Pub Date : 2025-01-01DOI: 10.1016/j.jagp.2024.07.018
Jeonghyun Shin M.D. , Ian C. Fischer Ph.D. , Peter J. Na M.D., M.P.H. , Dilip V. Jeste M.D. , Robert H. Pietrzak Ph.D., M.P.H.
Objectives
To determine the prevalence and correlates of successful aging in US veterans who screened positive for current major depressive disorder (MDD), generalized anxiety disorder (GAD), and/or posttraumatic stress disorder (PTSD).
Methods
In a nationally representative sample of 475 US military veterans (mean age=58.3, SD=14.7; range 24–92) who screened positive for MDD, GAD, and/or PTSD, multivariable logistic regression and relative importance analyses were conducted to identify independent correlates of successful aging.
Results
One-in-five (20.6%) veterans rated themselves as aging successfully. Resilience and gratitude were the strongest positive correlates of successful aging, accounting for 38.1% and 32.4% of the explained variance, respectively. Greater somatic symptoms were the strongest negative correlate, accounting for 11.2% of the explained variance. Higher gratitude moderated the negative association between somatic symptoms and successful aging.
Conclusions
Positive psychiatry interventions targeting psychosocial factors such as resilience and gratitude may help promote successful aging among US veterans with mental disorders.
{"title":"Successful Aging in US Veterans with Mental Disorders: Results From the National Health and Resilience in Veterans Study","authors":"Jeonghyun Shin M.D. , Ian C. Fischer Ph.D. , Peter J. Na M.D., M.P.H. , Dilip V. Jeste M.D. , Robert H. Pietrzak Ph.D., M.P.H.","doi":"10.1016/j.jagp.2024.07.018","DOIUrl":"10.1016/j.jagp.2024.07.018","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the prevalence and correlates of successful aging in US veterans who screened positive for current major depressive disorder (MDD), generalized anxiety disorder (GAD), and/or posttraumatic stress disorder (PTSD).</div></div><div><h3>Methods</h3><div>In a nationally representative sample of 475 US military veterans (mean age=58.3, SD=14.7; range 24–92) who screened positive for MDD, GAD, and/or PTSD, multivariable logistic regression and relative importance analyses were conducted to identify independent correlates of successful aging.</div></div><div><h3>Results</h3><div>One-in-five (20.6%) veterans rated themselves as aging successfully. Resilience and gratitude were the strongest positive correlates of successful aging, accounting for 38.1% and 32.4% of the explained variance, respectively. Greater somatic symptoms were the strongest negative correlate, accounting for 11.2% of the explained variance. Higher gratitude moderated the negative association between somatic symptoms and successful aging.</div></div><div><h3>Conclusions</h3><div>Positive psychiatry interventions targeting psychosocial factors such as resilience and gratitude may help promote successful aging among US veterans with mental disorders.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 1","pages":"Pages 85-91"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115189","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 : 2025-01-01DOI: 10.1016/j.jagp.2024.07.004
Patelle Jivalagian M.P.H. , Cameron J. Gettel M.D., M.H.S. , Colin M. Smith M.D., M.Sc.G.H. , Leah Robinson M.P.H. , Morgan Brinker B.A. , Dhruvil Shah B.S. , Anusha Kumar M.S. , Isaac V. Faustino M.S. , Bidisha Nath M.B.B.S., M.P.H. , Erika Chang-Sing M.D. , R. Andrew Taylor M.D., M.H.S. , Maura Kennedy M.D., M.P.H. , Ula Hwang M.D., M.P.H. , Ambrose H. Wong M.D., M.S.Ed., M.H.S.
Objectives
Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population.
Design, setting, participants, and measurements
This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015–2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint.
Results
Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29–1.42); 1.82 (1.73–1.91); 2.35 (2.15–2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27–1.34); 1.55 (1.50–1.60); 1.69 (1.59–1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18–1.35); AOR 1.22 (1.15–1.29)] and physical restraint [AOR 1.12 (95% CI 1.07–1.16); 1.22 (1.18–1.26)].
Conclusion
Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further research in agitation management for historically marginalized populations in older adults.
{"title":"Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department","authors":"Patelle Jivalagian M.P.H. , Cameron J. Gettel M.D., M.H.S. , Colin M. Smith M.D., M.Sc.G.H. , Leah Robinson M.P.H. , Morgan Brinker B.A. , Dhruvil Shah B.S. , Anusha Kumar M.S. , Isaac V. Faustino M.S. , Bidisha Nath M.B.B.S., M.P.H. , Erika Chang-Sing M.D. , R. Andrew Taylor M.D., M.H.S. , Maura Kennedy M.D., M.P.H. , Ula Hwang M.D., M.P.H. , Ambrose H. Wong M.D., M.S.Ed., M.H.S.","doi":"10.1016/j.jagp.2024.07.004","DOIUrl":"10.1016/j.jagp.2024.07.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population.</div></div><div><h3>Design, setting, participants, and measurements</h3><div>This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015–2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint.</div></div><div><h3>Results</h3><div>Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29–1.42); 1.82 (1.73–1.91); 2.35 (2.15–2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27–1.34); 1.55 (1.50–1.60); 1.69 (1.59–1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18–1.35); AOR 1.22 (1.15–1.29)] and physical restraint [AOR 1.12 (95% CI 1.07–1.16); 1.22 (1.18–1.26)].</div></div><div><h3>Conclusion</h3><div>Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further research in agitation management for historically marginalized populations in older adults.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 1","pages":"Pages 1-14"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690118","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}
In this three-armed RCT, we tested the effects of a telephone-delivered wisdom enhancement narrative therapy-based intervention (Tele-NT) and a telephone-delivered empathy-focused intervention (Tele-EP) in reducing loneliness against an active control group that received regular call (ACG) at the 4-week follow-up assessment.
Design, Setting, Intervention, and Participants
To evaluate the effects of the interventions on loneliness, we randomized 287 older adults based in Hong Kong, ages 65 to 90, into Tele-NT (N = 97), Tele-EP (N = 95), or ACG (N = 95).
Measurement
The primary outcome was loneliness, calculated using the De Jong Gierveld Scale and the UCLA Loneliness Scale. Secondary outcomes were sleep quality, depressive symptoms, social network engagement, and perceived social support. Assessments were done before training and 4 weeks after the intervention period.
Results
Results from linear mixed models showed significant positive effects of Tele-NT on loneliness measured by the De Jong Gierveld Loneliness Scale compared to ACG. Compared to the ACG, the Tele-NT group significantly reduced loneliness at the 4-week follow-up (mean difference = −0.51, p = 0.019, Cohen's d = 0.60). However, the difference between Tele-EP and the ACG at the 4-week follow-up was not significant (MD = −0.34, p = 0.179, Cohen's d = 0.49). Tele-NT and Tele-EP did not show significant effects on the secondary outcomes, compared to the ACG.
Conclusions
In this randomized clinical trial, we found that a 4-week wisdom enhancement narrative therapy program significantly reduced feelings of loneliness. This effective telephone-based, lay-therapist-delivered program is scalable for broader implementation.
{"title":"Effects of Wisdom-Enhancement Narrative-Therapy and Empathy-Focused interventions on loneliness over 4 weeks among older adults: A Randomized Controlled Trial","authors":"Da Jiang Ph.D. , Vivien Foong Yee Tang M.Sc. , Maninder Kahlon Ph.D. , Esther Oi-wah Chow Ph.D. , Dannii Yuen-lan Yeung Ph.D. , Rhonda Aubrey M.H.I. , Kee-Lee Chou Ph.D.","doi":"10.1016/j.jagp.2024.07.003","DOIUrl":"10.1016/j.jagp.2024.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>In this three-armed RCT, we tested the effects of a telephone-delivered wisdom enhancement narrative therapy-based intervention (Tele-NT) and a telephone-delivered empathy-focused intervention (Tele-EP) in reducing loneliness against an active control group that received regular call (ACG) at the 4-week follow-up assessment.</div></div><div><h3>Design, Setting, Intervention, and Participants</h3><div>To evaluate the effects of the interventions on loneliness, we randomized 287 older adults based in Hong Kong, ages 65 to 90, into Tele-NT (<em>N</em> = 97), Tele-EP (<em>N</em> = 95), or ACG (<em>N</em> = 95).</div></div><div><h3>Measurement</h3><div>The primary outcome was loneliness, calculated using the De Jong Gierveld Scale and the UCLA Loneliness Scale. Secondary outcomes were sleep quality, depressive symptoms, social network engagement, and perceived social support. Assessments were done before training and 4 weeks after the intervention period.</div></div><div><h3>Results</h3><div>Results from linear mixed models showed significant positive effects of Tele-NT on loneliness measured by the De Jong Gierveld Loneliness Scale compared to ACG. Compared to the ACG, the Tele-NT group significantly reduced loneliness at the 4-week follow-up (mean difference = −0.51, <em>p</em> = 0.019, Cohen's <em>d</em> = 0.60). However, the difference between Tele-EP and the ACG at the 4-week follow-up was not significant (MD = −0.34, <em>p</em> = 0.179, Cohen's <em>d =</em> 0.49). Tele-NT and Tele-EP did not show significant effects on the secondary outcomes, compared to the ACG.</div></div><div><h3>Conclusions</h3><div>In this randomized clinical trial, we found that a 4-week wisdom enhancement narrative therapy program significantly reduced feelings of loneliness. This effective telephone-based, lay-therapist-delivered program is scalable for broader implementation.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 1","pages":"Pages 18-30"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693663","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 : 2024-12-26DOI: 10.1016/j.jagp.2024.12.005
Valeria Bracca, Enrico Premi, Maria Sofia Cotelli, Anna Micheli, Daniele Altomare, Valentina Cantoni, Roberto Gasparotti, Barbara Borroni
Objectives: The present study aims to assess the prevalence, associated clinical symptoms, longitudinal changes, and imaging correlates of Loss of Insight (LOI), which is still unexplored in syndromes associated with Frontotemporal Lobar Degeneration (FTLD).
Design: Retrospective longitudinal cohort study, from Oct 2009 to Feb 2023.
Setting: Tertiary Frontotemporal Dementia research clinic.
Participants: A sample of 712 FTLD patients, 331 of whom had follow-up evaluation.
Measurements: LOI was assessed by interview with the primary caregiver. Univariate and multiple logistic regression and linear mixed models were used to estimate predictors and longitudinal changes over time associated with LOI. Voxel-based morphometry and structural covariance analyses of brain structural MRI images were implemented in Statistical Parametric Mapping.
Results: LOI was reported in 45% of patients (321/712, 95%CI = 41-49), with progressively increased prevalence from prodromal to severe dementia stages. LOI was more prevalent in the behavioural variant FTD, in the semantic variant of Primary Progressive Aphasia (svPPA) and FTD with Amyotrophic Lateral Sclerosis than in other phenotypes (all p-values<0.001). LOI severity increased over time only in patients with svPPA (β = +0.59, p <0.001) and clustered with other behavioral symptoms (all p-values <0.05). Finally, LOI was significantly associated with greater atrophy in the right medial orbital gyrus (p <0.001 uncorrected). Structural covariance analysis demonstrated loss of negative correlation between right medial orbital gyrus and regions belonging to the Default Mode Network (DMN), such as the left precuneus and the left angular gyrus (p ≤0.05 family-wise error-corrected) in FTLD patients with LOI.
Conclusions: A better comprehension of LOI mechanisms could lead to more effective interventions and healthcare policies.
{"title":"Loss of Insight in Syndromes Associated with Frontotemporal Lobar Degeneration: Clinical and Imaging Features.","authors":"Valeria Bracca, Enrico Premi, Maria Sofia Cotelli, Anna Micheli, Daniele Altomare, Valentina Cantoni, Roberto Gasparotti, Barbara Borroni","doi":"10.1016/j.jagp.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.12.005","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aims to assess the prevalence, associated clinical symptoms, longitudinal changes, and imaging correlates of Loss of Insight (LOI), which is still unexplored in syndromes associated with Frontotemporal Lobar Degeneration (FTLD).</p><p><strong>Design: </strong>Retrospective longitudinal cohort study, from Oct 2009 to Feb 2023.</p><p><strong>Setting: </strong>Tertiary Frontotemporal Dementia research clinic.</p><p><strong>Participants: </strong>A sample of 712 FTLD patients, 331 of whom had follow-up evaluation.</p><p><strong>Measurements: </strong>LOI was assessed by interview with the primary caregiver. Univariate and multiple logistic regression and linear mixed models were used to estimate predictors and longitudinal changes over time associated with LOI. Voxel-based morphometry and structural covariance analyses of brain structural MRI images were implemented in Statistical Parametric Mapping.</p><p><strong>Results: </strong>LOI was reported in 45% of patients (321/712, 95%CI = 41-49), with progressively increased prevalence from prodromal to severe dementia stages. LOI was more prevalent in the behavioural variant FTD, in the semantic variant of Primary Progressive Aphasia (svPPA) and FTD with Amyotrophic Lateral Sclerosis than in other phenotypes (all p-values<0.001). LOI severity increased over time only in patients with svPPA (β = +0.59, p <0.001) and clustered with other behavioral symptoms (all p-values <0.05). Finally, LOI was significantly associated with greater atrophy in the right medial orbital gyrus (p <0.001 uncorrected). Structural covariance analysis demonstrated loss of negative correlation between right medial orbital gyrus and regions belonging to the Default Mode Network (DMN), such as the left precuneus and the left angular gyrus (p ≤0.05 family-wise error-corrected) in FTLD patients with LOI.</p><p><strong>Conclusions: </strong>A better comprehension of LOI mechanisms could lead to more effective interventions and healthcare policies.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973371","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 : 2024-12-15DOI: 10.1016/j.jagp.2024.12.003
Emily M Briceño, Barbara Mendez Campos, Roshanak Mehdipanah, Wen Chang, Steven G Heeringa, Joshua Martins-Caulfield, Deborah A Levine, Nelda Garcia, Xavier F Gonzales, Kenneth M Langa, Darin B Zahuranec, Lewis B Morgenstern
Objectives: It is unknown whether cognitive test scores are equivalently associated with informant-rated cognitive decline across culturally and linguistically diverse older adults. We examined the association between cognitive domain scores on the Harmonized Cognitive Assessment Protocol (HCAP) and informant-rated cognitive decline in a harmonized population-based sample of older adults.
Design, setting, and participants: We combined data from the HCAP sub-study of the Health and Retirement Study (HRS; 2016) and the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C; 2018-2020) study. We included Hispanic/Latino-a-e-x (H/L; n = 566) and non-H/L white (NHW; n = 2,145) older adults.
Measurement: Both studies included the HCAP cognitive assessment with domain scores for memory, attention/executive function (EF), language, visuospatial, orientation, and general cognitive performance (GCP). Informants rated cognitive decline with the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE).
Results: Cognitive domain scores were more strongly associated with IQCODE scores for NHW than H/L participants for four of six domains (GCP, EF, visuospatial, and orientation) after adjusting for demographics (age, sex/gender, education) and study membership. Informants generally rated greater cognitive decline in NHW than H/L respondents for a given cognitive domain score, and the magnitude of this difference was greater for lower cognitive test scores.
Conclusions: We found generally weaker associations between cognitive performance and informant-rated cognitive decline in H/L compared to NHW older adults. These findings suggest cognitive measurement differences across culturally and linguistically diverse older adult populations, which may result in underestimation of cognitive impairment in H/L populations.
目的：在不同文化和语言的老年人中，认知测试分数是否与被调查者评价的认知能力下降同等相关尚不清楚。我们研究了统一认知评估协议（HCAP）上的认知领域得分与基于统一人群的老年人样本中被告知的认知衰退之间的关系。设计、环境和参与者：我们结合了健康与退休研究(HRS；2016)和Corpus christian - cognitive (BASIC-C；2018 - 2020年)的研究。我们纳入了Hispanic/ latin -a-e-x (H/L；n = 566)和非h /L白色(NHW；2145名老年人。测量方法：两项研究都包括HCAP认知评估，包括记忆、注意/执行功能（EF）、语言、视觉空间、定向和一般认知表现（GCP）的领域得分。被调查者使用老年人认知衰退问卷（IQCODE）对认知衰退进行评分。结果：在调整了人口统计学（年龄、性别/性别、教育程度）和研究成员资格后，NHW参与者的认知领域得分与IQCODE分数的相关性比H/L参与者在六个领域中的四个领域（GCP、EF、视觉空间和方向）的相关性更强。在给定的认知领域得分上，被调查者通常认为高智商者比高智商者认知能力下降更大，而且在认知测试得分较低的情况下，这种差异的幅度更大。结论：我们发现，与NHW老年人相比，认知表现与H/L老年人的认知能力下降之间的关联普遍较弱。这些研究结果表明，在文化和语言不同的老年人群中，认知测量存在差异，这可能导致对H/L人群认知障碍的低估。
{"title":"Ethnic Differences in the Association Between Cognitive Performance and Informant-rated Cognitive Decline.","authors":"Emily M Briceño, Barbara Mendez Campos, Roshanak Mehdipanah, Wen Chang, Steven G Heeringa, Joshua Martins-Caulfield, Deborah A Levine, Nelda Garcia, Xavier F Gonzales, Kenneth M Langa, Darin B Zahuranec, Lewis B Morgenstern","doi":"10.1016/j.jagp.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.12.003","url":null,"abstract":"<p><strong>Objectives: </strong>It is unknown whether cognitive test scores are equivalently associated with informant-rated cognitive decline across culturally and linguistically diverse older adults. We examined the association between cognitive domain scores on the Harmonized Cognitive Assessment Protocol (HCAP) and informant-rated cognitive decline in a harmonized population-based sample of older adults.</p><p><strong>Design, setting, and participants: </strong>We combined data from the HCAP sub-study of the Health and Retirement Study (HRS; 2016) and the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C; 2018-2020) study. We included Hispanic/Latino-a-e-x (H/L; n = 566) and non-H/L white (NHW; n = 2,145) older adults.</p><p><strong>Measurement: </strong>Both studies included the HCAP cognitive assessment with domain scores for memory, attention/executive function (EF), language, visuospatial, orientation, and general cognitive performance (GCP). Informants rated cognitive decline with the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE).</p><p><strong>Results: </strong>Cognitive domain scores were more strongly associated with IQCODE scores for NHW than H/L participants for four of six domains (GCP, EF, visuospatial, and orientation) after adjusting for demographics (age, sex/gender, education) and study membership. Informants generally rated greater cognitive decline in NHW than H/L respondents for a given cognitive domain score, and the magnitude of this difference was greater for lower cognitive test scores.</p><p><strong>Conclusions: </strong>We found generally weaker associations between cognitive performance and informant-rated cognitive decline in H/L compared to NHW older adults. These findings suggest cognitive measurement differences across culturally and linguistically diverse older adult populations, which may result in underestimation of cognitive impairment in H/L populations.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980449","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 : 2024-12-10DOI: 10.1016/j.jagp.2024.12.001
Barry W Rovner, Robin J Casten
Objective: To investigate the effects of discordant medication beliefs on diabetes self-management and glycemic control in older Black individuals with diabetes and Mild Cognitive Impairment (MCI).
Methods: Cross-sectional analysis of baseline data from two clinical trials testing behavioral interventions to improve glycemic control in older Black primary care patients with diabetes and MCI.
Results: The mean number of discordant medication beliefs was 6 (SD = 3; range 0 to 16). Sixty-seven of 246 (27%) participants held ≥ 9 discordant beliefs (i.e., one SD above the mean), and these participants had worse diabetes self-management and glycemic control than participants with fewer beliefs.
Conclusions: Discordant medication beliefs, low adherence to diabetes self-management, poor glycemic control, and impaired cognition may exist in a causal relationship. Modifying discordant medication beliefs may eliminate the first step of this pathogenic sequence and reduce risk of cognitive decline in a high-risk population of older Black individuals with diabetes.
{"title":"Discordant Medication Beliefs in Black Individuals With Mild Cognitive Impairment and Diabetes.","authors":"Barry W Rovner, Robin J Casten","doi":"10.1016/j.jagp.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.12.001","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of discordant medication beliefs on diabetes self-management and glycemic control in older Black individuals with diabetes and Mild Cognitive Impairment (MCI).</p><p><strong>Methods: </strong>Cross-sectional analysis of baseline data from two clinical trials testing behavioral interventions to improve glycemic control in older Black primary care patients with diabetes and MCI.</p><p><strong>Results: </strong>The mean number of discordant medication beliefs was 6 (SD = 3; range 0 to 16). Sixty-seven of 246 (27%) participants held ≥ 9 discordant beliefs (i.e., one SD above the mean), and these participants had worse diabetes self-management and glycemic control than participants with fewer beliefs.</p><p><strong>Conclusions: </strong>Discordant medication beliefs, low adherence to diabetes self-management, poor glycemic control, and impaired cognition may exist in a causal relationship. Modifying discordant medication beliefs may eliminate the first step of this pathogenic sequence and reduce risk of cognitive decline in a high-risk population of older Black individuals with diabetes.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878684","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 : 2024-12-04DOI: 10.1016/j.jagp.2024.11.016
J Barrie Shepherd
{"title":"All creatures great and small.","authors":"J Barrie Shepherd","doi":"10.1016/j.jagp.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.016","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878664","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 : 2024-12-04DOI: 10.1016/j.jagp.2024.11.014
J Barrie Shepherd
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Pub Date : 2024-12-03DOI: 10.1016/j.jagp.2024.11.015
Hyunwoo Lee, Bo-Hyun Kim, Eun Hye Lee, Daeun Shin, Heejin Yoo, Sang Won Seo, Jun Pyo Kim
Objective: Brain atrophy measured by structural imaging has been used to quantify resilience against neurodegeneration in Alzheimer's disease. Considering glucose hypometabolism is another marker of neurodegeneration, we quantified metabolic resilience (MR) based on Fluorodeoxyglucose positron emission tomography (FDG PET) and investigated its clinical implications.
Methods: We quantified the MR and other resilience metrics, including brain resilience (BR) and cognitive resilience (CR), using partial least squares path modeling from the ADNI database. A linear mixed-effects model and a Cox proportional hazards model were used to identify the impact of each resilience on longitudinal cognitive function and conversion to dementia, respectively.
Results: A total of 848 participants were included in this study. All resilience metrics (CR, BR, and MR) were associated with slower cognitive decline. Results from the ANOVA test, AIC and BIC values showed that the additional inclusion of MR improved the performances of the linear mixed effect models. In survival analysis, all resilience variables were negatively associated with the risk of conversion to dementia. In line with the results of the linear mixed effects models, the additional inclusion of MR into the models with different resilience variables increased the C-index.
Conclusion: Relative preservation of brain glucose metabolism is a valuable predictor of future cognitive decline and conversion to dementia, adding value to existing resilience metrics. While the utility of FDG PET in clinical settings is limited by cost and accessibility, it might have potential usefulness as a prognostic marker, especially in a context of resilience.
{"title":"Brain Metabolic Resilience in Alzheimer's Disease: A Predictor of Cognitive Decline and Conversion to Dementia.","authors":"Hyunwoo Lee, Bo-Hyun Kim, Eun Hye Lee, Daeun Shin, Heejin Yoo, Sang Won Seo, Jun Pyo Kim","doi":"10.1016/j.jagp.2024.11.015","DOIUrl":"10.1016/j.jagp.2024.11.015","url":null,"abstract":"<p><strong>Objective: </strong>Brain atrophy measured by structural imaging has been used to quantify resilience against neurodegeneration in Alzheimer's disease. Considering glucose hypometabolism is another marker of neurodegeneration, we quantified metabolic resilience (MR) based on Fluorodeoxyglucose positron emission tomography (FDG PET) and investigated its clinical implications.</p><p><strong>Methods: </strong>We quantified the MR and other resilience metrics, including brain resilience (BR) and cognitive resilience (CR), using partial least squares path modeling from the ADNI database. A linear mixed-effects model and a Cox proportional hazards model were used to identify the impact of each resilience on longitudinal cognitive function and conversion to dementia, respectively.</p><p><strong>Results: </strong>A total of 848 participants were included in this study. All resilience metrics (CR, BR, and MR) were associated with slower cognitive decline. Results from the ANOVA test, AIC and BIC values showed that the additional inclusion of MR improved the performances of the linear mixed effect models. In survival analysis, all resilience variables were negatively associated with the risk of conversion to dementia. In line with the results of the linear mixed effects models, the additional inclusion of MR into the models with different resilience variables increased the C-index.</p><p><strong>Conclusion: </strong>Relative preservation of brain glucose metabolism is a valuable predictor of future cognitive decline and conversion to dementia, adding value to existing resilience metrics. While the utility of FDG PET in clinical settings is limited by cost and accessibility, it might have potential usefulness as a prognostic marker, especially in a context of resilience.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873529","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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