American Journal of Geriatric Psychiatry最新文献

Objective: Research has linked subjective cognitive concerns with emotional functioning, but few studies have examined if there is a dynamic association across time. This study explored whether the association between subjective cognitive concerns, emotional functioning, and quality of life (QoL) is more trait-based (i.e., associated at an average-level) or more state-based (i.e., changes in emotional functioning at one timepoint are related to simultaneous changes in subjective cognitive concerns).

Design and participants: Participants included 1061 community-dwelling adults aged 50-99 at baseline from the observational Successful Aging Evaluation (SAGE) study in San Diego, California. This study analyzed data collected over eight years.

Measurements: Participants completed the Cognitive Failures Questionnaire (CFQ) to assess subjective cognitive concerns yearly. Self-reported emotional functioning (i.e., depression, anxiety, stress symptoms, and resiliency) and QoL were also assessed yearly. Associations between emotional functioning and QoL measures and CFQ scores were analyzed using multilevel modeling.

Results: Between-person analyses showed that worse average emotional functioning and QoL were associated with greater average cognitive concerns (ps <0.0001; partial R² > 0.28). Within-person analyses indicated that worse emotional functioning and QoL at a given timepoint were significantly associated with greater cognitive concerns at the same timepoint (ps <0.0001; partial R² = 0.007-0.017). Within all five examined predictors, stress had the greatest within- and between-person associations with CFQ scores.

Discussion: Findings suggest that subjective cognitive concerns are related to trait-like, and to a lesser extent, state-like emotional functioning and QoL. Incorporating assessment of both general and current emotional functioning could refine the use of subjective cognitive concern measures.

Objective: This study investigates the association of loneliness during the COVID-19 pandemic and the course of depressive, anxiety and sleep symptoms after psychological treatment in older adults.

Methods: During the first wave of the pandemic in 2020, we assessed additional, original data of 132 participants aged ≥60 years who had completed psychological treatment for late-life depression (LLD) in the context of a multicenter, randomized controlled trial (CBT-late). We measured loneliness using the UCLA Loneliness Scale. Depression, anxiety and sleep symptoms were assessed using the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), and Insomnia Severity Index (ISI).

Results: Participants with higher loneliness scores (n = 44) experienced a significant worsening of depressive and anxiety symptoms during the pandemic (estimated marginal mean difference (emmd) of change in GDS between post-treatment and COVID-19 visit: GDS_emmd= -4.61, [95% CI: -6.97 to -2.26], GAI_emmd= -2.21, [95% CI: -3.76 to -0.65]), while those with low to moderate loneliness (n = 72) maintained stable mild symptoms (GDS_emmd= -1.39, [95% CI: -3.00 to 0.22], GAI_emmd= -0.49, [95% CI: -1.69 to 0.72]). All patients reported increased sleep disturbances during the pandemic regardless of loneliness, while remaining in the range for sub-threshold insomnia.

Conclusions: Our results suggest an association of significant loneliness during the COVID-19 pandemic and a clinically relevant worsening of depressive and anxiety symptoms in older adults. Loneliness assessments and interventions may be incorporated into treatments for LLD, particularly during pandemics or other crises.

Objectives: To evaluate cariprazine in adults with older- and younger-age bipolar I disorder (OABD-I and YABD-I) and compare treatment effects between them.

Design and setting: Pooled post-hoc analysis of studies in depressive or acute manic/mixed episodes associated with bipolar I disorder.

Participants: 475/1383 patients (34.3%) in 3 depression trials and 238/1037 patients (23.0%) in 3 manic/mixed trials were OABD-I.

Interventions: Depression: placebo, cariprazine 1.5 mg/day, 3.0 mg/day, pooled 1.5-3.0 mg/day. Manic/mixed: placebo, cariprazine 3.0-6.0 mg/day, and 9.0-12.0 mg/day.

Measurements: Montgomery-Åsberg Depression Rating Scale (MADRS), Clinical Global Impression of Severity (CGI-S), and Young Mania Rating Scale (YMRS).

Results: In bipolar I depression, mean change from baseline in MADRS was significantly greater for the pooled cariprazine group vs. placebo in OABD-I (-13.72 vs. -11.98; p < 0.05) and for each cariprazine group vs. placebo among YABD-I. There was no significant difference in treatment effect between OABD-I and YABD-I for either individual cariprazine group vs. placebo. For mania/mixed states, mean change in YMRS was significantly greater for cariprazine 3.0-6.0 mg/day vs. placebo in OABD-I (-19.04 vs. -12.45; p < 0.001) and for both cariprazine groups in YABD-I (-12.49, -19.66 and -18.05 for placebo, cariprazine 3.0-6.0 mg/day and 9.0-12.0 mg/day, respectively [both p < 0.0001 vs. placebo]). There was no significant difference in treatment effect between OABD-I and YABD-I for cariprazine 3.0-6.0 mg/day vs. placebo; there was a significantly higher treatment effect for cariprazine 9.0-12.0 mg/day vs. placebo in the YABD-I subpopulation vs. OABD-I (4.20; p < 0.05).

Conclusions: Cariprazine appears to be effective for both depressive and manic/mixed episodes of bipolar I disorder, regardless of age.