American Journal of Geriatric Psychiatry最新文献

Objective: Low-income white older adults and those of color are at greater risk for depression but less likely to receive care. We evaluated the impact of a one-to-one peer support intervention compared to active control delivered by nonpeers for this population.

Design: Mixed methods, single-blind randomized controlled trial.

Setting: Community-based social service and aging organizations and geriatric primary care.

Participants: Low-income white older adults and those of color 50+ with depression.

Interventions: Peer Enhanced Depression Care and nonpeer, social interaction control.

Measurements: Primary outcome was depression (PHQ-9). Data were collected at baseline, postinterventions, 3, 6, 9, and 12 months. Poststudy interviews were conducted with both groups.

Results: Among 149 randomized participants, the mean age was 70, 84% were women, 52% Black and 41% White. Both groups experienced an average decrease of 3.7 (SE: 0.55, 95% CI: [-4.77, -2.63]) points in depression from baseline to postintervention and 2.56 (SE: 0.71, 95% CI: [-3.95, -1.17]) points from baseline to 12 months. Effect sizes at postintervention (Cohen's d = 0.81) and at 12-months (Cohen's d = 0.52) indicate large and medium effects, respectively. Both groups experienced decreases in loneliness and increases in adaptive coping and self-efficacy. Qualitative findings suggest the intervention group learned coping skills and experienced behavior change, whereas control group described a general positive experience.

Conclusions: Peer support intervention was not superior to social interactions delivered by nonpeers. Divergent quantitative and qualitative results suggest the need for additional effectiveness trials of peer support interventions outside of pandemic conditions. Trial Registration ClinicalTrials.gov Identifier: NCT04319094.

Objective: Research suggests that physical activity (PA) improves cognitive function across various domains. However, the specific role of different PA measures, including step count, remains to be explored. Our aim was to assess the correlation between objectively measured PA and cognitive function.

Methods: We included 663 adults, aged ≥66 years, from the Swedish SNAC-K study (2016-2019). Global cognition and three cognitive domains (processing speed, executive function, and episodic memory) were assessed with validated tests. PA was measured through ActivPAL3 accelerometers. We applied age-stratified (<70 vs. ≥80 years), multi-adjusted, quantile regression to examine the cross-sectional associations between cognitive function and PA, considering steps/day and time spent in moderate-to-vigorous PA (MVPA).

Results: Each 1000-step increment (β = 0.04; 95% CI: 0.01, 0.07) and each additional hour of MVPA per day (β = 0.28; 95% CI: 0.02, 0.54) were correlated with better processing speed in the youngest-old, but not in the oldest-old. When further stratifying by MVPA (<60 min vs. ≥60 min/week), each 1000-step increment was associated with better processing speed in the youngest-old, regardless of their MVPA levels.

Conclusion: Our study links accelerometer-assessed PA (steps and MVPA) with better processing speed in the youngest-old adults. Step count correlated with processing speed regardless of intensity. Further research is needed to determine the directionality of these associations.

Objective: Major depressive disorder in older adults (late-life depression; LLD) is frequently associated with cognitive impairment, and some deficits (e.g., executive function) have been associated with a higher level of treatment resistance. However, the cognitive profile of treatment-resistant LLD (TR-LLD) has not been characterized. We hypothesized that patients with TR-LLD would show deficits in cognitive function, especially executive function, and that executive function deficits would predict poorer response to pharmacotherapy.

Design: Secondary analysis of baseline cognitive data from OPTIMUM, a multicenter RCT evaluating pharmacotherapy strategies for TR-LLD.

Setting: Five outpatient academic medical centers (4 US, 1 Canada).

Participants: About 369 participants aged 60 and older from the OPTIMUM study.

Measurements: Baseline scores on individual tasks and composite scores from the NIH Toolbox-Cognition Battery were transformed into demographically-adjusted T-scores and compared to published norms. Impairments in the set shifting and inhibitory control tasks were investigated as predictors of depressive symptom change following treatment using ANCOVA models.

Results: Participants had low performance on tasks evaluating inhibitory control, processing speed, verbal/nonverbal memory, and the fluid composite, but normative performance on working memory and set shifting. Participants had high estimated premorbid IQ (superior Performance on oral reading recognition). Age and physical comorbidity negatively associated with processing speed. Impairments in set shifting predicted less improvement in depressive symptoms; impairments in inhibitory control did not.

Conclusions: Participants with TR-LLD presented with broad cognitive deficits relative to healthy norms. Given poorer outcomes following standard pharmacotherapy associated with impaired set shifting, future research needs to identify alternative treatment strategies.

Introduction: The rising prevalence of Alzheimer's disease (AD) and related dementia worldwide underscores the urgent need for effective interventions, particularly for managing neuropsychiatric symptoms (NPS) such as sleep disturbance. This review explores the emerging role of Dual Orexin Receptor Antagonists (DORA) in addressing sleep disturbance in patients with Alzheimer's disease dementia.

Methods: A comprehensive literature search identified four relevant publications between 2014 and 2024, detailing the use of DORA medications, including suvorexant and lemborexant, in patients with Alzheimer's disease.

Results: Findings suggest that suvorexant may improve total sleep time (TST), wakefulness after sleep onset (WASO), and sleep efficiency (SE) in Alzheimer's patients with insomnia. Lemborexant demonstrated potential in improving circadian rhythm parameters, particularly in patients with irregular sleep-wake rhythm disorder (ISWRD). Safety profiles of DORA medications appeared favorable, with mild to moderate adverse events reported. However, concerns over potential adverse events, such as falls, underscore the need for careful monitoring.

Conclusion: While the evidence suggests promise for DORA medications in addressing sleep disturbance in Alzheimer's disease, limitations in study populations and duration highlight the need for further investigation. Future clinical trials should aim for broader inclusion criteria, encompassing diverse dementia subtypes and severity levels, to enhance generalizability. Additionally, longer-term trials are essential to assess the sustained efficacy and safety of DORA interventions in this vulnerable population.

Objective: The assessment of sexual consent capacity has been a challenge due to its dynamic nature, influenced by factors such as time, environment, individuals involved, and the nature of activities. Particularly in people living with dementia, the complexity is intensified with the interplay of the disease's impact, residential care setting, and legal constraints. This amplifies the dilemma faced by practitioners-whether to prioritize protection or encourage and support sexual expression. This article aims to provide a sensible approach to uphold the sexual autonomy of people living with dementia while mitigating the potential risks of them being involved as either perpetrators or victims.

Methods: In this narrative review, a literature search spanning from 1990 to 2023 was carried out on PubMed. Relevant articles on people living with dementia and topics related to sexuality were scrutinized.

Results: 41 relevant articles identified themes related to the impact of cognitive impairment on sexuality, challenges in residential care facilities, sexual consent capacity assessment models, and ethical frameworks regarding sexual rights and law.

Conclusion: Discussions highlight the often neglected influence of prolonged suppression of sexual expression and the benefits of actualization of sexual autonomy, especially in people living with dementia, whose sense of identity is fading. It scrutinizes the limitations of existing sexual consent capacity evaluation models, emphasizing ethical concerns, practical challenges, and the need for a more balanced approach. Proposed strategies advocate for a shift from a gatekeeper to a facilitator role, offering principles for setting educational programs and policies to mitigate obstacles, supporting sexual rights, and safeguarding vulnerable groups.

Objectives: We examine the clinical utility of plasma-based detection for Alzheimer's disease (AD) pathophysiology in older adults with mild cognitive impairment (MCI) and whether cognitive screening can inform when to use plasma-based AD tests.

Methods: Seventy-four community-dwelling older adults with MCI had testing with plasma phosphorylated tau (p-tau) 217 and 181, positron emission tomography (PET) imaging for amyloid beta (Aβ), and cognitive assessment. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic value of plasma p-tau.

Results: Plasma p-tau217 distinguished MCI participants who had PET imaging evidence of Aβ accumulation from those without (AUC of 0.92, specificity of 0.96, and sensitivity of 0.90), outperforming plasma p-tau181 (AUC of 0.76, specificity of 0.87 and sensitivity of 0.59) for the same purpose. Of the 60 MCI participants that were amnestic, 22 were Aβ+. The 14 participants that were nonamnestic were all Aβ-.

Conclusions: Our findings support the clinical use of plasma p-tau, particularly p-tau217, for patient detection of AD pathophysiology in older adults with amnestic MCI, but not in those who are nonamnestic.