Journal of Geriatric Psychiatry and Neurology最新文献

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.

BackgroundAnxiety is poorly recognized and inadequately treated in persons with Parkinson's disease (PD).ObjectiveThe present study aimed to develop and validate a new clinical screening and research outcome measure to identify triggers and manifestations of anxiety specific to PD, the Parkinson's disease Specific Anxiety Inventory (PDSAI).MethodData from PDSAI derived from 172 people with PD across Australia and the United States was used to assess the reliability and validity of the inventory. Construct validity was assessed.ResultsFrequency analyses revealed low rates of missing data across the 40 items. The inventory demonstrated high reliability (Cronbach's a = 0.93, split-half = 0.68) and mid to high concurrent validity between the PDSAI and (i) Hamilton Anxiety Scale (r = 0.51), (ii) Liebowitz Social Anxiety Scale (r = 0.697) and Parkinson's Anxiety Scale (r = 0.747).ConclusionsThe PDSAI is a valid and reliable tool designed to capture PD specific triggers and manifestations of anxiety in people with PD.

BackgroundHearing loss has been related to impaired cognition among older adults. The cost effectiveness of existing hearing support tools is controversial. Other potential modifying strategies that could effectively intervene in this prevalent and far-reaching association between hearing loss and cognitive decline remain unclear. This study aimed to narratively and quantitatively synthesize the mediators and moderators involved in the link between hearing loss and cognitive impairment from a psycho-social and physical point of view.MethodWe searched 6 databases for articles exploring mediating or moderating associations of hearing loss-cognition association from inception to March, 2024. Data were synthesized narratively and quantitatively by meta-analytic approaches.ResultsThe search yielded 63 included studies. Social (social engagement, social support, age, sex, ethnicity, cognitive reserve)-psycho (depression, anxiety, loneliness, resilience)-physical (cardiovascular diseases and risk factors, perceived health, disability, APOE carrier, vision impairment, gait speed) variables mediated or moderated the relationship between hearing loss and cognitive impairment to varying degrees. Subgroup analyses identified susceptible populations at greater risk for cognitive decline, including women, younger elders with hearing loss, and older adults with dual sensory loss.ConclusionCombined interventions targeting these modifiable variables across psycho-social and physical dimensions may be more cost-effective for intervening in the ensemble of hearing loss-cognitive impairment in older adults.

BackgroundWomen with Parkinson's disease (PD) are less likely to have a caregiver.ObjectiveTo determine factors contributing to gender disparities in PD caregiving.MethodsWe conducted a cross-sectional survey of people with PD and caregivers participating in the Parkinson's Foundation Parkinson's Outcomes Project and compared patient and caregiver characteristics by gender.ResultsAmong PD patients, 20.7% of 1663 women and 14.2% of 3005 men had no caregiver (P < 0.001). Women without caregivers were older (69.1 vs 66.3, P < 0.001), less likely to be married (30.4% vs 54.7%, P < 0.001), and more likely to be taking an antidepressant (41.8% vs 30.9%, P = 0.002) than men. Using stepwise logistic regression models, gender differences in access to caregiving were explained by marital status. Among caregivers, women reported more strain (P < 0.001) and had less time for other family members (P < 0.001).ConclusionFewer women with PD have caregivers because they are less likely to have a spouse.

IntroductionThis study aims to investigate the locus coeruleus-norepinephrine system (LC-NE) function in late-life depression (LLD) patients by examining task-evoked pupil dilation in the emotional face-word Stroop task, given the recently established coupling between task-evoked pupil dilation and LC-NE activation.Materials and MethodsUsing video-based eye-tracking and principal component analysis, we explored task-evoked pupil responses and eye blinks in LLD patients (N = 25) and older healthy controls (CTRL) (N = 29) to determine whether there were alterations in pupil responses and eye blinks in LLD compared to CTRL.ResultsLLD patients exhibited significantly different pupil and eye-blink behavior compared to CTRL, with dampened task-evoked pupil dilation associated with emotional congruency and valence processing mediated by the sympathetic system compared to CTRL. Eye-blink rates associated with emotional valence were also altered in LLD compared to CTRL Moreover, Geriatric Depression Scale-15 scores in LLD correlated with emotional congruency effects revealed by task-evoked pupil dilation.ConclusionThe findings demonstrate that LLD patients display altered pupil behavior compared to CTRL. These altered responses correlated with the severity of depressive symptoms, indicating their potential as objective biomarkers for use in large at-risk populations for LLD.

ObjectiveThis study evaluated the usability of the Rhode Island Mobile Cognitive Assessment Tool (RIMCAT), a proctored digital cognitive screening measure to assess its potential for self-administration.Methods100 participants (Healthy Controls [HC] n = 50; Cognitively Impaired [CI] n = 50) were recruited, and 90 completed the RIMCAT twice, with verbal prompts when necessary. Participants then completed an exit survey regarding their experience.ResultsAll HC completed the RIMCAT, but four CI individuals could not. Most finished in under 30 min. HC (M = 2.18, SD = 1.93) required significantly fewer prompts during the first RIMCAT administration compared to the CI group (M = 3.82, SD = 2.87). Both groups needed fewer prompts on the second visit, with prompts often related to input methods, button use, and instruction comprehension.ConclusionsThe RIMCAT shows promise for self-administration, particularly with minor modifications that could improve clarity, interface design, and user experience for optimal usability and self-administration.