Journal of Geriatric Psychiatry and Neurology最新文献

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.

"Oldest old", although increasingly numerous, remain insufficiently described in mental health services. By studying those who visit the busiest Psychiatric Emergency Services (PES) in France, our primary objective was to describe the "oldest old" seeking psychiatric care and, secondly, to identify predictive factors of hospitalization. We chose a cut-off age of 80 years and recruited all patients who visited our monocentric PES over a five-year period between 2018 and 2022. This retrospective observational study relied on clinical assessments and medical records. A total of 306 visits from 274 distinct patients were analyzed. Patients were mostly women, living alone at home, with a psychiatric history and using psychotropic medications. The majority were diagnosed with mood disorders and did not appear to have cognitive impairment. Patients were primarily referred to either inpatient or outpatient psychiatric care. These results enhance our understanding of the psychiatric needs of the "oldest-old".

BackgroundOlfactory impairment might be already present at the subjective cognitive impairment (SCD) individuals, and deepens with disease severity in the Alzheimer's disease (AD) spectrum. However, the neuroanatomical correlates of olfactory impairment in SCD individuals are not fully elucidated.MethodsA hundred and twenty enrolled older adults without dementia (25 healthy controls (HCs), 45 SCD individuals and 50 mild cognitive impairment (MCI) individuals) completed olfactory assessment and structural magnetic resonance imaging (MRI) scanning. Olfactory function was evaluated by the 16-item Sniffin' Sticks odor identification test (SSIT). Region of interest (ROI) analysis was conducted for the gray matter volume (GMV) of 8 olfactory-related brain regions.ResultsIn ROI analysis, from HC, SCD to MCI group, smaller GMV of olfactory-related regions and olfactory impairment became increasingly severe. For HC group, olfactory impairment was only associated with smaller entorhinal cortex (P < 0.05). In SCD individuals, reduced GMVs of entorhinal cortex and hippocampus were associated with olfactory impairment (P < 0.05). In MCI individuals, decreased GMVs of piriform cortex, amygdala, entorhinal cortex, orbitofrontal cortex, hippocampus and parahippocampus were significantly associated with olfactory impairment (P < 0.05).ConclusionsThe atrophy of olfactory-related brain regions gradually increased and the corresponding olfactory function gradually decreased in older adults of HC, SCD and MCI. The olfactory regions associated with olfactory impairment in SCD individuals were mainly in entorhinal cortex and hippocampus.

IntroductionDelusions are common in Lewy body disease (LBD), significantly impacting quality of life. This study examined clinical factors, characteristics and themes associated with delusions in LBD.MethodsClinical and demographic factors were compared between 91 individuals attending St. James's Hospital in Ireland with LBD both with and without delusions. Clinical scales include the Clinical Dementia Rating Scale (CDR), Epworth sleepiness scale (ESS), Addenbrooke's Cognitive Evaluation (ACE-III), and Neuropsychiatric Inventory-12 (NPI-12). Themes of delusions extracted from clinical descriptions were mapped onto a typology from primary psychiatric populations.ResultsIndividuals with delusions were older, had higher CDR and ESS scores, lower ACE-III performance, higher scores on the NPI-12, and demonstrated cognitive impairment at the MCI or dementia level. Misidentification delusions were most common, followed by delusions of "being harmed, attacked, or killed" and "residence is not their home".ConclusionThese findings suggest delusions are related to disease stage, sleep, distinct cognitive and neuropsychiatric patterns, and follow a unique thematic typology.

BackgroundMild Behavioral Impairment (MBI) has been increasingly recognized as a potential early clinical marker of neurodegenerative disease, while blood-based biomarkers such as phosphorylated tau 217 (p-tau217) and neurofilament light chain (NfL) are associated with Alzheimer's disease and axonal damage, respectively.ObjectiveTo investigate the role of MBI and blood-based biomarkers of neurodegeneration in the early detection of dementia.MethodsFifty-one individuals without dementia aged 60 or older with mood or anxiety disorders underwent psychiatric, neuropsychiatric, and cognitive evaluations, as well as assessment of plasma p-tau217 and NfL at baseline and at one-year follow-up.ResultsA higher proportion of males was observed in the MBI group compared to the non-MBI group (P = 0.076). MBI was significantly associated with a higher risk of conversion to dementia (P = 0.006). MBI patients showed a trend toward higher baseline p-tau217 (P = 0.096) and significantly higher NfL at follow-up (P = 0.025), suggesting active neurodegeneration. Individuals who converted to dementia had marginally higher baseline p-tau217 (P = 0.053) and NfL (P = 0.091).ConclusionMBI and blood-based biomarkers of neurodegeneration appear to be promising clinical tools for identifying dementia risk in its early stages.

BackgroundClinician communication at the time of a dementia diagnosis often inadequately addresses patient and caregiver needs. We aimed to characterize the communication experiences of patients and caregivers affected by dementia using an evidence-based serious illness communication framework.MethodsWe conducted semi-structured interviews of patients with dementia and caregivers. An interdisciplinary research team used thematic content analysis to identify themes.ResultsParticipants included 6 patients and 15 caregivers recruited from the community and health care settings (n = 21; 17/21 female; n = 13 White (61%); n = 4 Black or African American (19%); n = 4 Latino/a (19%); n = 2 Asian; n = 2 other). Five themes were identified. First, perceptions of respectful or disrespectful communication affect the relationship with clinicians and contributes to positive or negative communication experiences. Second, participants described the emotional impact of sudden or unsupported disclosures, in which they felt unprepared to receive the news or emotionally abandoned after diagnosis. Third, the absence of, or ambiguity around, a definitive dementia diagnosis contributes to patient and caregiver distress and to feeling dismissed by clinicians. Fourth, mixed responses to illness education and clinician recommendations after disclosure reveals the need for more personalized and comprehensive care planning. Fifth, careful consideration around the timing of prognostic communication and advance care planning discussions is necessary to meet the needs of patients and caregivers with different emotional readiness, illness beliefs, and information preferences.ConclusionDementia diagnostic disclosure would benefit from a structured yet tailored communication approach that prioritizes respectful communication, emotional support, and comprehensive care planning to meet the needs of patients and caregivers.