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Treatment of Cognitive Impairment in Late Life Depression 治疗晚年抑郁症患者的认知障碍。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-26 DOI: 10.1016/j.jagp.2024.09.011
Paul A. Newhouse M.D. , Steven P. Roose M.D.
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引用次数: 0
Initiation and Persistence of Antipsychotic Medications at Hospital Discharge Among Community-Dwelling Veterans With Dementia. 居住在社区的痴呆退伍军人出院时开始服用和持续服用抗精神病药物。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-25 DOI: 10.1016/j.jagp.2024.09.010
Audrey D Zhang, Lindsay Zepel, Sandra Woolson, Katherine E M Miller, Loren J Schleiden, Megan Shepherd-Banigan, Joshua M Thorpe, Susan Nicole Hastings

Objectives: Adults with dementia are frequently prescribed antipsychotic medications despite concerns that risks outweigh benefits. Understanding conditions where antipsychotics are initially prescribed, such as hospitalization, may offer insights into reducing inappropriate use.

Design, setting, participants: Retrospective cohort study of community-dwelling veterans with dementia aged ≥68 with VA hospitalizations in 2014, using Veterans Health Administration (VA) and Medicare data.

Measurements: The primary outcome was new outpatient antipsychotic prescription at hospital discharge. We used generalized estimating equations to study associations between antipsychotic initiation and patient, hospitalization, and facility characteristics. Among veterans with antipsychotic initiation, we used a cumulative incidence function to evaluate discontinuation in the year following hospitalization, accounting for competing risks.

Results: 4,719 community-dwelling veterans with dementia had VA hospitalizations in 2014; 264 (5.6%) filled new antipsychotic prescriptions at discharge. Antipsychotic initiation was associated with discharge unit (surgical vs medical, OR 0.41, 95% CI 0.19-0.87; psychiatric vs medical, OR 6.58, 95% CI 4.48-9.67), length of stay (OR 1.03/day, 95% CI 1.02-1.05), and delirium diagnosis (OR 2.61, 95% CI 1.78-3.83), but not demographic or facility characteristics. Among veterans with antipsychotic initiation, the 1-year cumulative incidence of discontinuation was 18.2% (n = 47); 15.9% (n = 42) of those who were alive and not censored remained on antipsychotics at 1 year.

Conclusions: Antipsychotic initiation at hospital discharge was uncommon among community-dwelling veterans with dementia; however, once initiated, antipsychotic persistence at 1 year was common among those who remained community-dwelling. Hospitalization is a contributor to potentially-inappropriate medications in the community, suggesting an opportunity for medication review after hospitalization.

目的:尽管人们担心抗精神病药物的风险大于益处,但患有痴呆症的成年人仍经常被处方抗精神病药物。了解最初开具抗精神病药物处方的条件(如住院)可能有助于减少不适当用药:使用退伍军人健康管理局(VA)和医疗保险计划(Medicare)的数据,对2014年在社区居住、年龄≥68岁、在退伍军人健康管理局住院治疗的痴呆症退伍军人进行回顾性队列研究:主要结果是出院时新的门诊抗精神病药物处方。我们使用广义估计方程来研究抗精神病药物的使用与患者、住院和医疗机构特征之间的关联。在开始使用抗精神病药物的退伍军人中,我们使用累积发生率函数来评估住院后一年内的停药情况,并将竞争风险考虑在内:2014年,有4719名居住在社区的退伍军人患有痴呆症,其中264人(5.6%)在出院时开具了新的抗精神病药物处方。抗精神病药物的使用与出院单位(外科与内科,OR 0.41,95% CI 0.19-0.87;精神科与内科,OR 6.58,95% CI 4.48-9.67)、住院时间(OR 1.03/天,95% CI 1.02-1.05)和谵妄诊断(OR 2.61,95% CI 1.78-3.83)有关,但与人口统计或设施特征无关。在开始使用抗精神病药物的退伍军人中,1年内停药的累计发生率为18.2%(n = 47);15.9%(n = 42)的存活且未被删减的退伍军人在1年内仍在使用抗精神病药物:结论:出院时开始服用抗精神病药物的情况在居住在社区的痴呆症退伍军人中并不常见;但是,一旦开始服用抗精神病药物,1年后仍居住在社区的退伍军人中普遍仍在服用抗精神病药物。住院治疗可能会导致患者在社区内使用不适当的药物,这也为住院后的用药复查提供了机会。
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引用次数: 0
Acknowledgment of Triage Editors and Reviewers 2024 感谢分流编辑和审稿人 2024.
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-20 DOI: 10.1016/j.jagp.2024.09.008
Charles Reynolds
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引用次数: 0
Duties of a Friend and to the Profession are Many and Great- “Amici et Professionis Officia Multa et Magna Sunt” 朋友和职业的责任是多重而伟大的--"Amici et Professionis Officia Multa et Magna Sunt"。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jagp.2024.08.019
Christopher C. Colenda M.D., M.P.H.
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引用次数: 0
Social Cognition and Aging: The Importance of Performance Based Assessment Strategies to Detect Impairment Across Aging Related Conditions and Functional Domains 社会认知与老龄化:基于表现的评估策略对检测与老龄化相关的疾病和功能领域的损伤的重要性。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.jagp.2024.09.007
Philip D. Harvey Ph.D.
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引用次数: 0
Trends in Hyperpolypharmacy Before and After Nursing Home Admission Among Older Adults in Ontario, Canada 加拿大安大略省老年人入住养老院前后过度用药的趋势。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.jagp.2024.09.005
Laura C. Maclagan M.Sc. , Abby Emdin M.P.H. , Anjie Huang M.Sc. , Michael A. Campitelli M.P.H. , Mina Tadrous Ph.D., Ph.D. , Andrea Iaboni M.D., D.Phil. , Luis Viana Ph.D. , Colleen J. Maxwell Ph.D. , Susan E. Bronskill Ph.D.

Objectives

To examine trends in the prevalence of hyperpolypharmacy prior to and following nursing home admission in Ontario, Canada.

Methods

We conducted a cohort study of adults aged 75+ years admitted to nursing homes between 2017 and 2020 using health administrative data (n = 61,470). The prevalence of hyperpolypharmacy (≥10 dispensed drugs) was assessed quarterly from ten years prior to 1.5 years following admission.

Results

Over ten years, the prevalence of hyperpolypharmacy increased from 4.4% to 12.0% (+0.2% per quarter, [p <0.001]) and further increased after admission (13.8%). Antidepressants (three-fold), antipsychotics (seven-fold) and cholinesterase inhibitors (14-fold) increased significantly over ten years prior to admission, while cardiovascular medications peaked 4 to 5 years prior to admission.

Conclusions

While hyperpolypharmacy increased nearly three-fold in the ten years prior to nursing home admission, patterns varied by drug class. Increasing hyperpolypharmacy throughout the life course suggests opportunities exist for medication reconciliation in community and nursing home settings.
目的研究加拿大安大略省养老院入住前后过度用药的流行趋势:我们利用卫生行政数据(n = 61,470 人)对 2017 年至 2020 年期间入住养老院的 75 岁以上成年人进行了一项队列研究。从入院前十年到入院后 1.5 年,我们每季度对超配药率(配药≥10 种)进行一次评估:结果:十年间,过度配药率从 4.4% 增加到 12.0%(每季度增加 0.2%,[p 结论:在过度配药率增加的同时,配药次数也增加了:在入住疗养院前的十年中,过度用药率增加了近三倍,但不同类别药物的用药模式各不相同。在人的整个生命过程中,多药滥用现象不断增加,这表明在社区和养老院环境中存在着药物调节的机会。
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引用次数: 0
Temporal Associations Between Specific Depressive Symptoms and Physical Inactivity in Middle Aged and Older Adults 中老年人特定抑郁症状与缺乏运动之间的时间关联
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-10 DOI: 10.1016/j.jagp.2024.08.020
Eetu Soini M.A., Tom H. Rosenström Ph.D., Ilmari Määttänen Ph.D., Markus Jokela Ph.D.
Being physically inactive can worsen mental health. Physical inactivity and depression are associated, but the temporal precedence and underlying mechanism are unclear; symptoms affecting future physical activity may not be the same symptoms as those associated with and affected by it. We used large European cohort (Survey of Health, Ageing, and Retirement in Europe, SHARE, N = 124, 526) to study temporal associations between physical inactivity and individual depressive symptoms. Multivariate regression with robust standard errors were used to analyze how physical inactivity is associated with later depression and how depressive symptoms predict later physical inactivity. After adjusting the models for demographics, other health behaviors, BMI, and chronic diseases, physical inactivity was prospectively associated with 10 of the 12 depressive symptoms and 7 of the 12 baseline depressive symptoms were prospectively associated with physical inactivity. These findings were robust for adjusting for antidepressant medication. Age-stratified analyses suggested that the associations between physical inactivity and depressive symptoms were independent of age. Omitting the most influential symptom, lack of enjoyment, from the sum score attenuated the association by 13% in the longitudinal and by 26% in the cross-sectional analyses. These findings suggest that physical inactivity and depression are bidirectionally associated even at symptom-level.
缺乏运动会使心理健康恶化。缺乏体力活动与抑郁症有关联,但两者之间的时间先后关系和内在机制尚不清楚;影响未来体力活动的症状可能与与体力活动相关和受体力活动影响的症状不同。我们利用大型欧洲队列(欧洲健康、老龄化和退休调查,SHARE,N = 124,526)研究了缺乏体力活动与个人抑郁症状之间的时间关联。我们采用了带有稳健标准误差的多元回归方法来分析缺乏运动与日后抑郁症之间的关系,以及抑郁症状如何预测日后的缺乏运动。在根据人口统计学、其他健康行为、体重指数和慢性疾病对模型进行调整后,不运动与 12 种抑郁症状中的 10 种相关,12 种基线抑郁症状中的 7 种与不运动相关。在调整抗抑郁药物治疗后,这些结果仍保持稳定。年龄分层分析表明,缺乏运动与抑郁症状之间的关系与年龄无关。在纵向分析和横向分析中,从总分中剔除 "缺乏乐趣 "这一影响最大的症状会使两者之间的关系减弱 13%,减弱 26%。这些研究结果表明,即使在症状层面,缺乏运动和抑郁也是双向相关的。
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引用次数: 0
Facing a Catastrophic Illness: A Perspective from Contemporary Philosophy 面对灾难性疾病:当代哲学的视角。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-07 DOI: 10.1016/j.jagp.2024.08.017
George S. Alexopoulos M.D.
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引用次数: 0
A Systematic Review of Antidepressants and Psychotherapy Commonly Used in the Treatment of Late Life Depression for Their Effects on Cognition 关于治疗晚年抑郁症常用的抗抑郁药和心理疗法对认知影响的系统性综述》(A Systematic Review of Antidepressants and Psychotherapy commonly used in the Treatment of Late Life Depression for Their Effects on Cognition.
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1016/j.jagp.2024.08.015
J. Craig Nelson M.D. , Jason A. Gandelman M.D. , R. Scott Mackin Ph.D.
Cognitive dysfunction is common in late life depression (LLD) and is a major risk factor for dementia. Recent studies show limited improvement in cognition with commonly employed treatments for LLD, contradicting the notion that cognition “returns to normal” with treatment. However, findings differ with the treatments used. The aim of this study is to perform a systematic review of studies of antidepressants and psychotherapies commonly employed in LLD to determine their effects on cognition, particularly processing speed, memory, and executive function. We searched for trials of acute phase treatment, in nondemented individuals 60 years and older with unipolar nonpsychotic Major Depressive Disorder, that assessed cognitive performance with neuropsychological tests before and after treatment. We compared the magnitude of change in cognition by examining within group effect sizes. Six antidepressant trials and two psychotherapy trials (both using Problem Solving Therapy)(PST) provided relatively comparable data that allowed for quantitative comparison. Nine other antidepressant trials provided descriptive findings. Sertraline and vortioxetine had significant positive effects on processing speed and memory. Duloxetine had significant effects on memory. The most selective SRIs-citalopram and escitalopram-had minimal effects on cognition and citalopram had adverse effects in depression nonresponders. PST had modest effects on processing speed and no effect on memory. Effects of practice and improvement in depression on cognition are examined. In all but one study, cognition was a secondary outcome and various quality indicators (e.g. blinding cognitive assessment to treatment) were often not reported. As a consequence, these findings must be considered preliminary.
认知功能障碍是晚年抑郁症(LLD)的常见症状,也是痴呆症的主要风险因素。最近的研究表明,晚年抑郁症的常用治疗方法对认知功能的改善有限,这与认知功能随治疗 "恢复正常 "的说法相矛盾。然而,不同的治疗方法得出的结果也不尽相同。本研究的目的是对常用于 LLD 的抗抑郁药和心理疗法的研究进行系统回顾,以确定它们对认知(尤其是处理速度、记忆和执行功能)的影响。我们搜索了针对 60 岁及以上患有单相非精神病性重度抑郁症的非痴呆患者进行的急性期治疗试验,这些试验在治疗前后通过神经心理学测试评估了患者的认知表现。我们通过研究组内效应大小来比较认知能力的变化程度。六项抗抑郁试验和两项心理疗法试验(均采用问题解决疗法)(PST)提供了相对可比的数据,可以进行定量比较。另外九项抗抑郁试验提供了描述性结果。舍曲林和伏替西汀对处理速度和记忆力有显著的积极影响。度洛西汀对记忆力有明显影响。选择性最强的 SRIs--西酞普兰和艾司西酞普兰--对认知能力的影响微乎其微,而西酞普兰对抑郁症无反应者有不良影响。PST 对处理速度的影响不大,但对记忆力没有影响。研究还探讨了练习和改善抑郁对认知的影响。除一项研究外,其他所有研究的认知结果都是次要结果,而且往往没有报告各种质量指标(如认知评估与治疗之间的盲法)。因此,这些研究结果必须被视为初步结果。
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引用次数: 0
Corrigendum to the Effect of Diagnostic Criteria on Dementia Prevalence—A Population-Based Study From Gothenburg, Sweden The American Journal of Geriatric Psychiatry, 2023, 230-243/32:2 诊断标准对痴呆症患病率的影响--基于瑞典哥德堡人口的研究》更正 美国老年精神病学杂志,2023,230-243/32:2
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-05 DOI: 10.1016/j.jagp.2024.09.001
Hanna Wetterberg Ph.D. , Jenna Najar M.D., Ph.D. , Therese Rydberg Sterner Ph.D. , Silke Kern M.D., Ph.D. , Ingmar Skoog M.D., Ph.D.
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引用次数: 0
期刊
American Journal of Geriatric Psychiatry
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