Pub Date : 2025-10-11DOI: 10.1016/j.jagp.2025.10.003
Sungsu Lee M.D., Ph.D. , Grace S. Ro M.D. , Miriam T. Weber Ph.D. , Mark A. Oldham M.D.
Broadly analogous to the behavioral and psychological symptoms that plague dementia, the neuropsychiatric disturbances (NPD) of delirium pose significant burdens to patients, their loved ones, and clinicians. Moreover, these disturbances are often the most salient aspect of delirium, causing distress and placing patients and those around them at risk of harm. The field’s limited understanding of delirium’s NPD could also be a key reason why the pharmacology of delirium remains underdeveloped. In this narrative review, we propose clinically relevant neuropsychiatric syndromes in delirium, along with provisional definitions. We then discuss evidence for potential pharmacological and nonpharmacological interventions for each, both within the context of delirium and in other conditions, especially where these syndromes also occur in dementia. Candidate syndromes include excessive psychomotor activity and the related akathisia; inadequate psychomotor activity, either as reduced arousal or as avolition; psychosis, including perceptual disturbances and erroneous beliefs; emotional disturbances, either as affective dysregulation or as anxious distress; catatonia; and sleep-wake disturbances. The NPD of delirium should be differentiated from the global cognitive impairment of delirium as they often warrant independent clinical attention. The failure to tailor treatments to specific syndromes—for instance, treating akathisia in delirium with an antipsychotic, leading to greater behavioral activation—stands not only to prolong distress but also to worsen clinical outcomes. These syndromes deserve greater awareness and conceptual refinement to inform clinical management and to identify novel avenues for research.
{"title":"The Neuropsychiatric Disturbances of Delirium: A Review of Syndromes and Their Treatment","authors":"Sungsu Lee M.D., Ph.D. , Grace S. Ro M.D. , Miriam T. Weber Ph.D. , Mark A. Oldham M.D.","doi":"10.1016/j.jagp.2025.10.003","DOIUrl":"10.1016/j.jagp.2025.10.003","url":null,"abstract":"<div><div>Broadly analogous to the behavioral and psychological symptoms that plague dementia, the neuropsychiatric disturbances (NPD) of delirium pose significant burdens to patients, their loved ones, and clinicians. Moreover, these disturbances are often the most salient aspect of delirium, causing distress and placing patients and those around them at risk of harm. The field’s limited understanding of delirium’s NPD could also be a key reason why the pharmacology of delirium remains underdeveloped. In this narrative review, we propose clinically relevant neuropsychiatric syndromes in delirium, along with provisional definitions. We then discuss evidence for potential pharmacological and nonpharmacological interventions for each, both within the context of delirium and in other conditions, especially where these syndromes also occur in dementia. Candidate syndromes include excessive psychomotor activity and the related akathisia; inadequate psychomotor activity, either as reduced arousal or as avolition; psychosis, including perceptual disturbances and erroneous beliefs; emotional disturbances, either as affective dysregulation or as anxious distress; catatonia; and sleep-wake disturbances. The NPD of delirium should be differentiated from the global cognitive impairment of delirium as they often warrant independent clinical attention. The failure to tailor treatments to specific syndromes—for instance, treating akathisia in delirium with an antipsychotic, leading to greater behavioral activation—stands not only to prolong distress but also to worsen clinical outcomes. These syndromes deserve greater awareness and conceptual refinement to inform clinical management and to identify novel avenues for research.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 3","pages":"Pages 348-368"},"PeriodicalIF":3.8,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477400","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}
Pub Date : 2025-10-10DOI: 10.1016/j.jagp.2025.09.026
Caterina Rosano M.D., M.P.H. , Niles Frantz , Joseph Balintfy , Christopher Thomas , Margaret McDonald Ph.D., M.F.A. , Mary Ganguli M.D., M.P.H.
Public trust in research and scientific advances appears to be deteriorating. It behooves us, as researchers and educators, to take more responsibility for improving our communication strategies to reach the public and explain the value and relevance of our work to their lives. To address this need, the Training Program in Population Neuroscience of Aging at the University of Pittsburgh piloted a seminar on writing for the media, focusing on the local Western Pennsylvania audience. Six graduate and postdoctoral trainees in public health attended the seminar. Instructors besides public health faculty included local newspaper editors and science communication specialists working at the National Institutes of Health, at an advocacy organization, and at our university’s own communications program. In weekly seminar sessions, instructors discussed audiences, motivations, and formats for science writing. Trainees pitched story ideas, shared proposed outlines, and obtained ongoing feedback from instructors and fellow trainees. Over the course of several weeks, trainees prepared op-ed style articles for potential newspaper publication. Four of the six trainees succeeded in publishing articles in the local newspaper. A course to learn how to write for the public is both feasible and needed in academic settings.
{"title":"Writing for the Public: A Graduate Seminar in Science Communication","authors":"Caterina Rosano M.D., M.P.H. , Niles Frantz , Joseph Balintfy , Christopher Thomas , Margaret McDonald Ph.D., M.F.A. , Mary Ganguli M.D., M.P.H.","doi":"10.1016/j.jagp.2025.09.026","DOIUrl":"10.1016/j.jagp.2025.09.026","url":null,"abstract":"<div><div>Public trust in research and scientific advances appears to be deteriorating. It behooves us, as researchers and educators, to take more responsibility for improving our communication strategies to reach the public and explain the value and relevance of our work to their lives. To address this need, the Training Program in Population Neuroscience of Aging at the University of Pittsburgh piloted a seminar on writing for the media, focusing on the local Western Pennsylvania audience. Six graduate and postdoctoral trainees in public health attended the seminar. Instructors besides public health faculty included local newspaper editors and science communication specialists working at the National Institutes of Health, at an advocacy organization, and at our university’s own communications program. In weekly seminar sessions, instructors discussed audiences, motivations, and formats for science writing. Trainees pitched story ideas, shared proposed outlines, and obtained ongoing feedback from instructors and fellow trainees. Over the course of several weeks, trainees prepared op-ed style articles for potential newspaper publication. Four of the six trainees succeeded in publishing articles in the local newspaper. A course to learn how to write for the public is both feasible and needed in academic settings.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 117-122"},"PeriodicalIF":3.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461260","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}
Pub Date : 2025-10-10DOI: 10.1016/j.jagp.2025.09.027
Yue Li M.M., Yue Zhang M.M., Yuqi Ren M.M., Huanqiu Liu M.D.
{"title":"Response to Letter to the Editor","authors":"Yue Li M.M., Yue Zhang M.M., Yuqi Ren M.M., Huanqiu Liu M.D.","doi":"10.1016/j.jagp.2025.09.027","DOIUrl":"10.1016/j.jagp.2025.09.027","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 2","pages":"Page 264"},"PeriodicalIF":3.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433467","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}
Pub Date : 2025-10-08DOI: 10.1016/j.jagp.2025.09.025
Fu-Shan Xue M.D. , Yong-Bao Lin M.D. , Dan-Feng Wang M.D. , Yan-Hua Guo M.D.
{"title":"Intranasal Insulin Administration for Reducing Postoperative Delirium After Hip Fracture Surgery in Elderly Patients","authors":"Fu-Shan Xue M.D. , Yong-Bao Lin M.D. , Dan-Feng Wang M.D. , Yan-Hua Guo M.D.","doi":"10.1016/j.jagp.2025.09.025","DOIUrl":"10.1016/j.jagp.2025.09.025","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 2","pages":"Pages 265-266"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423860","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}
Pub Date : 2025-10-06DOI: 10.1016/j.jagp.2025.09.022
Charles F. Reynolds III M.D.
{"title":"Acknowledgment of Triage Editors and Reviewers 2025","authors":"Charles F. Reynolds III M.D.","doi":"10.1016/j.jagp.2025.09.022","DOIUrl":"10.1016/j.jagp.2025.09.022","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 113-116"},"PeriodicalIF":3.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395529","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}
Pub Date : 2025-10-04DOI: 10.1016/j.jagp.2025.10.001
Anderson Matheus Pereira da Silva B.Pharm. , Ocilio de Deus M.S. , Filipe Virgilio Ribeiro M.S. , Gabriel Caruso Novaes Tudella M.S. , Lucas Silva Cabeça M.S. , Levi Leal Silva M.S. , Mariana Lee Han M.S. , Julia Oliveira Franco M.S. , João Gabriel Pereira Costa M.S. , Maria da Vitória Santos do Nascimento B.Pharm. , João Vitor Andrade Fernandes M.S. , Eryvelton de Souza Franco Ph.D. , Maria Bernadete de Sousa Maia B.Pharm., Ph.D.
Background
Alzheimer’s disease (AD) dementia is the leading cause of cognitive decline in late life, yet treatment options remain limited. Lithium, widely used in bipolar disorder, has been suggested to exert neuroprotective effects through inhibition of GSK-3β and modulation of amyloid and tau pathology. We aimed to evaluate the efficacy and safety of lithium in AD dementia.
Methods
This systematic review and meta-analysis was prospectively registered in PROSPERO and conducted following PRISMA guidelines. We searched PubMed, Embase, and Cochrane Library through April 2025 for randomized controlled trials (RCTs) comparing lithium with placebo or standard therapy in patients with AD dementia or amnestic mild cognitive impairment. Outcomes included cognition (MMSE, ADAS-Cog, memory tasks), function (CDR-SB, conversion to AD), neuropsychiatric symptoms (NPI), CSF biomarkers, and safety (adverse events [AEs], serious AEs [SAEs]). Random-effects meta-analyses were complemented by Bayesian methods and trial sequential analyses.
Results
Six RCTs involving 394 participants (196 lithium, 198 placebo) met inclusion criteria. Lithium did not significantly improve global cognition (MMSE: MD −1.61, 95% CI −4.11 to 0.88; ADAS-Cog: MD −1.82, −3.05 to −0.60; both with high heterogeneity). Memory outcomes were mixed, with possible benefit for figure recall but not delayed verbal recall. No consistent benefits were observed for episodic memory, functional outcomes (CDR-SB), neuropsychiatric symptoms, or CSF biomarkers. Safety analyses showed no increased risk of SAEs; drug-related AEs were more frequent but heterogeneous across trials.
Conclusions
Lithium demonstrated an acceptable safety profile within the dosing regimens studied. However, current evidence does not support consistent cognitive or functional benefits in AD dementia. Larger, well-designed RCTs are warranted to clarify its potential therapeutic role.
{"title":"Efficacy and Safety of Lithium for Behavioral and Cognitive Symptoms in Alzheimer's Disease Dementia: A Systematic Review With Frequentist and Bayesian Meta-Analysis","authors":"Anderson Matheus Pereira da Silva B.Pharm. , Ocilio de Deus M.S. , Filipe Virgilio Ribeiro M.S. , Gabriel Caruso Novaes Tudella M.S. , Lucas Silva Cabeça M.S. , Levi Leal Silva M.S. , Mariana Lee Han M.S. , Julia Oliveira Franco M.S. , João Gabriel Pereira Costa M.S. , Maria da Vitória Santos do Nascimento B.Pharm. , João Vitor Andrade Fernandes M.S. , Eryvelton de Souza Franco Ph.D. , Maria Bernadete de Sousa Maia B.Pharm., Ph.D.","doi":"10.1016/j.jagp.2025.10.001","DOIUrl":"10.1016/j.jagp.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Alzheimer’s disease (AD) dementia is the leading cause of cognitive decline in late life, yet treatment options remain limited. Lithium, widely used in bipolar disorder, has been suggested to exert neuroprotective effects through inhibition of GSK-3β and modulation of amyloid and tau pathology. We aimed to evaluate the efficacy and safety of lithium in AD dementia.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was prospectively registered in PROSPERO and conducted following PRISMA guidelines. We searched PubMed, Embase, and Cochrane Library through April 2025 for randomized controlled trials (RCTs) comparing lithium with placebo or standard therapy in patients with AD dementia or amnestic mild cognitive impairment. Outcomes included cognition (MMSE, ADAS-Cog, memory tasks), function (CDR-SB, conversion to AD), neuropsychiatric symptoms (NPI), CSF biomarkers, and safety (adverse events [AEs], serious AEs [SAEs]). Random-effects meta-analyses were complemented by Bayesian methods and trial sequential analyses.</div></div><div><h3>Results</h3><div>Six RCTs involving 394 participants (196 lithium, 198 placebo) met inclusion criteria. Lithium did not significantly improve global cognition (MMSE: MD −1.61, 95% CI −4.11 to 0.88; ADAS-Cog: MD −1.82, −3.05 to −0.60; both with high heterogeneity). Memory outcomes were mixed, with possible benefit for figure recall but not delayed verbal recall. No consistent benefits were observed for episodic memory, functional outcomes (CDR-SB), neuropsychiatric symptoms, or CSF biomarkers. Safety analyses showed no increased risk of SAEs; drug-related AEs were more frequent but heterogeneous across trials.</div></div><div><h3>Conclusions</h3><div>Lithium demonstrated an acceptable safety profile within the dosing regimens studied. However, current evidence does not support consistent cognitive or functional benefits in AD dementia. Larger, well-designed RCTs are warranted to clarify its potential therapeutic role.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 3","pages":"Pages 371-385"},"PeriodicalIF":3.8,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433517","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}
Pub Date : 2025-10-03DOI: 10.1016/S1064-7481(25)00461-0
{"title":"Information for Subscribers","authors":"","doi":"10.1016/S1064-7481(25)00461-0","DOIUrl":"10.1016/S1064-7481(25)00461-0","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Page A1"},"PeriodicalIF":3.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223323","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}
Pub Date : 2025-10-01DOI: 10.1016/j.jagp.2025.09.024
Miriam I. Hehlmann Ph.D. , Delaney Callaghan B.A. , Julia Chafkin Ph.D. , Joohyun Kang B.A. , Lindsey Sankin Ph.D. , Oded Bein Ph.D. , Nili Solomonov Ph.D.
Objectives
Late-life suicidality is rapidly increasing; psychotherapy may reduce suicidality, but trajectories of change in suicidality remain unclear. A strong therapeutic alliance may protect against persistent suicidality. We examined the association of alliance with suicidality trajectories during brief, remote interventions for depression.
Methods
Sixty middle-aged and older adults with major depression were randomized to brief remote psychosocial interventions. Suicidality and alliance were assessed during treatment. Patients’ suicidality trajectories were classified as: 1) absent; 2) improved; 3) persistent, based on pre- to post-treatment changes. All three groups were included in mixed-effects models to examine the association between suicidality and alliance.
Results
At baseline, 53% of patients endorsed suicidality, with 45% in the absent group, 45% improved, and 10% persistent. Patients in the absent and improved groups showed stable, strong alliance while the persistent group showed worsening alliance.
Conclusion
Simple, remote psychosocial interventions are promising first-line treatments for late-life suicidality. A strong alliance may reduce suicidality and enhance outcomes, guiding timely, personalized interventions.
{"title":"Therapeutic Alliance is Linked With Suicidality Trajectories in Psychotherapy for Late-Life Depression","authors":"Miriam I. Hehlmann Ph.D. , Delaney Callaghan B.A. , Julia Chafkin Ph.D. , Joohyun Kang B.A. , Lindsey Sankin Ph.D. , Oded Bein Ph.D. , Nili Solomonov Ph.D.","doi":"10.1016/j.jagp.2025.09.024","DOIUrl":"10.1016/j.jagp.2025.09.024","url":null,"abstract":"<div><h3>Objectives</h3><div>Late-life suicidality is rapidly increasing; psychotherapy may reduce suicidality, but trajectories of change in suicidality remain unclear. A strong therapeutic alliance may protect against persistent suicidality. We examined the association of alliance with suicidality trajectories during brief, remote interventions for depression.</div></div><div><h3>Methods</h3><div>Sixty middle-aged and older adults with major depression were randomized to brief remote psychosocial interventions. Suicidality and alliance were assessed during treatment. Patients’ suicidality trajectories were classified as: 1) absent; 2) improved; 3) persistent, based on pre- to post-treatment changes. All three groups were included in mixed-effects models to examine the association between suicidality and alliance.</div></div><div><h3>Results</h3><div>At baseline, 53% of patients endorsed suicidality, with 45% in the absent group, 45% improved, and 10% persistent. Patients in the absent and improved groups showed stable, strong alliance while the persistent group showed worsening alliance.</div></div><div><h3>Conclusion</h3><div>Simple, remote psychosocial interventions are promising first-line treatments for late-life suicidality. A strong alliance may reduce suicidality and enhance outcomes, guiding timely, personalized interventions.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 2","pages":"Pages 222-228"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799838","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}
Pub Date : 2025-10-01Epub Date: 2025-04-23DOI: 10.1016/j.jagp.2025.04.209
Vincent E S Allott, Benjamin H L Harris, Michael B Fertleman, Louis J Koizia
{"title":"Accelerometer-Derived Physical Activity, Sedentary Behavior, and the Risk of Depression and Anxiety.","authors":"Vincent E S Allott, Benjamin H L Harris, Michael B Fertleman, Louis J Koizia","doi":"10.1016/j.jagp.2025.04.209","DOIUrl":"10.1016/j.jagp.2025.04.209","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":"1106-1107"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082171","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}
Pub Date : 2025-09-30DOI: 10.1016/j.jagp.2025.09.021
Lisanne M. Jenkins Ph.D. , Ashley A. Heywood Ph.D. , Caroline Gurvich Ph.D.
{"title":"Beyond Alzheimer’s Pathology: Contributions to Cognitive Decline in Late Life Depression","authors":"Lisanne M. Jenkins Ph.D. , Ashley A. Heywood Ph.D. , Caroline Gurvich Ph.D.","doi":"10.1016/j.jagp.2025.09.021","DOIUrl":"10.1016/j.jagp.2025.09.021","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 2","pages":"Pages 195-198"},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369380","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}
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