American Journal of Geriatric Psychiatry最新文献

英文中文

Feasibility and Tolerability of Novel Deep Repetitive Transcranial Magnetic Stimulation for Depression in Older Adults: DIVINE Pilot Study 新的深度重复经颅磁刺激治疗老年人抑郁症的可行性和耐受性：DIVINE试点研究

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-20 DOI: 10.1016/j.jagp.2025.09.016

Dante Duarte M.D., Ph.D. , Anne-Marie Di Passa M.Sc. , Carly McIntyre-Wood M.Sc. , Emily MacKillop Ph.D. , Shelby Prokop-Millar B.Sc. , Horodjei Yaya M.Sc. , Allan Fein M.Sc. , Emily Vandehei M.Sc. , Jane De Jesus B.Sc., B.A. , Benicio N. Frey M.D., Ph.D. , James MacKillop Ph.D.

Objectives

Major depressive disorder (MDD) is a leading cause of global disability and is notably prevalent in older adults. Deep transcranial magnetic stimulation (dTMS), specifically the H1-coil targeting the lateral prefrontal cortex, is approved for adults with treatment-resistant MDD and has shown promise in seniors. However, substantive proportions do not respond to the H1-coil and other H-coils, targeting different brain regions implicated in MDD, may also offer therapeutic benefits. The current study examined the feasibility and tolerability of the H4-coil and H7-coil designs in seniors with MDD for the first time.

Materials and Methods

Participants were 21 older adults with moderate-to-severe treatment-resistant MDD randomized to 20 sessions of H4-coil or H7-coil dTMS for four weeks. Primary outcomes were feasibility (protocol completion) and tolerability (frequency of adverse events). Secondary outcomes were depression, anxiety, cognition, sleep, and somatic complaints, and coil differences.

Results

Intention-to-treat protocol completion rates were 86.8% for the H4-coil and 98% for the H7-coil. Both treatments were generally well-tolerated with low rates of AEs and no evidence of negative cognitive effects. There was a significant reduction in depression (F_(4,68) = 46.54, p < 0.0000001, η² = 0.73), but no significant coil differences. Both treatments also led to significant reductions in anxiety and somatic complaints.

Conclusion

This study provides evidence supporting the feasibility and tolerability of the H4-coil and H7-coil in seniors with MDD, with promising evidence of therapeutic benefits. The findings support future sham-controlled designs to formally evaluate clinical efficacy.

Clinical Trial Registration

The Clinicaltrials.gov registration number for the study is NCT05855850.

重度抑郁症（MDD）是全球致残的主要原因之一，在老年人中尤为普遍。深经颅磁刺激（dTMS），特别是针对外侧前额皮质的h1线圈，已被批准用于治疗难治性重度抑郁症的成人，并在老年人中显示出前景。然而，实质性比例对h1线圈和其他h线圈没有反应，针对与重度抑郁症有关的不同大脑区域，也可能提供治疗益处。本研究首次探讨了h4 -线圈和h7 -线圈设计在老年MDD患者中的可行性和耐受性。材料和方法研究对象为21名中重度难治性重度抑郁症老年人，随机分为20组h4线圈或h7线圈dTMS，疗程4周。主要结局是可行性（方案完成情况）和耐受性（不良事件发生频率）。次要结局是抑郁、焦虑、认知、睡眠、躯体疾患和线圈差异。结果h4盘管的意向治疗方案完成率为86.8%，h7盘管的完成率为98%。两种治疗通常耐受性良好，不良反应发生率低，无证据表明对认知有负面影响。抑郁显著降低（F(4,68) = 46.54, p < 0.0000001, η2 = 0.73），但无显著差异。这两种治疗方法也显著减少了焦虑和身体不适。结论本研究为H4-coil和H7-coil治疗老年重度抑郁症的可行性和耐受性提供了证据，证明其治疗效果良好。研究结果支持未来的假对照设计来正式评估临床疗效。临床试验注册该研究的Clinicaltrials.gov注册号为NCT05855850。

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引用次数: 0

A Walk With Grief: A Personal Narrative of Coping With the Death of a Same Sex Partner in Late Life 与悲伤同行：晚年应对同性伴侣死亡的个人叙述。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-20 DOI: 10.1016/j.jagp.2025.09.012

Sarah T. Stahl Ph.D., Joelle Kincman Ph.D., Katalin Szanto M.D.

Grief is a complex and multifaceted process. While there is no reason to think that the grieving process would be dissimilar if an LGBTQ+ individual loses a partner than the grief of a heterosexual individual, they often receive and perceive less practical and emotional support, empathy and are treated unequally legally post loss. To date no studies have investigated whether this experience (disenfranchised loss) more likely leads to prolonged grief disorder or other mental health sequelae. This article describes aspects of disenfranchised grief, loneliness, and artificial intelligence for emotional support based on the personal experience of an older gay widower who was moderately depressed and lonely at the time of enrollment in a clinical trial for late-life bereavement and suicide risk.

悲伤是一个复杂而多方面的过程。虽然没有理由认为LGBTQ+个体失去伴侣的悲伤过程会与异性恋个体的悲伤不同，但他们通常会得到和感受到更少的实际和情感支持、同情，并且在失去伴侣后受到不平等的法律对待。到目前为止，还没有研究调查这种经历（被剥夺公民权的丧失）是否更有可能导致长期的悲伤障碍或其他精神健康后遗症。这篇文章描述了被剥夺的悲伤、孤独和人工智能情感支持的各个方面，这是基于一位老年同性恋鳏夫的个人经历，他在参加一项针对晚年丧亲和自杀风险的临床试验时，患有中度抑郁和孤独。

引用次数: 0

Effects of Comorbid Anxiety on Treatment Outcomes After Accelerated Theta Burst Stimulation for Late-Life Depression 共病焦虑对加速θ波爆发刺激治疗晚期抑郁症疗效的影响。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-20 DOI: 10.1016/j.jagp.2025.09.017

Jeanette Hui M.Sc., M.D. , Alisson P. Trevizol M.D., Ph.D. , Hyewon H. Lee M.D. , Reza Zomorrodi Ph.D. , Christoph Zrenner M.D. , Benoit H. Mulsant M.D., M.S. , Daniel M. Blumberger M.D., M.Sc.

Objectives

Accelerated theta burst stimulation (TBS) offers a time-efficient alternative to conventional repetitive transcranial magnetic stimulation and has recently been explored in late-life depression (LLD). Anxiety symptoms frequently occur in depressed older adults and are known to reduce the effectiveness of first-line therapeutic options. The impact of anxiety symptoms on treatment outcomes from accelerated TBS is unknown.

Methods

Secondary analyses were performed on data from an open-label pilot trial where 78 outpatients with LLD received a 5-day course of accelerated sequential bilateral TBS (NCT05119699).

Results

Participants with a comorbid anxiety disorder had more severe depressive symptoms before and after treatment and lower remission rates at the 4-week follow-up, but not immediately at treatment end. Baseline anxiety symptoms did not significantly affect rates of remission from suicidal ideation at either follow-up time points.

Conclusions

Comorbid anxiety symptoms may reduce the effectiveness of accelerated TBS for treating depressive symptoms in older adults.

目的：加速θ波爆发刺激（TBS）为传统的重复经颅磁刺激提供了一种时间效率高的替代方案，最近在老年抑郁症（LLD）中得到了探索。焦虑症状经常出现在抑郁的老年人中，并且已知会降低一线治疗方案的有效性。焦虑症状对加速TBS治疗结果的影响尚不清楚。方法：对一项开放标签试点试验的数据进行二次分析，该试验中78名LLD门诊患者接受了5天的加速顺序双侧TBS疗程（NCT05119699）。结果：患有共病焦虑症的参与者在治疗前后有更严重的抑郁症状，在4周的随访中缓解率更低，但在治疗结束时不是立即。在任何随访时间点，基线焦虑症状对自杀意念缓解率均无显著影响。结论：共病性焦虑症状可能会降低加速TBS治疗老年人抑郁症状的有效性。

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引用次数: 0

Living Alone, Early Tau Pathology, and Loneliness in Cognitively Unimpaired Older Adults During the COVID-19 Pandemic 在COVID-19大流行期间，独居、早期Tau病理学和认知功能受损老年人的孤独感

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-20 DOI: 10.1016/j.jagp.2025.09.014

Benjamin S. Zide M.St , Geoffroy Gagliardi Ph.D. , Heidi I.L. Jacobs Ph.D. , Jennifer R. Gatchel M.D., Ph.D. , Yakeel T. Quiroz Ph.D. , Gad A. Marshall M.D. , Dorene M. Rentz Psy.D. , Keith A. Johnson M.D. , Reisa A. Sperling M.D. , Patrizia Vannini Ph.D. , Nancy J. Donovan M.D. , Harvard Aging Brain Study

Background

Social restrictions during the COVID-19 pandemic heightened concerns about the negative health impacts of loneliness on older adults, particularly among those living alone. This study evaluated whether Alzheimer’s disease (AD) pathology might be an underlying factor contributing to increased loneliness in cognitively unimpaired (CU) older adults living alone or with others during the pandemic.

Methods

One hundred-two CU participants from the Harvard Aging Brain Study completed pre-pandemic assessments of loneliness, cognition, cortical amyloid burden (PiB-PET), and tau pathology in inferior temporal (IT) and entorhinal cortical (EC) regions (FTP-PET). In May 2020, participants completed online surveys assessing living arrangements (alone versus with others) and current loneliness. Linear regressions estimated the interactive effects of living alone and either PiB, EC or IT FTP binding, or cognition on changes in loneliness, adjusting for age, sex, time since the pre-pandemic imaging, and pre-pandemic levels of depression, anxiety, and loneliness.

Results

Participants living alone during the pandemic reported greater increases in loneliness compared to those living with others (β = 1.22, p = 0.024). Higher right EC and right IT FTP binding interacted with living alone to amplify this association (for the right EC FTP interaction, β = 4.14, p = 0.043, R² = 0.21; for the right IT FTP interaction, β = 7.16, p = 0.017, R² = 0.23). Other interactions of living alone with PiB-PET or cognition were not associated with change in loneliness.

Conclusion

Greater tau pathology amplified the association between living alone and increased loneliness among CU older adults during the COVID-19 pandemic. AD pathological brain changes may play an unrecognized role in late-life loneliness.

背景：2019冠状病毒病大流行期间的社会限制加剧了人们对孤独对老年人，特别是独居老年人健康负面影响的担忧。本研究评估了阿尔茨海默病（AD）病理是否可能是导致大流行期间独居或与他人一起生活的认知未受损（CU）老年人孤独感增加的潜在因素。方法：来自哈佛大学老化脑研究的102名CU参与者完成了孤独感、认知、皮质淀粉样蛋白负担（PiB-PET）和下颞叶（IT）和内嗅皮质（EC）区域（FTP-PET）的tau病理学的大流行前评估。2020年5月，参与者完成了在线调查，评估生活安排（独自一人与他人）和当前的孤独感。线性回归估计了独居与PiB、EC或IT FTP绑定或认知对孤独感变化的交互影响，调整了年龄、性别、自大流行前成像以来的时间以及大流行前的抑郁、焦虑和孤独感水平。结果：与与他人同住的参与者相比，大流行期间独居的参与者报告的孤独感增加更大（β = 1.22, p = 0.024）。较高的右EC和右IT FTP绑定与独居相互作用，以扩大这种关联（对于右EC FTP交互，β = 4.14, p = 0.043, R2 = 0.21；对于右IT FTP交互，β = 7.16, p = 0.017, R2 = 0.23）。单独生活与PiB-PET或认知的其他相互作用与孤独感的变化无关。结论：在COVID-19大流行期间，更大的tau病理放大了独居与CU老年人孤独感增加之间的关联。阿尔茨海默病病理性大脑变化可能在晚年孤独中起着未被认识到的作用。

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引用次数: 0

Borderline Traits and the Simplification–Multidimensionality Tradeoff in Personality Profiling of Older Suicide Attempters: A Response to Satapathy and Zhao 老年自杀未遂者人格特征的边缘特征与简化-多维权衡：对Satapathy和Zhao的回应。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-19 DOI: 10.1016/j.jagp.2025.09.010

Anna Szücs M.D. , Meghan T. Wong M.S. , Emma J. O’Brien B.A. , Paulina K. Pankowska Ph.D. , Andrea B. Maier M.D., Ph.D. , Katalin Szanto M.D. , Hanga Galfalvy Ph.D.

引用次数: 0

Ketamine for Late-Life Depression: Where Do We Stand? 氯胺酮治疗老年抑郁症：我们的研究进展如何？

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-19 DOI: 10.1016/j.jagp.2025.09.008

Hanadi Ajam Oughli M.D. , Marie Anne Gebara M.D. , Alastair J. Flint M.B.

引用次数: 0

Being With a Dying, Nonreligious Person 与一个垂死的、不信教的人在一起。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-18 DOI: 10.1016/j.jagp.2025.09.006

George S. Alexopoulos M.D.

Death is a unique and dramatic event. The desire to imagine life as endless may be hard-wired, preserved through evolution because it promotes behaviors that protect the organism. Beliefs in an afterlife may be an extension of our theory-of-mind mental functions, our innate tendency to attribute consciousness to others, projected onto a self that persists after death. Afterlife beliefs also reflect the intuitive teleological thinking of childhood that is automatic and suppressed but not erased in adulthood. Religions respond to this need by offering narratives of survival after death. By contrast, most nonreligious people hold a physicalist worldview in which the person dies with the body, leaving them the task to construct a personal, coherent account of their own mortality. Existentialists view death as a boundary that exposes the fragility of human life. This awareness permeates every aspect of life, sustaining a tension between the longing for transcendence and the reality of finitude. A clinical vignette illustrates the need to listen attentively and try to understand the nonreligious dying patient. The person in the vignette, fully aware of her prognosis, avoided direct discussion of death. Despite her expertise in palliative care, she pursued treatments that prolonged both life and suffering. In her final days, she focused on easing the emotional turmoil her dying caused to loved ones, seeking continuity in her relationships. Facing mortality allows for authentic engagement with existence, a confrontation that deepens life’s meaning precisely because it is finite.

死亡是一个独特而戏剧性的事件。想象生命无穷无尽的欲望可能是与生俱来的，通过进化得以保存，因为它促进了保护有机体的行为。对来世的信仰可能是我们的心理功能理论的延伸，我们天生倾向于将意识归因于他人，投射到死后仍然存在的自我上。来世信仰也反映了童年的直觉目的论思维，这种思维是自动的，被压抑的，但在成年后不会被抹去。宗教通过提供死后生存的故事来回应这种需求。相比之下，大多数不信教的人持有物理主义世界观，认为人随肉体而死，留给他们的任务是为自己的死亡构建一个个人的、连贯的解释。存在主义者将死亡视为暴露人类生命脆弱性的边界。这种意识渗透到生活的方方面面，在对超越的渴望和有限的现实之间维持着一种张力。一个临床小插图说明了需要认真倾听，并试图理解非宗教垂死病人。小插图中的人，完全知道她的预后，避免直接讨论死亡。尽管她在姑息治疗方面很有专长，但她还是选择了延长生命和痛苦的治疗方法。在她最后的日子里，她专注于缓解她的死亡给她所爱的人带来的情感动荡，寻求与她的关系的连续性。面对死亡可以让我们真正地与存在接触，这种对抗恰恰加深了生命的意义，因为生命是有限的。

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引用次数: 0

Comment on “Personality Profiles of Older Suicide Attempters: Cross-Sectional and Prospective Differences From Depressed Nonattempter and Nonpsychiatric Comparisons” 对“老年自杀未遂者的人格特征：来自抑郁的非自杀未遂者和非精神病学比较的横断面和前瞻性差异”的评论。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-18 DOI: 10.1016/j.jagp.2025.09.005

Prajnasini Satapathy M.D. , Rachana Mehta M.Sc. , Ranjana Sah M.D.

引用次数: 0

How To Integrate Chatbots Into Geriatric Psychiatry 如何将聊天机器人融入老年精神病学

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-12 DOI: 10.1016/j.jagp.2025.07.013

Allen Frances M.D. , Lucianna Ramos

Chatbots may be remarkably useful for seniors by providing companionship, cognitive enhancement, organizational cues, resource information, medical information, and help managing medications. Chatbots may also remarkably harmful for seniors by promoting misinformation, scamming, invasion of privacy, and unwanted advertising. Tech companies have been irresponsible in failing to provide safety guardrails, privacy protections, and monitoring and reporting of adverse consequences. A hybrid model of geriatric care will likely be optimal in the future. Clinicians will need to up their game to include chatbots in the treatment of patients; chatbots will need to up their game to be more specific and safer for geriatric patients.

聊天机器人可能对老年人非常有用，它可以提供陪伴、增强认知、组织线索、资源信息、医疗信息，并帮助管理药物。聊天机器人还可能通过传播错误信息、欺诈、侵犯隐私和不受欢迎的广告，对老年人造成极大伤害。科技公司在未能提供安全护栏、隐私保护以及监测和报告不良后果方面是不负责任的。在未来，老年护理的混合模式可能是最理想的。临床医生需要提高他们的水平，将聊天机器人纳入患者治疗中；聊天机器人将需要提高他们的游戏，以更具体和更安全地为老年患者服务。

引用次数: 0

Daily Associations Between Caregiving Time and Spousal Caregivers’ Well-Being: The Moderating Roles of Daily Marital Interactions 照顾时间与配偶照顾者幸福感的日常关系：日常婚姻互动的调节作用。

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-09-02 DOI: 10.1016/j.jagp.2025.08.011

Iris S. Yang M.A. , David Rosenfield Ph.D. , Holly J. Bowen Ph.D. , Stephanie J. Wilson Ph.D.

Objectives

With more individuals providing informal care, understanding the impacts of this role is crucial. The literature on the well-being of informal caregivers is divided, with some studies reporting primarily harmful effects and others concluding that caregiving is fundamentally beneficial. We examined how everyday positive and negative marital interactions moderated the association between spousal caregiving time and caregiver affect in both within and between-person processes, aiming to clarify mechanisms behind the varied outcomes observed in caregiver well-being.

Methods

As part of the Midlife in the United States (MIDUS) study, 212 spousal caregivers participated in the National Study of Daily Experiences, an 8-day daily-diary study, providing 1634 days of data. Generalized linear mixed models examined the moderating role of daily interaction quality in associations between daily caregiving time and daily positive and negative affect. Covariates included caregiver health, sex, employment, minority status, education, and time spent caring for people besides a spouse.

Results

Both daily marital strain and uplifts significantly moderated the relationship between daily caregiving time and negative affect by reducing the association between increased care time and negative affect. Negative affect was already elevated on strain days, regardless of caregiving time. Conversely, daily marital strain and uplifts did not significantly moderate the association between caregiving time and positive affect.

Conclusions

Findings generally support the view that caregiving is predominantly linked with psychological burden while highlighting the potential role of daily marital uplifts in buffering this association.

随着越来越多的人提供非正式护理，了解这一角色的影响至关重要。关于非正式照顾者幸福感的文献存在分歧，一些研究报告了主要的有害影响，而另一些研究得出结论认为照顾从根本上是有益的。我们研究了日常积极和消极的婚姻互动如何调节配偶照顾时间和照顾者影响之间的关联，无论是在人内部还是人与人之间的过程中，旨在阐明在照顾者幸福感中观察到的不同结果背后的机制。方法：作为美国中年（MIDUS）研究的一部分，212名配偶照顾者参加了国家日常经历研究，这是一项为期8天的每日日记研究，提供了1634天的数据。广义线性混合模型检验了日常互动质量在日常护理时间与日常积极和消极情绪之间的关联中的调节作用。协变量包括照顾者的健康、性别、就业、少数民族身份、教育和照顾配偶以外的人的时间。结果：日常婚姻紧张和提升均显著调节了日常照顾时间与消极情绪之间的关系，降低了日常照顾时间增加与消极情绪之间的关联。在紧张的日子里，无论照顾时间长短，负面影响都已经升高。相反，日常婚姻紧张和提升并没有显著调节照顾时间和积极影响之间的关联。结论：研究结果普遍支持护理主要与心理负担相关的观点，同时强调了日常婚姻提升在缓冲这种关联方面的潜在作用。

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