Journal of Geriatric Psychiatry and Neurology最新文献

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.

BackgroundThere is limited and inconsistent evidence on the association between electroencephalography (EEG) measured sleep and depressive symptoms among community-dwelling older adults. This study aimed to investigate the cross-sectional association between EEG-measured sleep and depressive symptoms.MethodsUsing baseline data from a randomized clinical trial, we included 66 sedentary community-dwelling older adults with sleep complaints (≥ 1 self-reported insomnia symptom). Sleep was measured using an in-home sleep EEG (Sleep Profiler™) for 2 nights and the Geriatric Depression Scale (GDS-15) was used to measure depressive symptoms. Multiple linear regression analyses were conducted with each sleep parameter as the primary predictor and GDS score as the outcome, adjusting for age, sex, race, education, marital status, chronic conditions, and Montreal Cognitive Assessment (MoCA) score.ResultsSeveral sleep variables were associated with depressive symptoms (GDS score), including a higher percentage of sleep stage N1 (B = 0.11, 95% confidence interval [CI]: 0.02 - 0.20) and N2 (B = 0.04, 95% CI: 0.00 - 0.08), a lower percentage of N3 sleep (B = -0.04, 95% CI: -0.08 to -0.01), greater wake after sleep onset (B = 0.01, 95% CI: 0.00 - 0.02), and a greater number of awakenings ≥90s/hour (B = 0.87, 95% CI: 0.21-1.53).ConclusionsOur study reveals that among sedentary community-dwelling older adults with sleep complaints, more lighter sleep (stage N1, N2), less deep (N3) sleep, and increased awakenings are associated with more depressive symptoms. Sleep interventions aimed at enhancing sleep architecture may also help alleviate depressive symptoms in this population.

ObjectiveTo compare gray matter (GM) and white matter (WM) changes in patients with Alzheimer's disease (AD), Lewy body dementias (LBD), corticobasal syndrome (CBS), and healthy controls (HC).MethodsSurface-based morphometry (SBM) was assessed on 3D T1-weighted images using FreeSurfer image analysis and WM microstructure was studied using Tract-Based Spatial Statistics (TBSS) in 12 AD, 15 LBD, 10 CBS patients, and 10 HC.ResultsPatients with AD, compared with HC, exhibited reduced cortical surface area and volume in the superior frontal, middle frontal, and medial orbitofrontal cortex. In TBSS, AD patients, compared with HC and LBD, displayed decreased fractional anisotropy, axial diffusivity, and increased radial diffusivity in all major WM tracts. Other comparisons between the groups yielded no differences, either in the SBM or the TBSS analysis.ConclusionsThe results indicate significant early structural changes in the GM of the frontal lobe, along with WM alterations early in AD patients.

Switching, a critical executive function, can manifest as task switching (TS) or response switching (RS). Although TS impairments in Parkinson's disease (PD) are well-studied, RS, especially in contexts requiring adaptive behavior to external or internal cues, is less explored. This study evaluated the impact of PD on RS under exogenous and endogenous cueing. Using a gamified, remote task triggering these cues, RS was assessed in 85 PD patients and 82 neurologically healthy participants (NHP). RS cost was quantified by comparing reaction times between repeating and changing responses. A linear mixed model analyzed the effects of group, cueing mode, and their interaction on RS cost. PD patients exhibited increased RS costs under exogenous cueing but not under endogenous cueing. These findings indicate that while PD patients can effectively use predictive endogenous cues, they struggle with less predictive exogenous cues, emphasizing the need for compensatory strategies and technological aids in daily activities.

PurposeAnticholinergic medication use measured via the Anticholinergic Cognitive Burden (ACB) scale has been associated with an increased dementia incidence in older adults but has not been explored specifically for Parkinson disease dementia (PDD). We used adjusted Cox models to estimate the risk of incident PDD associated with demographic factors, clinical characteristics, and time-varying total ACB in a longitudinal, deeply-phenotyped prospective PD cohort.Major findings56.5% of study participants were taking ACB-scale drugs at enrollment. Increasing age, motor symptom burden and psychosis were associated with PDD risk. Female sex and educational achievement were protective against PDD. ACB categories were not associated with PDD overall, but depression and impulse control disorder were strongly associated with PDD in a subsample with high baseline ACB.ConclusionsPatient and clinical factors modify PDD risk. PD drug safety and drug-disease interaction studies may require considering multiple mechanisms and including dose-based, prospectively acquired medication exposure measures.

BackgroundMonolingual cognitive assessments are standard for bilinguals; the value of bilingual assessment is unknown. Since declines in animal naming accompany memory declines in dementia, we examined the association between bilingual animal naming and memory among bilingual Mexican American (MA) older adults.MethodsBilingual MA (n = 155) completed the Harmonized Cognitive Assessment Protocol (HCAP) in a Texas community study. Regressions included HCAP memory score (English) as the outcome and English and Spanish animal naming trials as independent variables; demographics and language dominance were covariates.ResultsEnglish animal naming (b = 0.06, P = 0.004) was more reliably associated with memory than Spanish (b = 0.05, P = 0.06). Considered together, only English (b = 0.05, P = 0.02) was associated with memory, not Spanish (b = 0.01, P = 0.63). Conclusions: Spanish animal naming did not uniquely add to English animal naming in its association with memory among bilingual older MA.

BackgroundPsychosis occurs in approximately 41% of patients living with Alzheimer's disease. Previous findings from our group based on analyses of a neuropathological cohort suggest that among AD patients with Lewy Body pathology, female APOE4 homozygotes are at significantly greater risk of psychosis. This study aims to replicate this finding in a clinical cohort using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset.MethodsOur group used data from a sample of patients with AD in the ADNI database from the ADNI1, ADNI2, ADNI3, and ADNIGO studies. We defined psychosis status as experiencing hallucinations or delusions at one time point based on the Neuropsychiatric Inventory. We then used forward binary logistic regression to determine if sex and APOE4 status are predictors of AD + P.ResultsIn total there were 204 participants who met the inclusion criteria, 133 of which were male, and 71 of which were female. Fifty-six patients were APOE4 non-carriers, 109 patients were APOE4 heterozygote carriers, and 39 were APOE4 homozygote carriers. In total, there were 59 patients with psychosis. When adjusting for mini mental state examination score, adjusted hippocampal volume, and age, we demonstrate that female APOE4 homozygotes have a significantly increased risk of psychosis compared to other groups (P = 0.0264, OR = 19.50).DiscussionThe results of our study demonstrate a significant association between psychosis risk and female APOE4 homozygotes, thus corroborating findings from a neuropathological cohort. The effects of APOE ε4 on psychosis risk are significant only in females, and not in males.

ObjectiveTraumatic Brain Injury (TBI) may contribute additional complexity to the clinical picture of mild behavioral impairment (MBI). MBI, a behavioral analog to mild cognitive impairment (MCI), is comprised of five neuropsychiatric domains: decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, and abnormal perception/thought content. We investigated (1) if cross-sectional associations of cognitive status with MBI symptoms differ by TBI status and (2) if prospective associations of MBI domain positivity with incident dementia risk differ by TBI status.Methods2246 participants without dementia from the Atherosclerosis Risk in Communities Study were included (mean age = 75.6 years, 59.0% female). TBI was defined by self-report/ICD-9/10 codes, MBI via an established algorithm based on the Neuropsychiatric Inventory Questionnaire, and baseline cognitive status/incident dementia using neuropsychological tests, informant interviews, and hospital/death certificate codes.ResultsCross-sectionally, although MCI status was associated with greater odds of MBI, this did not differ based on TBI status (MCI with TBI: OR = 2.04, 95% CI = 1.44-2.88, MCI without TBI: OR = 1.60, 95% CI = 1.20-2.14). Individuals with MCI (with or without TBI) were more likely to have decreased motivation, affective dysregulation, and impulse dyscontrol. Prospectively, positivity in 1+ MBI domains was associated with increased risk of incident dementia, not differing by TBI status (no TBI and MBI: HR = 2.15, 95% CI = 1.55-2.99, TBI and MBI: HR = 2.62, 95% CI = 1.81-3.80).ConclusionsNeither cross-sectional associations between cognitive status and MBI domain positivity nor prospective associations of MBI domain positivity with incident dementia risk differed by TBI status. How TBI may relate to neuropsychiatric symptomatology in the context of neurodegenerative processes requires further clarification.

Within the global population, depression and anxiety are common among older adults. Tai Chi is believed to have a positive impact on these disturbances. This study examined the network structures of depression and anxiety among older Tai Chi practitioners vs non-practitioners. Propensity score matching (PSM) was used to construct a non-practitioner group based on Chinese Longitudinal Healthy Longevity Survey (CLHLS) data. 346 Tai Chi practitioners and 1019 non-practitioners were included. The prevalence and severity rates of depression were significantly lower among Tai Chi practitioners compared to non-practitioners though there was no group difference for anxiety. Network analysis showed that, among Tai Chi practitioners, "Felt sadness", "Uncontrollable worrying" and "Trouble relaxing" were the most central symptoms. In contrast, among non-practitioners, the most central symptoms were "Felt sadness", "Uncontrollable worrying", and "Nervousness". Key bridge symptoms linking depressive and anxiety symptoms were "Worry too much", "Bothered by things" and "Uncontrollable worrying" in Tai Chi practitioners and "Nervousness", "Felt nervous/fearful" and "Sleep quality" in non-practitioners. This study underscored how practising Tai Chi is associated with reduced overall prevalence and severity of depression and different interactions of depressive and anxiety symptoms among older adults. Central and bridge symptoms differed between Tai Chi practitioners and non-practitioners.