where primary healthcare professionals' (HCPs) knowledge and preparedness remain underexplored. Understanding their knowledge and attitudes is vital for early diagnosis, quality care, and effective awareness strategies.MethodsWe conducted a cross-sectional study of 1224 HCPs across several Arab countries, primarily in primary care settings. Data were collected via an online survey using two validated instruments: the Dementia Knowledge Assessment Scale (DKAS) and the Dementia Attitudes Scale (DAS).ResultsMost participants demonstrated moderate knowledge (68.5%), while 19.9% demonstrated poor knowledge and 11.5% demonstrated good knowledge. Attitudes were largely neutral to positive (44.1%). Multivariate analysis revealed that higher age predicted better knowledge (OR = 1.04, 95% CI: 1.02-1.06, P < .001), while positive attitudes were significantly associated with older age (OR = 1.02, 95% CI: 1.01-1.04, P = .002), female gender (OR = 1.44, 95% CI: 1.14-1.84, P = .003), and higher knowledge scores (OR = 1.23, 95% CI: 1.17-1.28, P < .001).Conclusionmoderate knowledge and generally positive attitudes, important gaps persist. Tailored education, particularly for younger and male HCPs, is needed to improve dementia literacy and care.

BackgroundPhysical exercise is a promising approach to address non-motor symptoms (NMS) in Parkinson's disease (PD), although the most effective modalities remain under investigation.ObjectiveTo compare the effects of three upper limb (UL) exercise modalities-resistance training (RES), aerobic exercise (AER), and task-specific training (TST)-on NMS in PD.MethodsThirty-seven community-dwelling individuals with PD (mean age = 62 ± 10 years; mean diagnosis duration = 7 ± 5 years; mean Hoehn & Yahr stage = 2 ± 0.4) were randomized into three intervention groups (RES, AER, TST) and a usual care control group. Interventions were performed three times per week, 40-50 minutes per session, over 8 weeks. Clinical outcomes included overall NMS (Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part I, MDS-UPDRS I), global and domain-specific cognition (Mini-Mental State Examination [MMSE], Addenbrooke's Cognitive Examination-Revised [ACE-R], Trail Making Test), depression (Geriatric Depression Scale [GDS]), and anxiety (Beck Anxiety Inventory [BAI]). Intervention effects were analyzed using mixed-effects models and non-parametric factorial analyses.ResultsBetween-group analyses showed that UL exercises similarly reduced overall NMS severity and cognitive dysfunction, while maintaining baseline fatigue levels, in contrast to deterioration in the CON. RES and TST reduced anxiety (BAI), and RES also reduced apathy. Within-group improvements in cognitive domains, depression, hallucinations, and sleep problems were observed in the RES and TST groups.ConclusionsThis is the first study to demonstrate that isolated UL exercise modalities exert clinically relevant effects on NMS in PD. These modalities may be valuable additions to multidimensional rehabilitation strategies in PD care. [Brazilian Registry of Clinical Trials: RBR-7zjgnrx].

ObjectiveNeuropsychological assessment (NPA) is recommended to support differential diagnosis of dementia but little is known about its impact on clients and their experience of negative effects. This study investigated clinicians' understanding of their clients' negative experiences and explored similarities in clinician and client reports.MethodA mixed-methods approach was employed using qualitative and quantitative data. Semi-structured interviews with clinicians, and a questionnaire for clinicians and clients were collected from NHS settings across Scotland. Reflexive Thematic Analysis was used to analyse 11 clinician interviews. Descriptive statistics were reported for the 25 clinician and 12 client questionnaires and exploratory analysis investigated associations between clinician and clients reporting of negative experiences.ResultsIn the qualitative analysis, three overarching themes and 13 sub-themes were identified. The over-arching themes were: assessment can produce negative impacts for clients, indirect factors can produce harmful effects, and clinicians can take action to reduce adverse effects of NPA. For the questionnaire responses, the most endorsed negative effects were the same for clients and clinicians and included feeling stressed, worried, disappointed with their performance in assessment, frustrated, critical of themselves and worried about the outcome.ConclusionThese data provide some of the first clear empirical descriptions of the negative effects of NPA as reported by both clinicians and clients. The study also identified challenges with recruiting clients who are willing to give feedback on their experience of assessment. Future studies are needed to refine the available data capture methods and to determine if the current results are replicable.

ObjectiveCognitive reserve is a resilience construct that mitigates the impact of brain aging and disease on cognition, yet validated instruments remain scarce in older adults with cognitive frailty. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Chinese version of the Cognitive Reserve Index questionnaire (C-CRIq) among community-dwelling older adults with cognitive frailty.MethodsA methodological study was conducted. The C-CRIq was translated using a modified Brislin back-translation model, and translation validity was examined. Psychometric testing followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), assessing content validity, convergent validity, known-groups validity, and test-retest reliability. Partial Least Squares regression was applied to confirm the measurement model.ResultsA total of 231 participants with cognitive frailty were recruited. Translation validity index reached 100%. Item-level and scale-level content validity indices were high (0.875-1.00; 0.82; 0.98). Convergent validity exceeded 0.60, known-groups validity demonstrated sex differences, and test-retest reliability was strong (intraclass correlation coefficient = 0.85).ConclusionsThe C-CRIq is a valid, reliable, and feasible instrument for assessing cognitive reserve in older adults with cognitive frailty, supporting neuropsychiatric care, risk stratification, and cross-cultural geriatric research.

PurposeAgitation is a neuropsychiatric symptom commonly observed in Alzheimer's dementia, which causes substantial burden for patients and caregivers. In this exploratory analysis, Neuropsychiatric Inventory (NPI) data were pooled from two randomized, double-blind, fixed-dose, placebo-controlled trials of brexpiprazole in agitation associated with dementia due to Alzheimer's disease. The analysis explored the efficacy of brexpiprazole on agitation and other neuropsychiatric symptoms, including their impact on caregivers.Major FindingsBrexpiprazole 2 or 3 mg/day (N = 368) showed greater improvement vs placebo (N = 253) from baseline in NPI agitation/aggression domain score (Week 6 onwards), and in the associated occupational disruptiveness/caregiver distress score (Week 4 onwards). Improvements with brexpiprazole vs placebo also occurred on other NPI and occupational disruptiveness/caregiver distress scores, including irritability/lability, aberrant motor behavior, and anxiety.ConclusionsOver 12 weeks, brexpiprazole was associated with greater improvements vs placebo in agitation/aggression and other neuropsychiatric symptoms, and in associated caregiver disruption/distress. ClinicalTrials.gov identifiers: NCT01862640; NCT03548584.

BackgroundThe Penn Parkinson's Daily Activities Questionnaire (PDAQ-15) assesses the difficulty in performing cognitive instrumental activities of daily living (IADL) in people with Parkinson's disease (PD).ObjectivesTo translate, cross-culturally adapt and investigate measurement properties of the Brazilian version of the PDAQ-15 Knowledgeable Informant (KI) and Patient (PT).MethodsFollowing the translation, cross-cultural adaptation, face and content validity analyses; floor and ceiling effects, reliability (test-retest, inter-rater, internal consistency) and validity (convergent, divergent, discriminant) were evaluated in 50 persons with PD and their KI. The KI and Patient PDAQ-15 were rater-administered.ResultsThe translated and adapted KI and PT PDAQ-15 did not show floor or ceiling effects. They had appropriate internal consistency (PT = 0.825; KI = 0.923), excellent test-retest (PT = 0.97; KI = 0.99) and interrater reliability (PT = 0.92; KI = 0.99). PT and KI agreement was moderate, ICC = 0.58. The correlations with the Scales for Outcomes of Parkinson's disease - Cognition were: PT (rho = 0.50), KI (rho = 0.67); with the Direct Assessment of Functional Status: PT (rho = 0.66), KI (rho = 0.80); with Unified Parkinson's Disease Rating Scale (UPDRS) Part II: PT (rho = -0.29), KI (rho = -0.30), all P < 0.05; and with UPDRS part III: PT (rho = -0.27), KI (rho = -0.27), P > 0.05. PT and KI PDAQ-15 discriminated between the mild and moderate/severe stages of the Hoehn & Yahr Scale (P = 0.03).ConclusionThe two Brazilian versions of the PDAQ-15 have acceptable measurement properties for assessing the cognitive IADL of persons with PD. For those with suspected or diagnosed cognitive impairment, the application of both versions is suggested.

ObjectivesThis study aimed to compare the effects of different exercise interventions on brain-derived neurotrophic factor (BDNF) levels in patients with neurodegenerative diseases and to explore regulatory factors.MethodsSearched PubMed, Scopus, Web of Science Core Collection, CNKI and Cochrane Library databases up to March 15, 2025. Bayesian network meta-analysis was conducted using R software, and meta-regression analyzed the moderating effects of training period and frequency.Results42 randomized controlled trials covering 1482 patients were included. The Surface Under the Cumulative Ranking (SUCRA) indicated that stretching training (SUCRA = 78.92) and high-intensity interval training (SUCRA = 69.73) were ranked higher than other exercise modalities and exhibited more favorable effect on BDNF enhancement, although neither demonstrated statistically significant superiority over the blank control. In contrast, combined training (SUCRA = 35.58), aerobic training (SUCRA = 35.17), and resistance training (SUCRA = 12.98) showed relatively lower potential for BDNF enhancement (blank control SUCRA = 67.62). Meta-regression analysis showed that the effect of combined training was significantly and positively correlated with intervention period (P < 0.01).ConclusionsStretching training and high-intensity interval training appear promising for enhancing BDNF level in neurodegenerative diseases, while isolated aerobic or resistance training show relatively lower potential on improving BDNF. Combined training requires sustained implementation for significant benefits. These findings highlight the importance of tailored exercise prescription for improving BDNF levels.

BackgroundAccurate sleep assessment is key to promoting healthy aging, yet self-reported measures often diverge from actigraphy. The factors driving these discrepancies in older adults remain unclear.MethodsThis cross-sectional secondary analysis examined the prevalence and correlates of subjective-objective sleep discrepancies in 195 community-dwelling older adults (69.84 ± 6.83 years old, 78.97% women) without dementia using baseline data from two clinical trials. Time in bed (TIB), sleep onset latency (SOL), total sleep time (TST), and sleep efficiency were collected via ≥3 days of actigraphy, sleep diaries, and the Pittsburgh Sleep Quality Index (PSQI). Discrepancies were calculated as self-reported minus actigraphy values, using ±15 min (±15% for sleep efficiency) as thresholds. Validated scales assessed insomnia, sleepiness, pain, and depression. Computerized batteries assessed processing speed, attention, executive function, working memory, and episodic memory.ResultsDiscrepancies greater than ±15 min (or ±15%) were prevalent: 88.50% for TST, 81.25% for TIB (PSQI), 45.71% for TIB (diary), 45.87% for SOL, and 42.20% for sleep efficiency. Adjusted multinomial logistic regression revealed that more severe insomnia symptoms were significantly associated with reduced odds of over-reporting sleep efficiency on the PSQI (OR = 0.82, 95% CI [0.72, 0.94]). Although no longer significant after correcting for multiple comparisons, better verbal episodic memory was associated with greater odds of over-reporting sleep efficiency (OR = 2.11, 95% CI [1.10, 4.07]) and lower odds of under-reporting diary-based TIB (OR = 0.32, 95% CI [0.13, 0.76]).ConclusionCognitive function and insomnia are linked to sleep discrepancies and may affect perceived sleep quality, warranting careful interpretation of self-reported sleep in older adults.