Journal of Geriatric Psychiatry and Neurology最新文献

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.

ObjectiveInsomnia and obstructive sleep apnea (OSA) are prevalent in the geriatric population, with co-morbid insomnia and sleep apnea (COMISA) increasing the risk of suicidal ideation. Anhedonia, a core depression feature, is associated with suicidal ideation. This study aimed to explore the relationship between COMISA and suicidality including the mediating effect of anhedonic symptoms.MethodsFrom August 2021 to December 2023, 243 participants from South Korea were enrolled in a prospective case-control study at a Veterans' hospital. Participants underwent interviews, self-report measures, and polysomnography. 214 untreated OSA participants were categorized into COMISA and OSA-only groups. Anhedonic symptoms and their correlates were investigated.Results69 participants (32.2%) had an Insomnia Severity Index score >15, forming the COMISA group. Suicidal ideation was more prevalent in the COMISA group (43.1% vs 23.4%, P = 0.007). After adjusting for covariates such as age, gender, body mass index, alcohol and smoking consumption, caffeine intake, hypertension, diabetes mellitus, and sleep-related factors, the odds of suicidal ideation were higher in the COMISA group (OR = 2.42, 95% CI = 1.14 - 5.11). However, after adjusting for anhedonic symptoms, this association was no longer significant. Anhedonic symptoms mediated the relationship between insomnia and suicidal ideation (OR = 1.045, 95% CI = 1.013-1.074).ConclusionsThe findings of this study underscore the emergence of suicidal ideation among individuals with COMISA. Understanding the mechanisms of anhedonic symptoms underlying the relationship between COMISA and suicidal ideation is crucial for developing targeted interventions to mitigate suicidality in this population.

BackgroundAddressing modifiable risk factors can potentially prevent 45% of cases of dementia. Here, we present the development of Brain-WISE, a low-intensity, group-based intervention to improve brain health in community settings. We conducted preliminary testing to refine intervention materials and procedures, assess acceptability and adherence, and evaluate preliminary effects.Methods143 community-dwelling adults aged 56-93 completed the non-randomized pilot trial. The 6-session intervention included psychoeducation, discussion/activities, and health screenings. Adherence was measured by attendance and acceptability was measured with questionnaires. Brain health knowledge and motivation to improve brain health were assessed before and after the program.ResultsAcross 6 cohorts, attendance was 80% - 97% and 96% of participants agreed that the program was worthwhile. Knowledge (d = 0.83, P < .001) and motivation (d = 0.43, P < .001) increased significantly.ConclusionsThe Brain-WISE program displayed good adherence and acceptability and evidence of an effect on knowledge and motivation. Further testing is warranted.

Objective: This study compared emotional recognition in participants with mild cognitive impairment (MCI) and mild to moderate Alzheimer 's disease (AD) against caregivers' perceptions of these participants' emotional states, while exploring the influence of clinical variables. Methods: We included 141 participants (32 with MCI, 50 with mild AD, and 59 with moderate AD) and their primary caregivers. We employed tasks assessing emotional decoding, identification, and correspondence, along with objective evaluations. Results: Participants across all groups showed significant differences in cognition and functionality. However, emotional recognition abilities did not significantly differ between MCI and mild or moderate AD groups. Most cognitive and neuropsychiatric variables had no significant impact on emotion recognition or social functioning. No differences emerged in patients' self-evaluations of social and emotional functioning. Caregiver assessments revealed significant differences only between the MCI and moderate AD groups. Conclusion: Participants with MCI and AD displayed expected clinical progression while retaining some emotional recognition and social functioning capabilities.

ObjectiveApathy and APOE ε4 genotype are risk factors for developing Alzheimer's disease dementia (ADD). Antidepressant use is known to induce apathy. This study aimed to examine associations between APOE ε4, apathy, and antidepressant use with progression from cognitively normal (CN) to mild cognitive impairments (MCI), and MCI to ADD.MethodsParticipants aged 55-90 were recruited from the Alzheimer's Disease Neuroimaging Initiative. Participants were CN or had MCI at baseline and had completed at least 3 consecutive study visits. The NPI and NPI-Q apathy subscales were used to index the presence of apathy. Antidepressants used by participants included SSRIs, SNRIs, and AYTADs. Cox proportional hazards analyses examined the combined effects of apathy, APOE ε4 genotype, and antidepressant use on conversion from CN to MCI and from MCI to ADD.ResultsApathy and APOE ε4 were associated with increased risk of conversion along the CN-MCI-ADD continuum. Antidepressant use was associated with progression from MCI to ADD, and progression from CN to MCI in non-apathetic APOE ε4 carriers.ConclusionOur findings support apathy and APOE ε4 as robust predictors of conversion to MCI and ADD, and demonstrate novel associations between antidepressant use and conversion. Future research should explore whether antidepressant use in MCI and ADD causes apathetic symptoms or serves to index apathy/depression severity.

Background and ObjectivesWhile hearing loss is a known risk factor for dementia, the impact of incident hearing loss on subsequent dementia risk remains underexplored. This study examined the association between newly reported hearing loss and dementia risk in U.S. adults, focusing on critical intervention periods for dementia prevention.Research Design and MethodsParticipants from the Health and Retirement Study who reported no hearing loss or hearing aid use in 2010 or 2012 were included. Incident hearing loss and dementia were assessed via self-report and proxy report. Pooled logistic regression models with inverse probability weighting estimated the cumulative incidence of dementia at 2, 4, 6, and 8 years after baseline. Risk ratios (RR) with 95% confidence intervals were calculated from 200 bootstrap samples. Subgroup analyses were conducted by age, sex, and cardiovascular disease (CVD) status.ResultsAmong 13,599 participants, 1125 (8.3%) reported incident hearing loss. Dementia incidence was higher among those with hearing loss (6.6%) compared to those without (4.9%). Starting at 4 years, incident hearing loss was associated with a higher dementia risk, persisting at 8 years (RR = 1.34; 95% CI: 1.05, 1.59). This association was significant among individuals aged 50-64 years and those with CVD.Discussion and ImplicationsIncident hearing loss is associated with a heightened dementia risk, particularly in midlife and among individuals with CVD. Future research should investigate the effectiveness of timely interventions aimed at preventing dementia in individuals with hearing loss.