Pub Date : 2025-09-19DOI: 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.
{"title":"Borderline Traits and the Simplification–Multidimensionality Tradeoff in Personality Profiling of Older Suicide Attempters: A Response to Satapathy and Zhao","authors":"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.","doi":"10.1016/j.jagp.2025.09.010","DOIUrl":"10.1016/j.jagp.2025.09.010","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 131-133"},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319005","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 : 2025-09-19DOI: 10.1016/j.jagp.2025.09.008
Hanadi Ajam Oughli M.D. , Marie Anne Gebara M.D. , Alastair J. Flint M.B.
{"title":"Ketamine for Late-Life Depression: Where Do We Stand?","authors":"Hanadi Ajam Oughli M.D. , Marie Anne Gebara M.D. , Alastair J. Flint M.B.","doi":"10.1016/j.jagp.2025.09.008","DOIUrl":"10.1016/j.jagp.2025.09.008","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 103-105"},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295041","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 : 2025-09-18DOI: 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.
{"title":"Being With a Dying, Nonreligious Person","authors":"George S. Alexopoulos M.D.","doi":"10.1016/j.jagp.2025.09.006","DOIUrl":"10.1016/j.jagp.2025.09.006","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 138-143"},"PeriodicalIF":3.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260418","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 : 2025-09-12DOI: 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.
{"title":"How To Integrate Chatbots Into Geriatric Psychiatry","authors":"Allen Frances M.D. , Lucianna Ramos","doi":"10.1016/j.jagp.2025.07.013","DOIUrl":"10.1016/j.jagp.2025.07.013","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1275-1278"},"PeriodicalIF":3.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223326","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 : 2025-09-09DOI: 10.1016/j.jagp.2025.09.001
Antonio Bullejos-Caballero M.D. , José A. Carnicero Ph.D. , Ana Alfaro-Acha M.D., Ph.D. , Amelia Guadalupe-Grau Ph.D. , Ignacio Ara Ph.D. , Leocadio Rodriguez-Mañas M.D., Ph.D. , Francisco J. García-García M.D., Ph.D. , Fabio A. Quiñónez-Bareiro M.D., Ph.D.
Introduction
Frailty and the depression are two distinct, yet interrelated conditions commonly observed in the elderly population, whose prevalences rise alongside the ageing process. Although both conditions have been shown to be risk factors for adverse outcomes, they have been treated separately, omitting their interrelationship.
Aims
To evaluate the associations between frailty-depression categories, and adverse events through a prospective, population-based cohort design using data from 1,412 individuals in the Toledo Study of Healthy Ageing.
Methods
The depressive symptoms was evaluated using the Geriatric Depression Scale questionnaire, and frailty was assessed through both the Frailty Phenotype and the 5 item Frailty Trait Scale (FTS5). The associations of frailty and the depressive symptoms, both as independent factors and in combination, with adverse events were assessed using a Cox proportional hazards regression model for mortality analysis and logistic regression for incident and worsening disability. Additionally, analyses stratified by sex were performed.
Results
We found that when both conditions were treated as independent, each was associated with adverse events. However, when the resulting categories were analyzed, having depressive symptoms increased the risk of adverse events only in the presence of frailty, specifically in prefrail and frail categories of the Frailty Phenotype and in the frail category of the FTS5.
Conclusions
This study suggests a possible synergistic effect between the studied factors when frailty is affected. Similar synergistic effects may also exist with other clinical conditions, so that obtaining a more accurate risk of adverse outcomes would be better achieved by using such resulting categories.
{"title":"“Frailty and Depression: A Comprehensive Perspective on Their Role in Adverse Health Outcomes”","authors":"Antonio Bullejos-Caballero M.D. , José A. Carnicero Ph.D. , Ana Alfaro-Acha M.D., Ph.D. , Amelia Guadalupe-Grau Ph.D. , Ignacio Ara Ph.D. , Leocadio Rodriguez-Mañas M.D., Ph.D. , Francisco J. García-García M.D., Ph.D. , Fabio A. Quiñónez-Bareiro M.D., Ph.D.","doi":"10.1016/j.jagp.2025.09.001","DOIUrl":"10.1016/j.jagp.2025.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Frailty and the depression are two distinct, yet interrelated conditions commonly observed in the elderly population, whose prevalences rise alongside the ageing process. Although both conditions have been shown to be risk factors for adverse outcomes, they have been treated separately, omitting their interrelationship.</div></div><div><h3>Aims</h3><div>To evaluate the associations between frailty-depression categories, and adverse events through a prospective, population-based cohort design using data from 1,412 individuals in the Toledo Study of Healthy Ageing.</div></div><div><h3>Methods</h3><div>The depressive symptoms was evaluated using the Geriatric Depression Scale questionnaire, and frailty was assessed through both the Frailty Phenotype and the 5 item Frailty Trait Scale (FTS5). The associations of frailty and the depressive symptoms, both as independent factors and in combination, with adverse events were assessed using a Cox proportional hazards regression model for mortality analysis and logistic regression for incident and worsening disability. Additionally, analyses stratified by sex were performed.</div></div><div><h3>Results</h3><div>We found that when both conditions were treated as independent, each was associated with adverse events. However, when the resulting categories were analyzed, having depressive symptoms increased the risk of adverse events only in the presence of frailty, specifically in prefrail and frail categories of the Frailty Phenotype and in the frail category of the FTS5.</div></div><div><h3>Conclusions</h3><div>This study suggests a possible synergistic effect between the studied factors when frailty is affected. Similar synergistic effects may also exist with other clinical conditions, so that obtaining a more accurate risk of adverse outcomes would be better achieved by using such resulting categories.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 3","pages":"Pages 284-297"},"PeriodicalIF":3.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246190","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 : 2025-09-02DOI: 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.
{"title":"Daily Associations Between Caregiving Time and Spousal Caregivers’ Well-Being: The Moderating Roles of Daily Marital Interactions","authors":"Iris S. Yang M.A. , David Rosenfield Ph.D. , Holly J. Bowen Ph.D. , Stephanie J. Wilson Ph.D.","doi":"10.1016/j.jagp.2025.08.011","DOIUrl":"10.1016/j.jagp.2025.08.011","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 18-27"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181079","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}
This study aimed to explore the longitudinal association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and cognitive impairment in older adults and further assess potential causality using Mendelian randomization (MR).
Design
Longitudinal population-based analysis combined with two-sample MR. Data from Waves 6–8 (2015–2019) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) were analyzed using hierarchical regression models and mixed linear effects models. MR utilized genome-wide association studies (GWAS) summary data.
Participants
11,444 adults aged ≥60 years from SHARE Wave 6, with longitudinal follow-up in Waves 7 (N = 2,775) and 8 (N = 5,469).
Measurements
TG/HDL-C ratio, cognitive function (orientation, immediate/delayed recall, verbal fluency, numeracy), and cognitive impairment (defined as scores >1.5 SD below age-group mean). Covariates included socio-demographics, health behaviors, comorbidities, and national-level factors. MR employed genetic variants associated with TG/HDL-C as instrumental variables.
Results
Higher TG/HDL-C ratios were negatively associated with total cognitive scores (β = −0.115, χ² = 15.44, df = 1, p < 0.001), immediate recall (β = −0.029, χ² = 12.34, df = 1, p < 0.001), delayed recall (β = −0.028, χ² = 7.33, df = 1, p < 0.001), verbal fluency (β = −0.038, χ² = 11.53, df = 1, p < 0.001), and numeracy (β = −0.019, χ² = 4.55, df = 1, p < 0.05) in fully adjusted models. Longitudinal analysis revealed increased cognitive impairment risk in the highest TG/HDL-C quartile (OR=1.43, 95% CI:1.01–2.03, χ² = 9.24, df = 1) over 4 years. MR supported a causal link between elevated TG/HDL-C and cognitive decline.
Conclusions
Elevated TG/HDL-C ratios are longitudinally associated with cognitive decline in older adults. Managing lipid metabolism may mitigate cognitive impairment, highlighting the importance of TG/HDL-C as a modifiable risk factor in aging populations.
目的：本研究旨在探讨甘油三酯与高密度脂蛋白胆固醇（TG/HDL-C）比值与老年人认知功能障碍之间的纵向关联，并利用孟德尔随机化（MR）进一步评估潜在的因果关系。设计：采用分层回归模型和混合线性效应模型，结合欧洲健康、老龄化和退休调查（SHARE）第6-8期（2015-2019）的双样本mr数据，进行纵向人群分析。MR利用全基因组关联研究（GWAS）汇总数据。参与者：来自SHARE第6波的11444名年龄≥60岁的成年人，在第7波（N = 2775）和第8波（N = 5469）进行纵向随访。测量：TG/HDL-C比值、认知功能（定向、即时/延迟回忆、语言流畅性、计算能力）和认知障碍（定义为得分>低于年龄组平均1.5 SD）。协变量包括社会人口统计学、健康行为、合并症和国家层面的因素。MR采用与TG/HDL-C相关的遗传变异作为工具变量。结果:高TG / hdl - c比值与总认知得分负相关(β= -0.115,χ²= 15.44,df = 1, p < 0.001),立即召回(β= -0.029,χ²= 12.34,df = 1, p < 0.001),延迟回忆(β= -0.028,χ²= 7.33,df = 1, p < 0.001),语言流利(β= -0.038,χ²= 11.53,df = 1, p < 0.001),计算能力(β= -0.019,χ²= 4.55,df = 1, p < 0.05)在充分调整模型。纵向分析显示，4年内TG/HDL-C最高四分位数的认知障碍风险增加（OR=1.43, 95% CI:1.01-2.03, χ²= 9.24,df =1）。MR支持TG/HDL-C升高与认知能力下降之间的因果关系。结论：TG/HDL-C比值升高与老年人认知能力下降具有纵向相关性。管理脂质代谢可能减轻认知障碍，强调TG/HDL-C作为老龄化人群可改变的危险因素的重要性。
{"title":"Association Between Ratio of Triglycerides to HDL-C and Cognitive Impairment: A Longitudinal Population-Based Analysis and Mendelian Randomization Study","authors":"Yucheng Huang M.B.B.S. , Lijia Zheng M.P.H. , Meng-Meng Lyu Ph.D.","doi":"10.1016/j.jagp.2025.08.007","DOIUrl":"10.1016/j.jagp.2025.08.007","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to explore the longitudinal association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and cognitive impairment in older adults and further assess potential causality using Mendelian randomization (MR).</div></div><div><h3>Design</h3><div>Longitudinal population-based analysis combined with two-sample MR. Data from Waves 6–8 (2015–2019) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) were analyzed using hierarchical regression models and mixed linear effects models. MR utilized genome-wide association studies (GWAS) summary data.</div></div><div><h3>Participants</h3><div>11,444 adults aged ≥60 years from SHARE Wave 6, with longitudinal follow-up in Waves 7 (<em>N</em> = 2,775) and 8 (<em>N</em> = 5,469).</div></div><div><h3>Measurements</h3><div>TG/HDL-C ratio, cognitive function (orientation, immediate/delayed recall, verbal fluency, numeracy), and cognitive impairment (defined as scores >1.5 SD below age-group mean). Covariates included socio-demographics, health behaviors, comorbidities, and national-level factors. MR employed genetic variants associated with TG/HDL-C as instrumental variables.</div></div><div><h3>Results</h3><div>Higher TG/HDL-C ratios were negatively associated with total cognitive scores (β = −0.115, χ² = 15.44, df = 1, p < 0.001), immediate recall (β = −0.029, χ² = 12.34, df = 1, p < 0.001), delayed recall (β = −0.028, χ² = 7.33, df = 1, p < 0.001), verbal fluency (β = −0.038, χ² = 11.53, df = 1, p < 0.001), and numeracy (β = −0.019, χ² = 4.55, df = 1, p < 0.05) in fully adjusted models. Longitudinal analysis revealed increased cognitive impairment risk in the highest TG/HDL-C quartile (OR=1.43, 95% CI:1.01–2.03, χ² = 9.24, df = 1) over 4 years. MR supported a causal link between elevated TG/HDL-C and cognitive decline.</div></div><div><h3>Conclusions</h3><div>Elevated TG/HDL-C ratios are longitudinally associated with cognitive decline in older adults. Managing lipid metabolism may mitigate cognitive impairment, highlighting the importance of TG/HDL-C as a modifiable risk factor in aging populations.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 1-14"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181098","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 : 2025-09-02DOI: 10.1016/S1064-7481(25)00437-3
{"title":"Information for Subscribers","authors":"","doi":"10.1016/S1064-7481(25)00437-3","DOIUrl":"10.1016/S1064-7481(25)00437-3","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Page A1"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926774","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 : 2025-08-29DOI: 10.1016/j.jagp.2025.08.008
Emma Rhodes Ph.D. , Philip S. Insel Ph.D. , Michelle Kassel Ph.D. , Maria Kryza-Lacombe Ph.D. , Meryl A. Butters Ph.D. , David Bickford M.D. , Duygu Tosun Ph.D. , Ruth Morin Ph.D. , Paul Aisen M.D. , Howie Rosen M.D. , Rema Raman Ph.D. , Susan Landau Ph.D. , Andrew Saykin Psy.D. , Arthur W. Toga Ph.D. , Clifford R. Jack M.D. , Michael W. Weiner M.D. , Craig Nelson M.D. , R. Scott Mackin Ph.D. , Alzheimer’s Disease Neuroimaging Initiative
Objectives
Late life depression (LLD) is associated with cognitive impairment and dementia, but studies of cognitive decline in LLD have been confounded by underlying Alzheimer’s disease (AD). We evaluated longitudinal cognition in LLD against nondepressed (ND) older adults with equivalent AD risk and pathology and assessed relative contributions of clinical and neuroimaging characteristics to cognitive change.
Design
Longitudinal.
Setting
Outpatient psychiatry program.
Participants
Participants (120 LLD, 240 ND) were matched on demographics, global cognition, mild cognitive impairment diagnosis, and Amyloid-β (Aβ) positivity.
Measurements
Participants underwent genetic testing, 3T MRI, and Aβ PET at baseline, and serial neuropsychological assessment extending up to 36 months postbaseline.
Results
After accounting for demographics, MCI diagnosis, and AD risk and pathology, LLD showed accelerated decline on tests of global cognition, verbal memory, and attention/processing speed. Lower baseline cortico-limbic volume was associated with greater decline in global cognition, verbal memory, and attention/processing speed regardless of LLD diagnosis. Baseline Aβ positivity predicted greater decline on tests of global cognition and verbal learning and memory regardless of LLD diagnosis. White matter hyperintensity burden predicted faster decline in attention/processing speed and verbal learning in LLD. MCI diagnosis did not predict cognitive decline in either group.
Conclusions
These findings demonstrate significant cognitive decline in LLD independent of Aβ pathology and highlight the importance of identifying causal mechanisms for cortico-limbic volume abnormalities in this patient population.
{"title":"Accelerated Cognitive Decline in Late Life Depression: The Role of Amyloid-β, Cortico-Limbic Volume, and White Matter Hyperintensities","authors":"Emma Rhodes Ph.D. , Philip S. Insel Ph.D. , Michelle Kassel Ph.D. , Maria Kryza-Lacombe Ph.D. , Meryl A. Butters Ph.D. , David Bickford M.D. , Duygu Tosun Ph.D. , Ruth Morin Ph.D. , Paul Aisen M.D. , Howie Rosen M.D. , Rema Raman Ph.D. , Susan Landau Ph.D. , Andrew Saykin Psy.D. , Arthur W. Toga Ph.D. , Clifford R. Jack M.D. , Michael W. Weiner M.D. , Craig Nelson M.D. , R. Scott Mackin Ph.D. , Alzheimer’s Disease Neuroimaging Initiative","doi":"10.1016/j.jagp.2025.08.008","DOIUrl":"10.1016/j.jagp.2025.08.008","url":null,"abstract":"<div><h3>Objectives</h3><div>Late life depression (LLD) is associated with cognitive impairment and dementia, but studies of cognitive decline in LLD have been confounded by underlying Alzheimer’s disease (AD). We evaluated longitudinal cognition in LLD against nondepressed (ND) older adults with equivalent AD risk and pathology and assessed relative contributions of clinical and neuroimaging characteristics to cognitive change.</div></div><div><h3>Design</h3><div>Longitudinal.</div></div><div><h3>Setting</h3><div>Outpatient psychiatry program.</div></div><div><h3>Participants</h3><div>Participants (120 LLD, 240 ND) were matched on demographics, global cognition, mild cognitive impairment diagnosis, and Amyloid-β (Aβ) positivity.</div></div><div><h3>Measurements</h3><div>Participants underwent genetic testing, 3T MRI, and Aβ PET at baseline, and serial neuropsychological assessment extending up to 36 months postbaseline.</div></div><div><h3>Results</h3><div>After accounting for demographics, MCI diagnosis, and AD risk and pathology, LLD showed accelerated decline on tests of global cognition, verbal memory, and attention/processing speed. Lower baseline cortico-limbic volume was associated with greater decline in global cognition, verbal memory, and attention/processing speed regardless of LLD diagnosis. Baseline Aβ positivity predicted greater decline on tests of global cognition and verbal learning and memory regardless of LLD diagnosis. White matter hyperintensity burden predicted faster decline in attention/processing speed and verbal learning in LLD. MCI diagnosis did not predict cognitive decline in either group.</div></div><div><h3>Conclusions</h3><div>These findings demonstrate significant cognitive decline in LLD independent of Aβ pathology and highlight the importance of identifying causal mechanisms for cortico-limbic volume abnormalities in this patient population.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 2","pages":"Pages 183-194"},"PeriodicalIF":3.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093348","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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