Journal of Geriatric Psychiatry and Neurology最新文献

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.

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.