Journal of Geriatric Psychiatry and Neurology最新文献

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.

IntroductionThe global rise in dementia presents significant challenges for healthcare systems. While Alzheimer's disease (AD) dominates dementia care, people with non-Alzheimer's dementias (non-AD), such as dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), vascular dementia (VD), and Parkinson's disease dementia (PDD), often have distinct and unmet healthcare needs.AimThis systematic review aimed to summarise evidence on healthcare utilisation (HCU) patterns and factors affecting care among people living with non-AD dementias.MethodsFollowing a PROSPERO-registered protocol (CRD42024568391), comprehensive searches of Embase, Ovid MEDLINE, Global Health, PsycINFO, and PubMed were conducted in February and June 2024. Peer-reviewed English-language studies reporting on HCU or its determinants in DLB, FTD, VD, or PDD were included. Reviews, case reports, grey literature, and studies without subtype-specific data were excluded. Quality was assessed using the Newcastle-Ottawa Scale.ResultsThirty-one studies (16 cohort; 10 cross-sectional, 4 case-description, and 1 chart review) were included. HCU varied by dementia subtype and was influenced by sociodemographic, cognitive, and clinical factors. Compared with AD, non-AD dementias had higher healthcare use and costs. PDD showed the highest inpatient, outpatient, and skilled nursing care use, driven by severe cognitive decline. DLB was linked to unplanned hospital admissions and frequent ambulance use, often due to falls and pneumonia. FTD resulted in extended hospital stays related to behavioural symptoms, while VD incurred high costs due to chronic comorbidities and long-term care needs.ConclusionPeople with non-AD dementias have greater and distinct healthcare needs. Future research should develop standardised measures and tailored interventions to address their complex socioeconomic and clinical requirements.

BackgroundAgitation is a frequent and distressing neuropsychiatric symptom in patients with Alzheimer's disease (AD), often leading to increased caregiver burden, institutionalization, and healthcare costs. While antipsychotics are commonly prescribed, their use is limited by safety concerns. Selective serotonin reuptake inhibitors (SSRIs), such as citalopram and escitalopram, have emerged as alternative treatments with a more favorable safety profile. This study aimed to evaluate the efficacy and safety of these agents in the management of agitation in AD.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing citalopram or escitalopram with placebo or other pharmacological treatments in older adults with AD and clinically defined agitation. Primary outcomes included changes in agitation severity, assessed by the Neuropsychiatric Inventory-Clinician Rating (NPI-C) and the Neurobehavioral Rating Scale (NBRS). Secondary outcomes included cognitive function (MMSE), anxiety symptoms, and adverse events. Standardized mean difference (SMD) and risk ratio (RR) were pooled using a random-effects model.ResultsFour RCTs comprising 502 patients were included. Pooled analysis showed no significant improvement in agitation severity (SMD -0.67; 95% CI -2.58, 1.25; I² = 98.3%) or cognitive outcomes (SMD 2.43; 95% CI -2.55, 7.41). Rates of serious adverse events (RR 0.85; 95% CI 0.50, 1.45) and treatment discontinuation (RR 1.05; 95% CI 0.80, 1.37) were similar between groups. However, SSRI use was associated with an increased risk of falls (RR 1.78; 95% CI 1.15, 2.75; I² = 0%).ConclusionEscitalopram and citalopram do not significantly reduce agitation in AD but are generally well tolerated. Increased fall risk warrants cautious clinical use.Registration PROSPERO protocol numberCRD420251055237.

BackgroundLate-life depression often co-occurs with neurological disorders such as dementia, significantly impacting cognitive function and overall well-being. Mild cognitive impairment represents a critical stage between normal aging and dementia, often accompanied by depressive symptoms. Electroencephalography (EEG) offers a non-invasive method to investigate underlying neural mechanisms associated with depressive symptoms and cognitive dysfunction.MethodsThis study included 80 participants categorized into four groups: MCI without depressive symptoms (MCI), MCI with depressive symptoms (MCI-d), cognitively unimpaired individuals without depressive symptoms (CU), and cognitively unimpaired individuals with depressive symptoms (CU-d). Participants underwent neuropsychological evaluations and EEG recordings during a visual oddball paradigm. Event-related oscillations (EROs) in delta, theta, alpha, and beta frequencies were analyzed in frontal, central, parietal, temporal, and occipital electrode locations.ResultsDelta ERO showed a significant decrease in amplitude in CU-d, MCI, and MCI-d groups compared to CU in frontal, central, and parietal regions. In the temporal area, MCI-d exhibited lower delta amplitudes compared to both CU and CU-d, while MCI showed lower amplitudes compared to CU. No significant differences were observed in theta, alpha, and beta frequencies. Correlation analyses revealed moderate to strong associations between frontal, central, parietal, and temporal delta amplitudes with various neuropsychological test scores, indicating a link between delta oscillations and cognitive function.DiscussionOur findings suggest that delta oscillations may serve as potential marker for cognitive dysfunction, particularly in individuals with MCI and depressive symptoms. Notably, lower delta amplitudes were observed in cognitively unimpaired individuals with depressive symptoms compared to those without, underlining the impact of depressive symptoms on cognitive function in healthy elderly individuals. Further studies can bring out that neurophysiological measures may help revealing the effect of depressive symptoms on cognition that was undetected by cognitive testing.

ObjectiveThe Montreal Cognitive Assessment (MoCA) Memory Index Score (MIS) is a supplemental assessment of memory composed of word list delayed free-recall followed by step-down category cued- and multiple-choice cued-recall. This paper reviews the MIS literature within Alzheimer's and other neurodegenerative dementias to synthesize evidence regarding its clinical utility, identify gaps, and inform future research directions.MethodWe searched electronic databases of OVID Medline, Embase, PsycINFO, and PubMed from 2014, when the MIS was first described, to July 2025. Peer-reviewed studies that reported data on the diagnostic or prognostic utility of the MIS in assessing neurodegenerative dementia populations were included.ResultsWe screened 278 articles, and 14 were included in the review. The current literature includes limited reporting on the diagnostic or prognostic utility of the MIS and is characterized by minimal diversity of samples and non-rigorous validation methods. Initial findings are promising and suggestive of incremental validity over the MoCA total score for identifying episodic memory impairment and therefore aiding in differentiation of suspected dementia etiology. However, evidence is insubstantial for the MIS as a tool for predicting progression and additional research is needed to evaluate the incremental validity of the MIS over the conventional MoCA five-word recall score.ConclusionsLarge literature gaps exist regarding the clinical utility of the MIS within neurodegenerative dementias. Additional research exploring the psychometric properties of the MIS using diverse samples with rigorous validation methods is needed to better inform its application.

BackgroundAs the prevalence of Alzheimer disease (AD) rises, early identification of at-risk individuals is essential for effective intervention. Mild behavioral impairment (MBI), which captures emergent and persistent neuropsychiatric symptoms (NPS) in later life, may enhance early detection of AD; however, its associations with 2024 NIA-AA Core 1 biomarkers remain unexplored. We investigated associations between MBI and cerebrospinal fluid (CSF) amyloid β-42 (Aβ42) and phosphorylated tau-181 (p-tau181).MethodBaseline data from 1327 dementia-free Alzheimer's Disease Neuroimaging Initiative (ADNI) participants were analyzed. Participants were classified as MBI, non-MBI NPS, or no NPS. Gaussian mixture modeling defined biomarker positivity. Logistic and multinomial logistic regressions modeled associations between NPS status and biomarker positivity or biomarker profiles, adjusting for age, sex, education, and cognition.ResultsMBI was associated with Aβ42+ (aOR = 2.26; 95% CI = 1.71-2.99), p-tau181+ (aOR = 1.72; 95% CI = 1.30-2.28), and AD continuum profile (aOR = 2.33; 95% CI = 1.73-3.14), but not with non-AD pathology. Non-MBI NPS showed no associations.ConclusionMBI may serve as a behavioral marker of AD pathology.