Journal of Geriatric Psychiatry and Neurology最新文献

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.

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.

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.

Background: Physical activity has been shown to improve motor symptoms in numerous Parkinson's Disease (PD) clinical trials. However, the relationship between physical activity (PA), patient-reported outcomes, and quality of life (QoL) in a community-dwelling cohort has not been well-characterized. Methods: To evaluate this association, data were obtained from the internet-based Modifiable Variables in Parkinsonism Study (n = 415). Patient-reported outcomes and QoL were assessed by the Patient-Reported Outcomes in Parkinson's Disease (PRO-PD) and Patient-Reported Outcomes Measurement Information System (PROMIS), respectively. Regression models controlled for age, sex, and disease duration. Results: As PA increased, PROMIS scores increased (P < 0.001) and motor and non-motor symptom PRO-PD scores decreased (P < 0.001) implying improved symptoms and QoL. The association between PA and symptom severity was significant in women, but not men. Conclusions: These data may imply improved symptoms and QoL with increased PA frequency in individuals with PD. Sex differences in the relationship between PA and PD outcomes warrant further investigation.

IntroductionCaregiving for people with dementia poses emotional, social, and ethical challenges, which are intensified by socio-cultural factors and limited external support.AimThis study explores the complex challenges, ethical dilemmas and socio-cultural factors, faced by informal caregivers of individuals with dementia in Albania, focusing on their experiences, views, and attitudes towards caregiving responsibilities and decision-making processes.MethodsQualitative research using interpretative phenomenological analysis, was conducted through in-depth, semi-structured interviews with 12 family caregivers.ResultsThree main themes emerged: (1) The Heavy Burden of Family Caregiving; (2) Balancing Autonomy, Safety, Dignity, and Well-being and (3) Injustice in Care: The Plight of Dementia Caregivers in Albania.ConclusionThis study underscores the necessity for systemic changes that prioritize the health and well-being of both caregivers and people with dementia highlighting the impact of cultural norms, family dynamics, and insufficient external support on caregivers.

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.