American Journal of Geriatric Psychiatry最新文献

A Comparative Analysis of Fatal Outcomes in 5,370 Geriatric Versus 12,254 Nongeriatric Adult Patients: A Clozapine Study in VigiBase 5370名老年患者与12254名非老年成年患者致命结局的比较分析：一项氯氮平在VigiBase的研究

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-02-20 DOI: 10.1016/j.jagp.2025.08.010

Jose de Leon M.D. , Can-Jun Ruan Ph.D. , Georgios Schoretsanitis M.D., Ph.D. , Hélène Verdoux M.D., Ph.D. , Joseph Friedman M.D. , Emilio J. Sanz M.D., Ph.D. , Carlos De las Cuevas M.D.

Objective

Fatal outcomes associated with clozapine adverse drug reactions (ADRs) were studied for over/underrepresentation in geriatric patients.

Design, Setting, Participants

The worldwide pharmacovigilance database (VigiBase) was studied for fatal outcomes associated with clozapine ADRs from 1974 to January 15, 2023. They included 5,370 geriatric cases (≥65 years) versus 12,254 nongeriatric adult controls.

Measurements

Fatal outcomes of clozapine ADRs were ranked by frequency. Over/underrepresentation was determined by comparison with nongeriatric controls using univariate odds ratios (OR), their 95% confidence intervals (CIs) and adjusted ORs after adjusting for major confounders.

Result

Respiratory complications likely associated with swallowing impairment led to 1,042 fatal outcomes (19% of all geriatric fatal outcomes and 31% of those with specific information) and was the most overrepresented ADR among the geriatric cases (adjusted OR = 2.53; CI, 2.31–2.78). More than 99% of these 1,042 respiratory fatal outcomes were not explained by agranulocytosis. Agranulocytosis led to only 39 fatal outcomes (0.7% of the geriatric fatal outcomes) and was underrepresented in the geriatric cases (adjusted OR = 0.59; CI, 0.41–0.85). Other underrepresented fatal outcomes were acute cardiac fatal outcomes (adjusted OR = 0.62, CI, 0.59–0.69), myocarditis (adjusted OR = 0.08, CI, 0.03–0.25), completed suicide (adjusted OR=0.14, CI 0.09–0.14) and pulmonary embolism (adjusted OR = 0.37, CI, 0.28–0.49).

Conclusion

As hematological monitoring is used in most countries for clozapine, agranulocytosis is very rarely fatal. According to VigiBase, in order to prevent the largest number of deaths in clozapine-treated patients, psychiatrists need to focus on respiratory complications likely associated with swallowing impairment; this is most evident in geriatric patients.

目的：研究与氯氮平不良反应（adr）相关的致命结局在老年患者中的代表性过高/不足。设计、环境、参与者：从1974年到2023年1月15日，研究了全球药物警戒数据库（VigiBase）中与氯氮平不良反应相关的致命结局。他们包括5370例老年病例（≥65岁）和12254例非老年成人对照。测量：氯氮平不良反应的致死结果按频率排序。通过使用单变量优势比（OR）、95%置信区间（ci）和调整主要混杂因素后的调整ORs与非老年对照进行比较，确定代表性过低。结果：可能与吞咽障碍相关的呼吸并发症导致1042例死亡结果（占所有老年死亡结果的19%，占具有特定信息的患者的31%），并且是老年病例中最严重的ADR（调整后OR = 2.53； CI, 2.31-2.78）。在1042例呼吸系统死亡病例中，99%以上不能用粒细胞缺乏症来解释。粒细胞缺乏症仅导致39例死亡结果（占老年死亡结果的0.7%），并且在老年病例中的代表性不足（调整后OR = 0.59； CI, 0.41-0.85）。其他未被充分代表的死亡结局包括急性心脏死亡结局（校正OR= 0.62， CI, 0.59-0.69）、心肌炎（校正OR= 0.08， CI, 0.03-0.25）、自杀未遂（校正OR=0.14, CI 0.09-0.14）和肺栓塞（校正OR= 0.37， CI, 0.28-0.49）。结论：由于大多数国家对氯氮平进行血液学监测，因此粒细胞缺乏症很少致死性。根据VigiBase的说法，为了防止氯氮平治疗的患者死亡人数最多，精神科医生需要关注可能与吞咽障碍相关的呼吸系统并发症；这在老年患者中最为明显。

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引用次数: 0

Allostatic Load and Physical Frailty Increase the Risk of Depression Recurrence in Middle-Aged and Older Adults: A Prospective Cohort Study 适应负荷和身体虚弱增加中老年人抑郁症复发的风险：一项前瞻性队列研究。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-07-29 DOI: 10.1016/j.jagp.2025.07.009

Boyue Zhao , Xin Qi , Jinyu Xia , Xinyang Li , Jingni Hui , Yifan Gou , Wenming Wei , Chuyu Pan , Dan He , Jin Feng , Xuena Yang , Shiqiang Cheng , Feng Zhang

Aims

Individuals with prior depressive episodes have a more fragile homeostasis, but the exploration of depression recurrence remains limited. Our study aimed to explore the associations of allostatic load (AL) and frailty with the risk of depression recurrence.

Methods

This study included 9,936 individuals from the UK Biobank who reported depression prior to recruitment. AL and frailty were estimated based on 10 biomarkers and 5 indicators, respectively. The outcome was recurrence of depression, determined by International Classification of Diseases (ICD-10) codes based on self-report, inpatient hospital data, primary care, and death records. Cox proportional hazards models were used to assess the prospective association of AL and frailty with the risk for recurrence of depression, and stratified analyses were conducted by gender, age, and Townsend deprivation index (TDI). Additionally, the mediating effect of either AL or frailty on the association of the other with the recurrence of depression was examined.

Results

During a median follow-up of 13.19 years, 1,864 individuals with depression experienced recurrence of depression. Compared to those with low AL, individuals with medium (HR: 1.25; 95% CI: 1.11–1.41) and high AL (HR: 1.42; 95% CI: 1.26–1.60) had an increased risk of depression recurrence. Compared to nonfrail individuals, those with prefrailty (HR: 1.43; 95% CI: 1.28–1.59) and frailty (HR: 1.72; 95% CI: 1.48–1.99) had an increased risk of depression recurrence. The stronger effects were observed in women and middle-aged groups. Bidirectional mediation analyses revealed that frailty mediated 22.42% of allostatic load's effect on recurrence risk, while AL mediated 12.27% of frailty's effect.

Conclusion

Assessing AL and frailty may help identify individuals at high risk of depression recurrence, with their simultaneous management potentially mitigating this risk.

目的：既往抑郁发作的个体具有更脆弱的体内平衡，但对抑郁症复发的探索仍然有限。我们的研究旨在探讨适应负荷（AL）和虚弱与抑郁症复发风险的关系。方法：本研究包括9936名来自英国生物银行的个体，他们在招募前报告有抑郁症。AL和脆弱性分别根据10个生物标志物和5个指标进行评估。结果是抑郁症复发，由国际疾病分类（ICD-10）代码确定，该代码基于自我报告、住院患者数据、初级保健和死亡记录。采用Cox比例风险模型评估AL和虚弱与抑郁症复发风险的前瞻性关联，并按性别、年龄和汤森剥夺指数（TDI）进行分层分析。此外，研究了AL或虚弱对另一方与抑郁症复发的关联的中介作用。结果：在中位随访13.19年期间，1,864名抑郁症患者经历了抑郁症复发。与低AL患者相比，中度AL患者（HR: 1.25; 95% CI: 1.11-1.41）和高AL患者（HR: 1.42; 95% CI: 1.26-1.60）抑郁症复发风险增加。与非体弱个体相比，易患（HR: 1.43; 95% CI: 1.28-1.59）和体弱（HR: 1.72; 95% CI: 1.48-1.99）的个体抑郁症复发风险增加。在女性和中年人群中观察到更强的影响。双向中介分析显示，衰弱介导了22.42%的适应负荷对复发风险的影响，而AL介导了12.27%的衰弱效应。结论：评估AL和虚弱可能有助于识别抑郁症复发的高风险个体，同时对其进行管理可能会降低这种风险。

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引用次数: 0

Agitation in Alzheimer’s Disease as a Qualifying Condition for Medical Cannabis in the United States: A Brief Report on Current Trends 在美国，阿尔茨海默病的躁动作为医用大麻的合格条件：关于当前趋势的简要报告。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-06-11 DOI: 10.1016/j.jagp.2025.06.003

Erin E. Bonar Ph.D. , Chiu Yi Tan M.S.W. , Adam Patyk B.A. , Lianlian Lei Ph.D. , Donovan T. Maust M.D., M.S.

Objectives

We assessed state-level access to medical cannabis with Alzheimer’s Disease and related agitation (AD) as a qualifying condition.

Methods

In 2024–2025, we examined regulatory agencies’ publicly available online reports regarding medical cannabis, including use specifically for AD.

Results

Of 38 states that allow medical cannabis, 19 (50%) allow medical cannabis for AD. AD accounts for <1% of medical cannabis certifications. Some data suggest that AD as a qualifying condition is declining in states that have legalized recreational cannabis use.

Conclusions

Despite limited evidence of efficacy supporting medical cannabis for AD, this remains a qualifying condition in 19 states, though it is invoked for a small minority of the population. With increasing medical and recreational cannabis access, there is a need for geriatric clinicians to assess and monitor cannabis use among the growing population of patients with AD across states with varied policies, particularly given decreases in medical program involvement.

目的：我们评估了阿尔茨海默病和相关躁动（AD）作为合格条件的州一级获得医用大麻。方法：在2024-2025年，我们审查了监管机构关于医用大麻的公开在线报告，包括专门用于AD的使用。结果：在38个允许医用大麻的州中，19个（50%）允许用于AD的医用大麻。结论：尽管支持医用大麻对阿尔茨海默病有效的证据有限，但这仍然是19个州的合格条件，尽管它适用于少数人口。随着越来越多的医疗和娱乐大麻的获取，老年临床医生有必要评估和监测政策不同的州越来越多的阿尔茨海默病患者的大麻使用情况，特别是考虑到医疗方案的参与减少。

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引用次数: 0

Decline of Aging: Aesthetics and Ethics of Care 衰老的衰落：护理的美学与伦理。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-14 DOI: 10.1016/j.jagp.2026.01.005

George S. Alexopoulos M.D.

Drawing on contemporary phenomenology, existential philosophy, predictive processing models and care ethics, this paper argues that finitude reorganizes both clinical attention and moral salience. Across philosophical traditions from Heidegger, Levinas, Carel, and Butler, beauty and ethics are intensified by transience. What is fragile, passing, and irreplaceable receives heightened attention because it cannot be secured. The paper challenges heroic existential models that consider awareness of death as a stimulus for authenticity, radical freedom, or rebellion. Such models assume a reliable body, an unconstrained agency, and an open future, assumptions undermined by aging. In phenomenology of aging and illness, agency is reconceptualized as dependent on both bodily abilities and external supports rather than the individual’s free choice among stable options. In clinical encounters, attention functions as a mechanism of precision-weighting that shapes the interpretation of clinical information and drives treatment choices. Predictive processing illustrates how diagnostic formulations can act as top-down constraints conferring salience to certain symptoms and undervaluing aspects of the patient’s narrative. Ethics of attention invites clinicians to examine the parts of a clinical encounter to which they allocate salience and remain responsive to patients’ vulnerability, partial persistence, and meaning of relationships. The paper proposes care ethics as a framework that locates moral value not in decisive interventions for restoring autonomy, but in sustained presence and responsiveness. Vulnerability and decline are not failures but conditions that generate shared responsibility. Recognizing temporality as central to aesthetic and moral experience supports an ethics of care attuned to what is transient and human.

本文借鉴当代现象学、存在主义哲学、预测加工模型和护理伦理学，认为有限性重构了临床关注和道德突出性。在海德格尔、列维纳斯、卡里尔和巴特勒等哲学传统中，美和伦理都因短暂而得到强化。易碎的、转瞬即逝的、不可替代的东西因为无法得到保障而受到高度关注。这篇论文挑战了英雄存在主义模型，这些模型认为对死亡的意识是对真实性、激进自由或反叛的刺激。这些模型假设了一个可靠的身体，一个不受约束的机构和一个开放的未来，这些假设被老龄化所破坏。在衰老和疾病的现象学中，能动性被重新定义为依赖于身体能力和外部支持，而不是个体在稳定选项中的自由选择。在临床遭遇中，注意力作为一种精确加权机制，塑造了对临床信息的解释，并推动了治疗选择。预测处理说明了诊断公式如何作为自上而下的约束，赋予某些症状的突出性，并低估了患者叙述的各个方面。关注伦理邀请临床医生检查临床遭遇的部分，他们分配了突出性，并对患者的脆弱性，部分持久性和关系的意义做出反应。本文提出护理伦理作为一个框架，定位道德价值，而不是决定性的干预恢复自主权，但在持续的存在和响应。脆弱性和衰退不是失败，而是产生共同责任的条件。认识到时间性是审美和道德经验的核心，支持了一种与短暂和人类相协调的关怀伦理。

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引用次数: 0

The Independent Effect of Depression on Financial Decision-Making in Older Adults—Commentary 抑郁对老年人财务决策的独立影响-评论。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-17 DOI: 10.1016/j.jagp.2026.01.008

Dora Kanellopoulos Ph.D. , Dimitris N. Kiosses Ph.D.

引用次数: 0

Electroconvulsive Therapy for Aggression and Agitation in Dementia: A Systematic Review With Exploratory Meta-analytic and Ethical Perspectives 电痉挛疗法治疗痴呆患者的攻击和躁动：一项探索性荟萃分析和伦理观点的系统综述。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.jagp.2026.01.004

Sarah Kayser M.D., M.Sc. , Andreas Fallgatter M.D. , Florian Funer M.D., M.A.

Aggression and agitation are among the most distressing and treatment-resistant behavioral and psychological symptoms of dementia (BPSD), and conventional pharmacological or behavioral interventions often provide limited benefit and carry substantial risks in frail older adults. We conducted a systematic review in accordance with PRISMA guidelines, searching PubMed, EMBASE and the Cochrane Library through September 24, 2025 for clinical studies of electroconvulsive therapy (ECT) for agitation and/or aggression in dementia, including case reports, case series, observational cohorts, chart reviews and randomized trial protocols. Data on patient characteristics, ECT parameters, outcomes, adverse events and consent procedures were extracted, and exploratory random-effects pooling of clinical response rates was performed. Thirteen studies including 206 patients met inclusion criteria. Across studies, most patients showed clinically relevant improvement, with reported response rates typically between 70% and 90%; exploratory meta-analytic pooling yielded a clinical response proportion of 77.7% confidence interval CI (95% CI 71.0%–83.3%), which remained stable in sensitivity analyses (n ≥ 5: 81.2%, 95% CI 71.7%–88.0%). Improvement usually emerged within 2–4 treatments (median = 3 sessions), and reductions in agitation and aggression were supported by validated instruments such as the Cohen–Mansfield Agitation Inventory (CMAI) and Pittsburgh Agitation Scale (PAS). ECT was generally well tolerated, with mostly mild and transient adverse effects and no reported treatment-related deaths or persistent severe complications. Available evidence suggests that ECT may provide a rapid, effective and relatively safe last-resort option for otherwise refractory aggression and agitation in dementia, but confirmatory prospective and ethically informed controlled studies are needed.

攻击和躁动是痴呆症（BPSD）中最令人痛苦和最难以治疗的行为和心理症状之一，传统的药物或行为干预措施通常对体弱的老年人提供有限的益处，并带来巨大的风险。我们按照PRISMA指南，检索PubMed、EMBASE和Cochrane图书馆，检索到2025年9月24日为止的关于电痉挛疗法（ECT）治疗痴呆患者躁动和/或攻击的临床研究，包括病例报告、病例系列、观察性队列、图表回顾和随机试验方案。提取患者特征、ECT参数、结局、不良事件和同意程序的数据，并对临床反应率进行探索性随机效应汇总。13项研究包括206例患者符合纳入标准。在所有研究中，大多数患者表现出临床相关的改善，报告的缓解率通常在70%至90%之间；探索性荟萃分析汇集的临床反应比例为77.7%，可信区间CI (95% CI 71.0%-83.3%)，在敏感性分析中保持稳定（n≥5:81.2%,95% CI 71.7%-88.0%）。改善通常在2-4次治疗中出现（中位数= 3次），并且躁动和攻击的减少得到了诸如Cohen-Mansfield躁动量表（CMAI）和匹兹堡躁动量表（PAS）等有效工具的支持。ECT的耐受性一般良好，主要是轻微和短暂的不良反应，没有报道与治疗相关的死亡或持续的严重并发症。现有证据表明，ECT可能为痴呆症患者提供一种快速、有效和相对安全的最后手段，否则将难以治愈的攻击和躁动，但还需要证实性的前瞻性和符合伦理的对照研究。

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引用次数: 0

From Cultural Context to System Resilience: Advancing Global Mental Health for Older Adults 从文化背景到系统弹性：促进全球老年人心理健康。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-02-26 DOI: 10.1016/j.jagp.2025.11.013

Jie Chen Ph.D.

Population aging worldwide has intensified the need to understand how mental health in later life is shaped by both cultural norms and structural systems. The book Mental Health in Older People Across Cultures underscores the central role of culture in shaping expectations about independence, emotional expression, and family roles, particularly in the context of depression. In this commentary, we build on that foundation by emphasizing system-level resilience as a necessary complement to cultural understanding. Drawing on the SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, we argue that mental health outcomes emerge from interactions among cultural beliefs, healthcare access, social infrastructure, and broader system capacity. Structural challenges, including fragmented care coordination, multimorbidity, polypharmacy, digital exclusion, and caregiver strain, often intensify cultural vulnerabilities. Depression also contributes to spending differences among older adults, reinforcing the need for whole-person and whole-system approaches. We discuss the potential of Health information technology (HIT) and artificial intelligence to strengthen system-level resilience by improving early identification, medication management, care coordination, and culturally grounded communication. We conclude by calling for system-level measures that reflect cultural variation, structural capacity, and caregiver context, and for applying SUNSHINE across cultures to guide the development of more adaptive and supportive mental health systems for older adults.

世界范围内的人口老龄化加剧了了解文化规范和结构系统如何影响晚年心理健康的需要。《跨文化老年人的心理健康》一书强调了文化在塑造对独立、情感表达和家庭角色的期望方面的核心作用，特别是在抑郁症的背景下。在本评论中，我们在此基础上强调系统级弹性是文化理解的必要补充。根据SUNSHINE框架，老年人团结全国支持健康，综合护理和进化，我们认为心理健康结果来自文化信仰，医疗保健获取，社会基础设施和更广泛的系统能力之间的相互作用。结构性挑战，包括分散的护理协调、多种疾病、多种药物、数字排斥和护理人员压力，往往会加剧文化脆弱性。抑郁症也造成了老年人之间的消费差异，从而加强了对整个人和整个系统方法的需求。我们讨论了健康信息技术（HIT）和人工智能的潜力，通过改善早期识别、药物管理、护理协调和文化基础沟通来加强系统级弹性。最后，我们呼吁采取反映文化差异、结构能力和照顾者背景的系统级措施，并在不同文化中应用SUNSHINE来指导老年人更具适应性和支持性的心理健康系统的发展。

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引用次数: 0

Social Cognition and Loneliness in Older Adults: A Population-based Study 老年人社会认知与孤独感：一项基于人群的研究。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-12-06 DOI: 10.1016/j.jagp.2025.11.019

Soyoung Lee M.D. , Ruopu Song M.S. , Tiffany F. Hughes Ph.D. , Erin P. Jacobsen M.S. , Chung-Chou H. Chang Ph.D. , Nancy J. Donovan M.D. , Mary Ganguli M.D., M.P.H.

Background

Social isolation and loneliness represent objective and subjective aspects of low social connection. They are important psychosocial risk factors in late life, associated with poor physical health, cognitive decline, and psychiatric morbidities. Social cognition, the set of cognitive abilities essential for adaptive social interactions, could play a role in social isolation and loneliness, but has not been extensively investigated.

Methods

We investigated associations of social cognition with social isolation and loneliness in a large, prospective population-based cohort of older adults, followed for up to 5 years. Social cognition was measured by the Social Norms Questionnaire (SNQ22), measuring awareness of prevailing norms, and the Reading the Mind in the Eyes Test (RMET10), measuring cognitive empathy. Social connection was measured by composite measures of social isolation and loneliness. Cross-sectional linear regression and longitudinal linear mixed-effect models were performed to investigate the associations between social cognition, social isolation, and loneliness, adjusting for demographics, depression, anxiety, and general cognition.

Findings

The study included 792 older adults with mean age 74.9 years. Higher social norms awareness, but not cognitive empathy, was cross-sectionally associated with lesser loneliness, adjusting for all covariates, and it also predicted lesser loneliness over time. This association remained significant after adjusting for social isolation. Neither social cognition measure was associated with social isolation.

Interpretation

Better awareness of social norms, but not emotional perception and cognitive empathy, was associated with lesser loneliness concurrently and over time. These results warrant further investigation into the mechanisms linking social cognition and loneliness.

背景：社会隔离和孤独代表了低社会联系的客观和主观方面。它们是晚年生活中重要的社会心理风险因素，与身体健康状况不佳、认知能力下降和精神疾病有关。社会认知是适应性社会互动所必需的一套认知能力，它可能在社会隔离和孤独中发挥作用，但尚未得到广泛的研究。方法：我们调查了社会认知与社会隔离和孤独感的关系，在一个大型的前瞻性人群为基础的老年人队列中，随访长达5年。社会认知采用社会规范问卷（SNQ22）和眼读心术测试（RMET10）进行测量。社会联系是通过社会孤立和孤独的综合测量来衡量的。采用横截面线性回归和纵向线性混合效应模型来调查社会认知、社会隔离和孤独感之间的关系，并对人口统计学、抑郁、焦虑和一般认知进行调整。研究结果：该研究包括792名平均年龄74.9岁的老年人。更高的社会规范意识，而不是认知同理心，与更少的孤独感横断面相关，调整了所有协变量，随着时间的推移，它也预示着更少的孤独感。在对社会孤立进行调整后，这种关联仍然显著。两项社会认知测试都与社会孤立无关。解释：随着时间的推移，更好的社会规范意识，而不是情感感知和认知同理心，与更少的孤独感相关。这些结果为进一步研究社会认知和孤独之间的联系机制提供了依据。

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引用次数: 0

Closing the Gap: Telepsychology and Quality of Life in Parkinson’s Disease 缩小差距：帕金森病的远程心理学和生活质量。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-10 DOI: 10.1016/j.jagp.2025.12.019

Bhavana Patel D.O., Gregory M. Pontone M.D., M.H.S.

引用次数: 0

You Just Don’t Get It! Social Isolation, Loneliness, and Social Cognition 你就是不明白！社会隔离、孤独和社会认知。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-01 DOI: 10.1016/j.jagp.2025.12.013

Dan G. Blazer M.D., Ph.D.

引用次数: 0