Journal of Geriatric Psychiatry and Neurology最新文献

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.

Background: Although primarily characterised as a motor disorder, Parkinson's Disease (PD) also presents with non-motor symptoms, including cognitive decline and affective dysfunction, which are major predictors of quality of life and mortality for individuals. However, factors associated with these non-motor symptom trajectories remain under-characterised. Purpose: This study aimed to investigate predictors of cognitive and affective function over a 5-year follow-up period using data from the Progressive Parkinson's Marker Initiative. Results: Fuzzy C-means clustering analysis of year-5 cognitive and affective function scores showed two clusters. The second group (n = 96) were older and had worse cognition, affective, and motor functioning at year-5 follow-up compared to the first (n = 213). Predictors of cluster membership was assessed in n = 113 individuals for whom data on all variables of interest were available (cluster 1/2 = 79/34). Cluster membership at 5-year follow-up was significantly predicted by baseline cognitive and affective function, as well as decreased levels of CSF amyloid-beta and increased CSF concentrations of phosphorylated-tau at baseline. Alternative non-linear supervised machine learning model (support vector regressor) using the same predictors improved classification accuracy by 5%. Conclusion: Our analysis highlights that including established biomarkers of other neurocognitive disorders (namely, amyloid-beta and phosphorylated-tau) also has utility for predicting cognitive and affective trajectory in PD. This suggests that assessing a multi-modal panel of prognostic markers, beyond clinical symptom presentation alone, may have utility for informing prognosis of cognitive and affective outcomes in PD. This is significant, potentially allowing for the earlier development of personalised therapeutic interventions for those at highest risk of impairment within these non-motor domains.

Major Depressive Disorder (MDD) and Alzheimer's disease (AD) represent two of the most prevalent diseases worldwide. Notably, it is estimated that 30%-50% of individuals with AD have co-occurring MDD and there are overlapping symptoms across numerous domains. In this pilot study, a Deep TMS protocol (targeting the left frontal and bilateral temporal regions) was delivered for 36 sessions to patients with co-occurring MDD and early-stage AD (N = 12). All participants received the treatment and there was no control condition. The treatment yielded a response rate of 83.33% (defined by a ≥50% reduction in depressive symptoms on the Patient Health Questionnaire-9 [PHQ-9]) and a remission rate of 50.00% (PHQ-9 score of 4 or less following treatment). Further, participants displayed reductions in left prefrontal and right temporal delta power using QEEG analysis pre- and -post treatment. Alpha coherence was also enhanced in key areas. The observed shift in neurophysiological measures suggested reduced cortical slowing and dysconnectivity, which are hallmark traits in MDD and AD. This proof-of-concept study suggests that further research on the application of Deep TMS (paired with QEEG) for early-stage AD is warranted.

ObjectivesTo address the prevalence and risk factors of suicidal outcomes in people with mild cognitive impairment or dementia.MethodsFour databases were searched for studies reporting data on the prevalence or the risk of a suicidal event, in people with a clinical diagnosis of MCI or dementia. The research was conducted according to PRISMA guidelines. A narrative synthesis was used to report the main findings. A random effect model was used across all analyses to calculate the prevalence and the odds ratio of suicidal outcomes in people with dementia.ResultsFifty-nine studies were included. The pooled prevalence of suicidal outcomes in people with dementia were as follows: suicidal ideation: 9.7% (95%CI 6.7-13.9), suicide attempt: 0.8% (95%CI 0.3-2.4), and suicidal death: 0.2% (95%CI 0.1-0.4). People with dementia had an increased risk of suicidal ideation (OR 1.87, 95%CI 1.21-2.88) and suicide attempt (OR 2.4, 95%CI 1.24-4.65) but no significant increase in the risk of suicidal death. The heterogeneity was high for each outcome. The risk factors for suicidal death in dementia were younger age, recent diagnosis, previous mental health disorder, and frontotemporal dementia. The prevalence of suicidal ideation in MCI ranged from 5 to 17.6%, with a moderate increase in suicide attempts (HR 1.34, 95%CI 1.09-1.65) and no increase in suicidal death.ConclusionsPeople with dementia frequently have suicidal thoughts and are at an increased risk of suicide attempts. Clinicians should be careful to identify those at higher risk in order to offer them supportive care and restrict their access to lethal means.

BackgroundPerceived fatigability-subjective physical or mental energy depletion within specified activity contexts-is prevalent in aging and neurological conditions. Although the Pittsburgh Fatigability Scale (PFS) is validated for older adults and those with multiple sclerosis (OAMS), its subscale cut-offs and clinical relevance for cognitive and mobility outcomes have not been examined in neurologically affected aging populations.MethodsWe studied 224 older adults (≥60 years): 109 OAMS and 115 controls who completed the PFS, neuropsychological testing, the Short Physical Performance Battery (SPPB), and, for OAMS, the Patient Determined Disease Steps (PDDS). Receiver operating characteristic (ROC) analyses assessed PFS subscales' accuracy in discriminating MS, mild cognitive impairment (MCI), mobility impairment (SPPB ≤9), and worse MS-related disability (PDDS ≥2). Logistic regression adjusting for demographic and clinical covariates generated refined ROC curves and cut-offs.ResultsBoth PFS subscales demonstrated moderate accuracy (area under the curve 0.59-0.75) for discriminating MS, MCI, and mobility impairment when unadjusted, with accuracy often exceeding 0.80 after covariate adjustment. Among OAMS, mental fatigability more accurately identified MCI, whereas physical fatigability better detected worse MS-related disability. Cut-offs were higher in OAMS than in healthy controls, varying by subscale and clinical outcome. Adjusted analyses revealed nuances in cut-offs, with physical fatigability thresholds consistently higher than mental fatigability.ConclusionPFS subscales can identify MS, cognitive impairment, and mobility impairment in older adults. Cut-offs appear population- and outcome-specific, indicating that thresholds derived from healthy older cohorts may not apply directly to neurological populations. Covariate adjustment refines discriminative accuracy, potentially guiding need for further functional monitoring.

ObjectiveAnosognosia for memory deficits is frequently observed in patients with Alzheimer's disease (AD). Despite its relevance, this phenomenon is understudied in individuals with Mild Cognitive Impairment (MCI). People with MCI often struggle to update self-referential beliefs about memory functioning. Nonetheless, findings on error monitoring capacity are mixed and methodologically weak, especially in visuospatial tasks. Here, we investigated online metamemory appraisal for verbal and visuospatial material in patients with MCI due to AD. The potential diagnostic utility of metamemory accuracy was evaluated.MethodsSixteen patients with MCI and 19 healthy controls completed metamemory tasks involving predictions on list and position memory performance. Metamemory accuracy was quantified using the Objective Judgment Discrepancy (OJD) index, the percentage difference between predicted and actual performance. Linear mixed-effects models were used to analyze main effects and interactions.ResultsCompared to controls, patients overestimated their memory performance (P < 0.001, d = 0.51), with greater overestimation in the visuospatial task (P < 0.001, d = 0.57). After adjusting for cognitive functioning, only overestimation in visuospatial memory persisted. Visuospatial OJD correlated significantly with executive and visuospatial abilities (all rho ≥ -0.50, P < 0.05). Clinimetric analyses highlighted visuospatial OJD as a promising marker for diagnostic use (AUC = 0.814, P < 0.001, sensitivity = 0.67, specificity = 0.95).ConclusionOverestimation in verbal memory reflects a statistical artifact consistent with the Dunning-Kruger effect. A selective metacognitive deficit was found in visuospatial memory. Our results support the view of AD as a visuospatial-driven disease and underscore the diagnostic potential of visuospatial metamemory assessments.