American Journal of Geriatric Psychiatry最新文献_第2页

Investigating the Multidimensional Structure of Apathy in Cognitive Decline: An Exploratory Network Analysis of the Apathy Evaluation Scale 认知衰退中冷漠的多维结构研究：冷漠评价量表的探索性网络分析。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-07-26 DOI: 10.1016/j.jagp.2025.07.010

Claudia Savia Guerrera Ph.D. , Giuseppe Alessio Platania Ph.D. , Simone Varrasi M.Sc. , Pierfrancesco Sarti M.Sc. , Francesco Maria Boccaccio M.Sc. , Vittoria Torre M.Sc. , Mario Santagati M.D. , Giovanna Furneri Ph.D. , Concetta Pirrone Ph.D. , Santo Di Nuovo Ph.D. , Johanna M.C. Blom Ph.D. , Filippo Caraci Ph.D. , Sabrina Castellano Ph.D.

Objective

Apathy is a multidimensional syndrome present in neurodegenerative disorders such as Alzheimer’s disease and mild cognitive impairment, distinct from depression. It requires targeted assessment tools able to explore and measure it as a complex system. This study aimed to explore the latent structure of apathy in individuals with cognitive decline using Exploratory Graph Analysis (EGA) applied to the Apathy Evaluation Scale – Clinician version (AES-C), and to compare this structure with traditional factorial models.

Methods

A total of 214 individuals, including patients with mild cognitive impairment (MCI), Alzheimer’s disease (AD), and healthy controls, completed the AES-C and a standardized neuropsychological battery. EGA was used to estimate the network-based factor structure of the AES-C. Confirmatory factor analysis compared the EGA-derived model with both the original structure proposed by Marin et al. and a model derived through exploratory factor analysis (EFA).

Results

EGA revealed a four-factor structure: interest and motivation, autonomy, novelty, and social apathy. This solution demonstrated better fit, parsimony, and conceptual clarity than both the original and EFA-derived models. The EGA model showed good internal consistency, convergent and discriminant validity, and performed consistently across MCI and AD subgroups.

Conclusions

EGA provided a clearer understanding of apathy by identifying specific, clinically relevant, and objective dimensions that differ in disease progression. This precise characterization facilitates targeted and timely interventions and has the potential to initiate the development of new test batteries fully validated through network methods, allowing more complex analysis of apathy symptoms.

目的：冷漠是存在于神经退行性疾病如阿尔茨海默病和轻度认知障碍的多维综合征，不同于抑郁症。它需要有针对性的评估工具，能够探索和衡量它作为一个复杂的系统。本研究旨在运用临床医师版冷漠量表（AES-C）中的探索性图分析（EGA）来探讨认知衰退个体冷漠的潜在结构，并将其与传统的因子模型进行比较。方法：214例轻度认知障碍（MCI）患者、阿尔茨海默病（AD）患者和健康对照者完成AES-C和标准化神经心理学测试。采用EGA对AES-C基于网络的因子结构进行估计。验证性因子分析将ega导出的模型与Marin等人提出的原始结构和探索性因子分析（exploratory factor analysis， EFA）导出的模型进行比较。结果：EGA表现出兴趣与动机、自主性、新颖性和社会冷漠的四因素结构。该解决方案比原始模型和efa衍生模型更适合、更简洁、概念更清晰。EGA模型具有良好的内部一致性、收敛效度和判别效度，在MCI和AD亚组中表现一致。结论：EGA通过识别疾病进展中不同的特定、临床相关和客观维度，提供了对冷漠的更清晰理解。这种精确的表征有助于有针对性和及时的干预，并有可能启动通过网络方法充分验证的新测试电池的开发，从而允许对冷漠症状进行更复杂的分析。

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引用次数: 0

The Effect of Displacement During Extreme Circumstances on Digital Engagement and Well-Being Among Older Adults 极端情况下的流离失所对老年人数字参与和幸福感的影响。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-03-15 DOI: 10.1016/j.jagp.2025.03.004

Ittay Mannheim Ph.D. , Rinat Lifshitz Ph.D. , Yaacov G. Bachner Ph.D. , Ella Cohn-Schwartz Ph.D.

Objectives

Currently, there are increasing instances of forced displacement due to extreme circumstances such as armed conflicts. Under threatening conditions, certain factors, such as displacement, can decrease one's well-being. On the other hand, specific capabilities and resources such as digital engagement, may serve as coping mechanisms. This study examines the associations between digital engagement and the well-being of older adults during armed conflict situations, comparing displaced persons to those who were not displaced.

Methods

Ninety-three displaced and 150 nondisplaced older Israeli adults aged 60 and above completed an online or paper questionnaire two months after the beginning of the Israel-Hamas war on 7th of October 2023. Measurements included indicators of well-being (loneliness, depressive symptoms, subjective health, and sense of control), rocket threat, digital engagement, digital ageism, and socio-demographic characteristics.

Results

Displaced older adults reported lower subjective health, higher levels of loneliness, and a diminished sense of control, compared to those not displaced. Following the war, individuals who were displaced reported using fewer digital devices, exhibited different patterns of use, and reported twice as many limitations in using technology. A hierarchical regression analysis revealed that various aspects of digital engagement were associated with different well-being components, mitigating the initial negative effects of displacement on loneliness and subjective health.

Conclusions

This study highlights the importance of digital engagement as a potential protective factor for the well-being of older adults during extreme circumstances such as armed conflicts.

目标：目前，由于武装冲突等极端情况而被迫流离失所的情况越来越多。在受到威胁的情况下，某些因素，如流离失所，会降低一个人的幸福感。另一方面，具体的能力和资源，如数字参与，可以作为应对机制。本研究考察了武装冲突局势中数字参与与老年人福祉之间的关系，比较了流离失所者和未流离失所者。方法：在2023年10月7日以色列-哈马斯战争开始两个月后，93名流离失所和150名60岁及以上的以色列老年人完成了在线或纸质问卷调查。测量包括幸福感指标（孤独、抑郁症状、主观健康和控制感）、火箭威胁、数字参与、数字年龄歧视和社会人口特征。结果：与没有流离失所的老年人相比，流离失所的老年人报告的主观健康状况较差，孤独感较高，控制感减弱。战争结束后，流离失所的人报告说，他们使用的数字设备减少了，表现出不同的使用模式，并报告说，在使用技术方面的限制是以前的两倍。分层回归分析显示，数字参与的各个方面与不同的幸福感组成部分相关，减轻了流离失所对孤独感和主观健康的最初负面影响。结论：本研究强调了数字参与作为极端情况下（如武装冲突）老年人福祉的潜在保护因素的重要性。

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引用次数: 0

Information for Subscribers 订户资讯

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/S1064-7481(26)00044-8

引用次数: 0

Is the Time Right to Start Testing if Late-Onset Depression is Associated With the Development of an α-Synucleinopathy Like Parkinson’s Disease? A Double Systematic Review and Meta-Analysis 晚发性抑郁症是否与α-突触核蛋白病（如帕金森病）的发展相关？双系统评价和荟萃分析。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-08-12 DOI: 10.1016/j.jagp.2025.07.014

Jan Booij M.D., Ph.D. , Rik Schalbroeck Ph.D. , Madeleine Wartenhorst B.Sc. , Carmen F.M. van Hooijdonk Ph.D. , Youssef Chahid Ph.D. , Robin Cobben M.D. , Annemieke Dols M.D., Ph.D. , Natasja Schutter M.D., Ph.D. , Mardien L. Oudega M.D., Ph.D. , Rob M.A. de Bie M.D., PhD. , Sem E. Cohen M.D. , Jasper Zantvoord M.D., Ph.D. , Karel Scheepstra M.D., Ph.D.

Parkinson’s disease (PD) is characterized by two neurobiological markers: pathological α-synuclein and/or a dopaminergic deficit. Depression is common in PD, and may precede motor signs, particularly in late-onset depression (LOD). We conducted two systematic reviews and a meta-analysis to examine the relationship between depression and PD development. First, we evaluated whether depression is associated with an increased risk of developing PD, and whether pathological α-synuclein or dopaminergic deficits were observed in depressed patients prior to PD diagnosis. Second, we evaluated whether studies examined neurobiological markers in LOD patients, regardless of subsequent PD development. Our first review identified 39 studies showing a positive association between depression and subsequent PD. This was supported by an exploratory meta-analysis, stratified by index condition: 1) retrospective studies of patients with PD reporting prior depression (odds ratio [OR] = 2.17, 95% CI: 1.92–2.46) and 2) prospective studies of depressed patients who developed PD (OR = 2.01, 95% CI: 1.20–3.38). Importantly, none of these studies examined neurobiological data. Our second review identified three cross-sectional studies reporting that 24%–79% of the LOD patients had a dopaminergic deficit as detected by dopamine transporter (DAT) imaging. We found no studies in LOD in which α-synuclein was determined. Given the observed moderately elevated risk for developing PD in depressed patients, the high incidence of abnormal DAT scans in LOD, and ageing as a major risk factor for developing PD, longitudinal studies in LOD patients are essential to establish neurobiological evidence that depression can be an early manifestation of an α-synucleinopathy like PD.

帕金森病（PD）以两种神经生物学标志物为特征：病理性α-突触核蛋白和/或多巴胺能缺陷。抑郁症在PD中很常见，并且可能先于运动体征，特别是迟发性抑郁症（LOD）。我们进行了两项系统综述和一项荟萃分析来研究抑郁症与PD发展之间的关系。首先，我们评估了抑郁症是否与PD发病风险增加有关，以及抑郁症患者在PD诊断前是否存在病理性α-突触核蛋白或多巴胺能缺陷。其次，我们评估了这些研究是否检测了LOD患者的神经生物学标志物，而不考虑PD的后续发展。我们的第一篇综述确定了39项研究，显示抑郁症与随后的PD呈正相关。一项探索性荟萃分析支持了这一结论，该分析按指标条件分层：1)报告既往抑郁的PD患者的回顾性研究（优势比[OR] = 2.17, 95% CI: 1.92-2.46）和2)发展为PD的抑郁患者的前瞻性研究（OR = 2.01, 95% CI: 1.20-3.38）。重要的是，这些研究都没有检查神经生物学数据。我们的第二篇综述确定了三个横断面研究，报告24%-79%的LOD患者有多巴胺转运蛋白（DAT）成像检测到的多巴胺能缺陷。我们没有发现LOD中有α-突触核蛋白的研究。考虑到抑郁症患者发生PD的风险中等升高，LOD中DAT扫描异常的发生率高，以及衰老是发生PD的主要危险因素，对LOD患者进行纵向研究对于建立神经生物学证据证明抑郁症可能是α-突触核蛋白病（如PD）的早期表现至关重要。

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引用次数: 0

Association of Social Relationships and Genetic Risk With Frailty 社会关系和遗传风险与脆弱的关联。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-03-01 DOI: 10.1016/j.jagp.2025.02.015

Wei-Qi Song Ph.D. , Wen-Fang Zhong Ph.D. , Hao-Yu Yan M.P.H. , Zhi-Hao Li Ph.D. , Jian Gao Ph.D. , Xiao-Meng Wang Ph.D. , Pei-Liang Chen Ph.D. , Fang-Fei You Ph.D. , Chuan Li Ph.D. , Huan Chen Ph.D. , Jia-Hao Xie M.P.H. , Yue-Bin Lv Ph.D. , Xiao-Ming Shi Ph.D. , Chen Mao Ph.D.

Objectives

To investigate the association between social relationships and their changes with frailty among older adults, and whether genetic risk modifies these associations.

Methods

This study included 11,559 older adults (mean age 80.1 years) from the Chinese Longitudinal Healthy Longevity Survey. Social relationships were categorized into three dimensions: social activities, social networks, and social support, each classified as favorable or unfavorable groups. Changes in social relationships were assessed at two time points. The polygenic risk score (PRS) was constructed using 59 single-nucleotide polymorphisms associated with frailty. Cox proportional hazards models were used to assess the effects of social relationships and their changes, and PRS on frailty. Two-sample Mendelian randomization identified causal associations.

Results

During a median follow-up of 5.4 years, 4773 participants developed frailty. Unfavorable social relationships, particularly in social activities and social networks, were associated with increased frailty risk, with stronger effects in those with high genetic risk. Mendelian randomization revealed their harmful effects on frailty. An additive interaction between social relationships and genetic risk on frailty was observed. Combined unfavorable social relationships and high genetic risk increased frailty risk by 39% (HR: 1.39, 95% CI: 1.23–1.57). Persistent unfavorable relationships further increased frailty risk by 58% in those with high genetic risk (HR: 1.58, 95% CI: 1.27–1.97).

Conclusion

Unfavorable social relationships increase frailty risk, particularly for individuals with high genetic susceptibility. Persistent unfavorable relationships further increase this risk over time, with the highest frailty risk observed in those with both persistent unfavorable social relationships and high genetic risk.

目的：研究老年人的社会关系及其变化与虚弱之间的关系，以及遗传风险是否会改变这些关系：研究老年人社会关系及其变化与虚弱之间的关联，以及遗传风险是否会改变这些关联：本研究纳入了中国健康长寿纵向调查的 11559 名老年人（平均年龄 80.1 岁）。社会关系分为三个维度：社会活动、社会网络和社会支持，每个维度又分为有利组和不利组。社会关系的变化在两个时间点进行评估。利用 59 个与虚弱相关的单核苷酸多态性构建了多基因风险评分（PRS）。采用 Cox 比例危险模型来评估社会关系及其变化以及 PRS 对虚弱的影响。双样本孟德尔随机化确定了因果关系：在中位 5.4 年的随访期间，4773 名参与者出现了虚弱。不利的社会关系，尤其是社会活动和社会网络中的不利社会关系，与虚弱风险的增加有关，对高遗传风险人群的影响更大。孟德尔随机法揭示了这些社会关系对虚弱的有害影响。社会关系和遗传风险对虚弱的影响是相加作用的。不利的社会关系和高遗传风险会使虚弱风险增加 39%（HR：1.39，95% CI：1.23-1.57）。在遗传风险高的人群中，持续的不利社会关系会使虚弱风险进一步增加 58%（HR：1.58，95% CI：1.27-1.97）：结论：不利的社会关系会增加虚弱的风险，尤其是对遗传易感性高的人而言。随着时间的推移，持续的不利关系会进一步增加这种风险，同时具有持续的不利社会关系和高遗传风险的人的虚弱风险最高。

{"title":"Association of Social Relationships and Genetic Risk With Frailty","authors":"Wei-Qi Song Ph.D. , Wen-Fang Zhong Ph.D. , Hao-Yu Yan M.P.H. , Zhi-Hao Li Ph.D. , Jian Gao Ph.D. , Xiao-Meng Wang Ph.D. , Pei-Liang Chen Ph.D. , Fang-Fei You Ph.D. , Chuan Li Ph.D. , Huan Chen Ph.D. , Jia-Hao Xie M.P.H. , Yue-Bin Lv Ph.D. , Xiao-Ming Shi Ph.D. , Chen Mao Ph.D.","doi":"10.1016/j.jagp.2025.02.015","DOIUrl":"10.1016/j.jagp.2025.02.015","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the association between social relationships and their changes with frailty among older adults, and whether genetic risk modifies these associations.</div></div><div><h3>Methods</h3><div>This study included 11,559 older adults (mean age 80.1 years) from the Chinese Longitudinal Healthy Longevity Survey. Social relationships were categorized into three dimensions: social activities, social networks, and social support, each classified as favorable or unfavorable groups. Changes in social relationships were assessed at two time points. The polygenic risk score (PRS) was constructed using 59 single-nucleotide polymorphisms associated with frailty. Cox proportional hazards models were used to assess the effects of social relationships and their changes, and PRS on frailty. Two-sample Mendelian randomization identified causal associations.</div></div><div><h3>Results</h3><div>During a median follow-up of 5.4 years, 4773 participants developed frailty. Unfavorable social relationships, particularly in social activities and social networks, were associated with increased frailty risk, with stronger effects in those with high genetic risk. Mendelian randomization revealed their harmful effects on frailty. An additive interaction between social relationships and genetic risk on frailty was observed. Combined unfavorable social relationships and high genetic risk increased frailty risk by 39% (HR: 1.39, 95% CI: 1.23–1.57). Persistent unfavorable relationships further increased frailty risk by 58% in those with high genetic risk (HR: 1.58, 95% CI: 1.27–1.97).</div></div><div><h3>Conclusion</h3><div>Unfavorable social relationships increase frailty risk, particularly for individuals with high genetic susceptibility. Persistent unfavorable relationships further increase this risk over time, with the highest frailty risk observed in those with both persistent unfavorable social relationships and high genetic risk.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 533-543"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Commentary on “Association Between the Ratio of Triglycerides to HDL-C and Cognitive Impairment: A Longitudinal Population-Based Analysis and Mendelian Randomization Study” 对“甘油三酯与HDL-C比值与认知障碍之间的关系：纵向人群分析和孟德尔随机化研究”的评论。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-08 DOI: 10.1016/j.jagp.2025.12.014

Shangavi Vellingiri Pharm.D

引用次数: 0

Response to the Letter to the Editor by Wu et al. Regarding the Article “Improvements in Depressive Symptoms, Perceived Social Support, and Quality of Life Through an Educational Program in Community-Dwelling Older Adults With Frailty Phenotype” 对Wu等人致编辑信的回应。关于文章“通过社区居住的虚弱表型老年人的教育计划改善抑郁症状，感知社会支持和生活质量”。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2026-01-21 DOI: 10.1016/j.jagp.2026.01.002

Manuel Costilla M.Sc. , Juan Corral-Pérez Ph.D. , María Ángeles Vázquez-Sánchez Ph.D. , Laura Ávila-Cabeza-de-Vaca M.Sc. , Andrea González-Mariscal M.Sc. , Cristina Casals Ph.D.

引用次数: 0

Humane Intelligence in Geropsychiatric Care: Relational Artificial Intelligence, Clinical Wisdom, and the Moral Grid Operational Index 老年精神病学护理中的人文智能：关系人工智能、临床智慧和道德网格操作指数。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-12-31 DOI: 10.1016/j.jagp.2025.12.012

Helen H. Kyomen M.D., M.S. , Group for the Advancement of Psychiatry (GAP) Committee on Aging

Artificial intelligence (AI) already influences how older adults are identified for services, supported between provider visits, and referred for care, yet most AI governance currently focuses on algorithms and infrastructure rather than the actual experiences of older adults and their caregivers. Humane Intelligence is a patient-centered, ethically attuned, relational framework for designing, evaluating, and monitoring AI in older adult care. It rests on four pillars: Relational Intelligence, Transparency with Care, Reciprocity and Consent, and Ethical Governance in Strategic Regions, and applies them from point-of-care encounters to system-level decisions. For each pillar, guidelines follow the same sequence: signal a problem, take action, and verify benefit or harm. The framework prioritizes outcomes that matter in geriatric psychiatry, including function, distress, caregiver burden, avoidable utilization, equity, and documented harms or overrides. To protect patients, it draws a firm boundary against fully automated clinical actions and recommends clinical-grade standards for patient-facing programs, including scope-of-action labels, human-in-the-loop safeguards for high-risk situations, postmarket monitoring, and periodic certification. This blueprint aligns with 2025 JAMA Summit on AI priorities, World Health Organization guidance for large multimodal models, United States Food and Drug Administration recommendations for Predetermined Change Control Plans, and Office of the National Coordinator for Health Information Technology decision-support intervention frameworks. The goal is practical: to translate ethics into testable patient-centered routines that clinicians can trust, healthcare systems can implement, and leaders can procure, so that AI augments rather than displaces care.

人工智能（AI）已经影响到如何识别老年人的服务，在提供者访问之间提供支持，以及转介护理，但大多数人工智能治理目前侧重于算法和基础设施，而不是老年人及其护理人员的实际经验。人文智能是一个以患者为中心、伦理协调、关系框架，用于设计、评估和监测老年人护理中的人工智能。它基于四个支柱：关系情报、谨慎透明、互惠和同意以及战略地区的道德治理，并将其从护理点接触应用到系统级决策。对于每个支柱，指导方针遵循相同的顺序：提出问题，采取行动，验证利益或危害。该框架优先考虑老年精神病学中重要的结果，包括功能、痛苦、照顾者负担、可避免的利用、公平以及记录在案的伤害或无效。为了保护患者，它对完全自动化的临床行动划定了明确的界限，并为面向患者的项目推荐了临床级标准，包括行动范围标签、高风险情况下的人在环保障措施、上市后监测和定期认证。该蓝图与2025年美国医学会人工智能优先事项峰会、世界卫生组织大型多模式指南、美国食品和药物管理局关于预定变更控制计划的建议以及卫生信息技术国家协调员办公室决策支持干预框架保持一致。其目标是切实可行的：将道德规范转化为临床医生可以信任、医疗保健系统可以实施、领导者可以促成的可测试的、以患者为中心的惯例，从而使人工智能增强而不是取代医疗保健。

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引用次数: 0

Mental Health of Older Adults Across the Globe: Addressing Current Challenges in a Cultural Context 全球老年人的心理健康：在文化背景下应对当前的挑战。

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.2025.11.009

Nhi-Ha Trinh M.D., M.P.H. , Iqbal Ahmed M.D. , Dinesh Bhugra M.B.B.S., Ph.D., M.Phil., M.Sc., M.A.

引用次数: 0

Functional Recovery and Mortality in Hospitalized Patients With Dementia and Severe Neuropsychiatric Symptoms: A 13-Year Spanish Study 住院痴呆伴严重神经精神症状患者的功能恢复和死亡率：一项为期13年的西班牙研究

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2026-04-01 Epub Date: 2025-06-11 DOI: 10.1016/j.jagp.2025.06.004

Kevin O'Hara-Veintimilla M.D. , Miguel German Borda M.D., Ph.D. , Leire Martínez-Alderete M.D. , Mario Salas-Carrillo M.D. , María Vidal-Millares M.D., Ph.D. , Raimundo Mateos M.D., Ph.D.

Objectives

To determine whether functional status in older adults with dementia and severe neuropsychiatric symptoms (NPS), particularly functional improvement during specialised psychogeriatric hospitalisation, is associated with better survival.

Methods

A retrospective cohort study was conducted using data from the Matia Psychogeriatric Hospitalisation Study (PHS-Matia), including 2,283 patients aged ≥60 years hospitalised between 2011 and 2024. Functional status was assessed with a modified Barthel Index (BI) at preadmission, admission, and discharge. Psychotropic burden was measured using the Psychotropic Drug Burden Index (pDBI). Survival was analysed with Kaplan-Meier (KM) curves and Cox regression models, while functional recovery was assessed using linear mixed-effects models.

Results

The median age was 83 years, and 51.8% were female. Functional recovery during hospitalization was significant (median BI improvement: +13, p <0.001). Increased pDBI was associated with an 87% lower mortality (HR: 0.13, 95% CI, [0.09–0.21], p <0.001). Among psychotropic subgroups, a higher antipsychotic pDBI correlated with greater functional recovery (coefficient: 2.65, 95% CI, [1.12–4.17], p = 0.001). The Spanish version of the Mini-Mental State Examination (MEC-35) ≥15 was associated with lower mortality (HR: 0.23, p <0.001).

Conclusions

Functional improvement during hospitalization is a key predictor of survival in older adults with dementia and severe neuropsychiatric symptoms (NPS). The observed association between increased pDBI and reduced mortality challenges conventional views on psychotropic use, warranting further research. These findings underscore the importance of an individualized, symptom-driven approach to treatment in this vulnerable population.

目的：确定老年痴呆和严重神经精神症状（NPS）患者的功能状态，特别是老年精神专科住院期间的功能改善，是否与更好的生存率相关。方法：采用来自Matia老年心理住院研究（PHS-Matia）的数据进行回顾性队列研究，包括2011年至2024年间住院的2,283例年龄≥60岁的患者。在入院前、入院和出院时使用改良的Barthel指数（BI）评估功能状态。采用精神药物负担指数（pDBI）测量精神药物负担。使用Kaplan-Meier （KM）曲线和Cox回归模型分析生存率，使用线性混合效应模型评估功能恢复。结果：中位年龄83岁，女性占51.8%。住院期间功能恢复显著（BI改善中位数：+13，p）。结论：住院期间功能改善是老年痴呆合并严重神经精神症状（NPS）患者生存的关键预测指标。观察到的pDBI增加与死亡率降低之间的关联挑战了传统的精神药物使用观点，值得进一步研究。这些发现强调了在这一弱势群体中采取个体化、症状驱动的治疗方法的重要性。

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引用次数: 0