Journal of Geriatric Psychiatry and Neurology最新文献

"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.

BackgroundAgitation is common in persons living with dementia (major neurocognitive disorder) and worsens with disease progression. Brexpiprazole is the sole FDA-approved drug for agitation in persons with Alzheimer's dementia, but requires daily dosing over weeks. Limited pharmacologic options exist for acute agitation management.PurposeTo show the efficacy of oxytocin for acute agitation management in dementia patients.CaseWe report a 70-year-old former professional wrestler with repetitive head trauma who developed dementia and severe agitation. He showed remarkable, rapid improvement with as-needed intranasal oxytocin 30 IU until his death. Post-mortem examination revealed mixed pathology: Alzheimer's disease (Intermediate stage), Lewy Body disease (Limbic/Transitional stage), cerebrovascular disease with multiple infarcts, and chronic traumatic encephalopathy.ConclusionThis case demonstrates the potential efficacy of intranasal oxytocin for acute agitation management in persons living with mixed dementia and may inspire further investigation.

ObjectiveThis study aims to examine educational heterogeneity in the relationship between internet use and episodic memory among older adults in China, within the context of advancing Chinese modernization.MethodsData from the 2018 and 2020 waves of China Health and Retirement Longitudinal Study (CHARLS) were used for analysis. By employing a longitudinal study design with lagged predictors and the inverse probability of treatment weighting (IPTW) approach alongside its extension-the marginal structural model (MSM) for sufficient cause interactions-this study mitigated potential reverse causality and self-selection biases related to internet use and educational attainment.ResultsThe findings indicate a significant positive longitudinal association between internet use and delayed word recall in older women, incorporating delayed and immediate recall scores at baseline as covariates for predicting propensity scores of internet use. Additionally, the preservation of delayed word recall linked to internet use was more pronounced among older women with less than an elementary school education. Doubly robust estimation results further confirmed the reliability of the core findings. Furthermore, we investigated the longitudinal associations between specific online activities and episodic memory. The results show that posting on social media and engaging in online chatting positively correlated with episodic memory in older women, whereas browsing news online was positively associated with episodic memory in older men.ConclusionThese findings support the cognitive enrichment hypothesis, which asserts that internet use serves as a mentally stimulating activity that may help delay cognitive aging, especially among individuals with limited cognitive stimuli.

Background: Accurate falls reporting is important in the management of Parkinson's disease. One way in which to improve accuracy is by providing a smartphone app to log fall events. This qualitative study sought to gain insights from healthcare professionals based in the United Kingdom on a novel smartphone application co-developed by people with Parkinson's (PwP) disease for falls reporting. Research Methods: A purposive sample of n=11 healthcare professionals with expertise in Parkinson's were recruited to take part in a focus group to explore their views on the smartphone app. Framework analysis was utilised to interpret the data. Results: Participants discussed the applications role in clinical practice, research, and provided recommendations for future improvements. Within the overarching theme of implementation of iFall in clinical and research practice, three subthemes emerged: (1) applicability to clinical practice, (2) the future of iFall in research and (3) future developments. The application was viewed positively, exhibiting potential to address important contemporary issues within falls reporting and research, whilst being clear, simple and easy to use. Implementation challenges of the application, such as IT integration were highlighted, while enhancements such as voice recognition were suggested. Conclusions: Incorporating suggestions from healthcare professionals and piloting of the application with PwP will increase the likelihood of successful implementation of the iFall app into clinical practice and research.

IntroductionRecent research in Parkinson's disease (PD) has highlighted the potential therapies of continuous subcutaneous infusions (CSCI) of levodopa/carbidopa (ND0612) and foslevodopa/foscarbidopa (ABBV-951). This systematic review aims to explore their effectiveness and safety for PD.MethodsGuided by the PRISMA statement, we systematically searched 3 electronic databases: MEDLINE, Embase, and Cochrane Central. We combined quantitative and qualitative data for synthesis and descriptive analysis. Quality assessment and risk of bias were evaluated by ROBINS-1 and Rob-2 criteria.ResultsWe included 6 records with a total of 698 patients. CSCI therapies reduced motor symptoms in PD patients with levodopa-related motor fluctuations and clinical improvements. Infusions-site reactions were the main adverse event recorded.ConclusionsND0612 and ABBV-951 are promising options for enhancing motor control and quality of life in PD patients. However, further research is needed to assess long-term efficacy, safety, and comparisons with oral levodopa and device-aided treatments.

BackgroundAmong neuropsychiatric sequelae of Parkinson's disease (PD), psychosis may have the most adverse impacts on prognosis and quality of life.ObjectivesTo summarize and critically review the literature on potential risk factors for psychosis in PD, with particular focus on potentially modifiable risk factors.MethodsWe conducted a literature review using PubMed and EMBASE. We included articles if: (1) the study population was comprised of patients with PD, (2) the presence of psychosis was systematically ascertained through clinician diagnosis, clinical outcome assessments and/or administrative data, and (3) potential risk factors were examined prior to the onset of psychosis.ResultsTwenty-six studies (15 prospective cohort, 10 retrospective cohort, 1 retrospective case-control) of 21 patient cohorts (n = 15,535 unique patients) were included in the review. Ten studies included minor phenomena in their definition of psychosis. The most consistent potential risk factors for psychosis were sleep disturbances, particularly rapid eye movement sleep behavior disorder and autonomic dysfunction. Potentially modifiable risk factors for psychosis included excessive daytime sleepiness and exposure to anticholinergic medications and levodopa. Possible biomarkers for psychosis in PD included reduced striatal dopamine transporter binding on imaging and mutations in the GBA gene.ConclusionsSeveral studies have identified potentially modifiable risk factors for the development of psychosis in PD. Future studies should utilize consistent, validated definitions of psychosis and focus on increasing understanding of, and developing interventions for, potentially modifiable risk factors for psychosis in patients with PD.