Journal of Geriatric Psychiatry and Neurology最新文献

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.

ObjectivesSocial Cognition (SC) can be impaired in Parkinson's Disease (PD), yet its longitudinal evolution relative to cognitive status is unclear. This study examined whether SC deficits in PD patients suffers different changes based on baseline cognitive status and cognitive progression.MethodsIn this observational study 48 non-demented PD patients (32 with normal cognition [PD-CN], 16 with mild cognitive impairment [PD-MCI]), and 22 healthy controls (HC) were assessed at baseline and after three years. SC was assessed for facial emotion recognition (FER), affective and cognitive Theory of Mind (ToM), and social behavior. A comprehensive neuropsychological battery provided domain-specific z-scores. Cognitive classification followed MDS Level II criteria. Adjusted linear mixed models examined SC changes. Delta scores for SC tasks and z-score changes were correlated.ResultsAt baseline, PD-MCI patients scored lower on cognitive ToM than PD-CN and HC, with no significant group differences in affective ToM, FER, or social behavior. Over three years, PD-MCI patients experienced a significant decline in cognitive ToM compared to PD-CN and HC, while affective ToM and emotion recognition declined only relative to HC. The converters (n = 16) to a worse cognitive state (PD-CN to PD-MCI or PD-MCI to PDD) showed lower baseline cognitive ToM and steeper decline than stable patients. All SC changes correlated with visuospatial ability; affective ToM also correlated with memory, language and attention, and FER with memory and executive function.ConclusionsCognitive ToM declines in parallel with cognitive deterioration in PD, while remaining stable in PD-CN. SC measures may help identify patients at higher risk of cognitive decline.

BackgroundMany patients with bipolar disorder (BD) report cognitive problems. Pathophysiology of cognitive impairment in BD is unclear, although prevalence of dementia in BD is high. In Older-Age Bipolar Disorder (OABD) patients with cognitive complaints, neurodegeneration may play a role. This could occur in at least 2 ways: (1) BD with 'comorbid' diagnosis of dementia; (2) specific neurobiological processes can underlie a cognitive impairment that is intrinsic of BD (ie, BD-related cognitive impairment).Methods102 OABD patients were selected from the Amsterdam Dementia Cohort study. Diagnostic workup included clinical and neuropsychological assessment, CSF biomarkers and MRI visual rating scales. About half of patients had depressive symptoms. We (1) examined which neurological diagnoses were identified by the memory clinic as the main cause of cognitive complaints. Subsequently, (2) in the remaining OABD patients with an unknown cause, we performed linear regression between biomarkers of neurodegeneration and composite cognitive score.Results29 OABD patients (28.4%) received a neurological diagnosis, 6 of which Alzheimer's Disease. In the remaining 73 (71.6%) OABD patients, a lower Aβ₄₂ CSF concentration was related to lower composite cognitive scores (B = -0.143, P = 0.034), whereas CSF T-Tau, P-Tau, and MRI markers were not.ConclusionIn most OABD patients visiting a memory clinic, a neurological cause of cognitive complaints was not identified despite extensive diagnostic work-up. Altered amyloid metabolism may be an extra biological factor in the multifactorial puzzle that is BD-related cognitive impairment. Future studies should investigate a large range of biomarkers in relation to cognition in BD, including amyloid.

Objective: This study examined the prevalence of anxiety, low mental well-being, loneliness, depression, and insomnia among older adults in a district of western Nepal and identified factors associated with each of these conditions. Methods: A community-based cross-sectional study was conducted in Dang, Nepal from August 2023 to January 2024 among adults aged 60 years or older using purposive sampling technique (n = 814). Validated tools were used to assess each mental health conditions. Multivariate logistic regressions were conducted to identify factors associated with each condition. Results: Five percent of older adults had low mental well-being, 7.25% experienced loneliness, 14.13% showed signs of general anxiety disorder (GAD), 6.58% had depression, and 1.97% had insomnia. Older adults of Dalit ethnicity, those with chronic illnesses, and those with a family history of mental illness had a disproportionately higher odds of developing one or more mental health conditions compared with their counterparts. Conclusion: Mental health conditions such as anxiety, depression, sleep difficulties and loneliness, and low mental well-being were less prevalent in Dang compared to previous studies in Nepal, and were associated with caste, chronic illnesses, and family history of mental illnesses. These findings highlight the need for targeted mental health screening and culturally sensitive interventions-such as community-based programs that acknowledge caste-based stigma, strengthen family and social support systems, and integrate local language counseling- to address mental health needs of vulnerable older adults. Future nationally representative studies are needed to provide a broader understanding of mental health among older adults in Nepal.

Background: Informal carers of people living with dementia can experience increased burden, stress and a decline in mental health and wellbeing. Growing evidence suggests these impacts are greater for those caring for individuals living with behavioural-variant frontotemporal dementia. However, little is known about their psychological needs and how these carers access psychological support. Objective: This study aimed to understand the impact of caring on psychological wellbeing and the experiences and needs of carers in seeking psychological support. Methods: Twelve carers participated in either a group or individual semi-structured interview. Data were analysed qualitatively using thematic analysis. Results: Five themes emerged: (1) The job of being a carer, (2) The carer and person living with bvFTD as a unit: Reciprocal wellbeing & Care for the carers, (3) Feeling seen, Feeling heard, and Being connected, (4) The power of information and (5) Meaning and purpose through caring. These themes captured the challenges, supports and meaningful aspects of the caring experience, and their impact on psychological wellbeing. While carers reported both positive and negative impacts of caregiving on their psychological wellbeing, they also highlighted a lack of tailored services in the context of behavioural-variant frontotemporal dementia. Conclusions: Psychological support services for carers should address common barriers to accessibility and flexibility and be developed in collaboration with carers to optimise feasibility and efficacy.

BackgroundCurrently, prognosis of Parkinson's Disease (PD) is limited. Emerging literature highlights potential of multi-modal biomarkers and neuroimaging to provide critical insight into clinical progression, potentially improving prediction of long-term outcomes.MethodsData were extracted from the Parkinson's Progression Markers Initiative (PPMI). Hierarchical clustering was applied to Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scores at year-five follow-up, identifying two clusters. Differences in progression, as well as retrospective assessment of baseline differences, between clusters were explored for pathological biomarkers, neuroimaging, and prodromal measures. Additionally, logistic regression, receiver operating characteristic curve analyses and machine learning were employed to determine utility of variables at baseline as predictors of cluster membership.ResultsThe more impaired cluster demonstrated worse motor and non-motor outcomes, including higher rates of dementia and cognitive complaints at year-five, as well as more profound rigidity than cluster one. Further, retrospective comparisons showed cluster two performing worse in all prodromal measures and demonstrated lower striatal dopamine transporter and cognitive ability. Logistic regression determined that membership in this cluster was predicted by higher autonomic dysfunction and p-tau, along with reduced smell and alpha-syn, predicting 49.1% of variance (AUC = 0.92). This was significantly higher (p < 0.001) than the model including MDS-UPDRS scores alone, only accounting for 27.4% of variance (AUC = 0.74). Findings were corroborated by machine learning, whereby multi-modal assessment corresponded to 74% classification accuracy, compared to 60% with MDS-UPDRS alone.ConclusionPrediction of more marked impairment at year-five was substantially improved via multi-modal assessment, specifically, pathological biomarkers, suggesting that incorporating biomarkers into clinical criteria could enhance long-term prognosis.

BackgroundParkinson's disease (PD) is the fastest-growing neurodegenerative condition globally, significantly impairing self-care capacity due to its complex motor and nonmotor symptoms. Caregiver involvement is often essential.ObjectiveThis review aims to synthesise qualitative evidence on self-care behaviours and experiences in individuals with PD, from both patient and caregiver perspectives.MethodsA qualitative meta-synthesis was conducted using Sandelowski and Barroso's methodology. Fifty-two eligible studies were analysed. Thematic categories were mapped onto Riegel's self-care framework: maintenance, monitoring, and management.ResultsSelf-care maintenance emerged as the most frequently reported dimension. Across all three dimensions, caregiver support played a central role in enabling effective symptom control and treatment adherence.ConclusionsThe synthesis highlights the critical importance of supporting self-care-especially maintenance behaviours-in PD management. It also emphasizes the vital role caregivers play in reinforcing self-care, pointing to the need for integrated support structures in clinical and research contexts.RegistrationThis review was registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024598072).

BackgroundPsychotic symptoms are common in patients with Parkinson's Disease Dementia and Dementia with Lewy Bodies, known collectively as the Lewy Body Dementias (LBD). It is important to identify these symptoms early and accurately. However, these symptoms are challenging to identify and quantify in clinical practice. The Psychosis and Hallucinations Questionnaire (PsycH-Q) was developed as a self-report tool using patient-friendly language to assess hallucinations and related phenomena and has been previously validated in Parkinson's Disease patients without dementia and their caregivers.ObjectivesThis study aimed to evaluate the utility of the PsycH-Q in patients diagnosed with a Lewy Body Dementia.MethodsA total of 33 LBD patients, assisted by their caregivers, completed the PsycH-Q, along with the Scales for Outcomes in Parkinson's Disease-Psychiatric Complications (SCOPA-PC) and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Items relating to hallucinations and psychotic phenomena from the SCOPA-PC and MDS-UPDRS were then compared with analogous ratings on the PsycH-Q.ResultsScores on the PsycH-Q were significantly correlated with SCOPA-PC Questions 1 and 3, as well as the MDS-UPDRS question 1.2 (Spearman's rho of 0.65, 0.73, and 0.47, respectively; p < 0.01 for all three correlations).ConclusionsThese results support the PsycH-Q as a patient-friendly questionnaire that accurately identifies hallucinatory phenomena and their features in LBD patients via self-report completed by patients with their caregivers. Future use of the PsycH-Q in clinical practice and research could improve early detection of psychotic symptoms in LBD patients, leading to improved management.

ObjectiveMirrored self-misidentification syndrome (MSMS) is a rare form of delusional misidentification syndrome characterized by the inability to recognize one's own reflection. We conducted a systematic review aiming to describe the epidemiology, clinical presentation, and management of individuals with MSMS.MethodsA comprehensive literature search was performed using original case reports/series on patients with MSMS. Univariate analyses were performed to assess patient demographics, clinical, paraclinical, and treatment-related characteristics. The methodological quality of included articles was evaluated using a standardized tool.ResultsOf 76 articles screened, 28 were included, with 36 patients analyzed. Median age was 77.0 (interquartile range: 72.0, 80.0) years; most patients were female (60.7%). Over half of the cases had a diagnosis of dementia, mostly Alzheimer's disease (50.0%), Lewy Body Disease (20.0%), and vascular dementia (10.0%), while the other diagnosis included stroke (3.3%), schizophrenia (3.3%), schizoaffective disorder (3.3%), and rabies (3.3%). Initial clinical manifestations included psychiatric symptoms (66.7%) and cognitive decline (70.0%). Brain magnetic resonance (MRI) was reported in 31 cases, with 14 cases (45.1%) showing right hemisphere dysfunction. Pharmacological interventions were effective for twelve cases (48.0%), and non-pharmacological interventions such as covering mirror were effective for 8 cases (32.0%). Most included articles (64.3%) were evaluated to be at low risk of bias.ConclusionsMSMS are rare conditions that mostly present in patients with dementia. Despite the varied clinical presentations, frontal and right hemisphere dysfunctions appear to play a role in the pathophysiology of MSMS, adding to the evidence supporting "a neuroanatomy of the self" in the non-dominant hemisphere.