American Journal of Geriatric Psychiatry最新文献

英文中文

Caregiver Contributions to Older Veterans’ Mental Health Utilization: New Opportunities for Exploring Caregiving Roles and Impacts 护理人员对老年退伍军人利用心理健康的贡献：探索护理角色和影响的新机遇

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-25 DOI: 10.1016/j.jagp.2024.07.010

引用次数: 0

Living Alone With Dementia: A Reality Check 痴呆症患者独自生活：现实检验

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-25 DOI: 10.1016/j.jagp.2024.07.006

引用次数: 0

Catatonia in Dementia: A Systematic Review of Case Reports and Case Series 痴呆症中的紧张症：病例报告和系列病例的系统回顾

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-22 DOI: 10.1016/j.jagp.2024.07.012

Background

Catatonia is a neuropsychiatric syndrome characterized by motor, behavioral, and autonomic abnormalities. It is often underdiagnosed in geriatric patients with dementia despite established diagnostic criteria and treatment options.

Objective

This systematic review investigates catatonia in the elderly, particularly those with dementia, to examine their clinical presentation, treatment response, and prognosis compared to elderly patients without dementia.

Methods

We comprehensively searched MEDLINE and EMBASE, including case reports and series on catatonia in elderly patients. Reviewers independently performed data extraction and quality assessments. Statistical significance was set at a p value ≤0.05, and a multivariate logistic regression model was used to analyze differences between patients with and without dementia.

Results

Our review included 182 articles with 225 cases. We found no significant differences in the clinical presentation of catatonia between patients with and without dementia, with both groups commonly exhibiting the hypokinetic variant. However, patients with dementia were more frequently treated with NMDA receptor antagonists (OR: 3.27; CI: 1.05–10.11; p = 0.040) and had a lower complete response rate to treatment (OR: 0.37; CI: 0.19–0.75; p = 0.006). Patients with dementia also exhibited fewer acute medical conditions (OR: 0.17; CI: 0.05–0.65; p = 0.009).

Conclusions

Catatonia in dementia does not have a different syndromic presentation. However, the diagnosis of dementia leads to varying preferences regarding the choice of symptomatic therapy and seems to be a predictor of a poorer therapeutic response. Actively treating catatonia, particularly in patients with dementia, addressing the characteristics of these patients is of paramount importance.

背景紧张症是一种以运动、行为和自主神经异常为特征的神经精神综合征。尽管已经建立了诊断标准和治疗方案，但老年痴呆症患者对该病的诊断往往不足。目的本系统性综述调查了老年，尤其是老年痴呆症患者的紧张症，以研究他们的临床表现、治疗反应和预后，并与无痴呆症的老年患者进行比较。审稿人独立进行数据提取和质量评估。统计显著性以 p 值≤0.05 为标准，并采用多变量逻辑回归模型分析痴呆患者与非痴呆患者之间的差异。我们发现失智症患者与非失智症患者在紧张症的临床表现上没有明显差异，两组患者都普遍表现为运动功能减退型。不过，痴呆症患者更常接受 NMDA 受体拮抗剂治疗（OR：3.27；CI：1.05-10.11；p = 0.040），而且对治疗的完全反应率较低（OR：0.37；CI：0.19-0.75；p = 0.006）。痴呆症患者的急性病症也较少（OR：0.17；CI：0.05-0.65；P = 0.009）。然而，痴呆症的诊断会导致患者在对症治疗的选择上有不同的偏好，并且似乎是治疗反应较差的一个预测因素。积极治疗紧张症，尤其是痴呆症患者的紧张症，最重要的是要针对这些患者的特点。

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引用次数: 0

Commentary on Neuropsychiatric Symptom Profile in Alzheimer's Disease and their Relationship with Functional Decline 关于阿尔茨海默病的神经精神症状及其与功能衰退的关系的评论。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-16 DOI: 10.1016/j.jagp.2024.07.007

引用次数: 0

Efficacy of Nonpharmacological Interventions in Cognitive Impairment: Systematic Review And Network Meta-Analysis 非药物干预对认知障碍的疗效：系统综述和网络荟萃分析

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-09 DOI: 10.1016/j.jagp.2024.06.012

Introduction

There is currently no known cure for cognitive impairment, which highlights the need to explore other ways of managing this condition. This topic has recently become an area of active research. However, the availability of nonpharmacological options poses a challenge when trying to determine the best treatment for improving cognitive function.

Methods

We conducted a systematic review and a Bayesian network meta-analysis to compare the effects of nonpharmacological interventions on global cognition in patients with mild cognitive impairment and dementia. The nonpharmacological interventions were classified as aerobic exercise, strength exercise, multicomponent physical exercise, other physical exercises, tai chi, mind-body exercises, traditional cognitive rehabilitation, computer-based cognitive rehabilitation, occupational therapy, music therapy, physical-cognitive rehabilitation, and reminiscence therapy.

Results

Physical-cognitive rehabilitation emerged as the most effective nonpharmacological intervention for enhancing global cognition in patients with unspecified cognitive impairment and dementia, whereas occupational therapy focused on dual-task interventions was found to be the most effective nonpharmacological intervention for mild cognitive impairment.

Conclusion

These results underscore the importance of adopting a dual approach to managing cognitive impairment, integrating both cognitive and physical rehabilitation within the same intervention.

导言：目前还没有已知的治疗认知障碍的方法，这就凸显了探索其他方法来控制这种疾病的必要性。这一课题最近已成为一个活跃的研究领域。方法我们进行了一项系统性综述和贝叶斯网络荟萃分析，比较了非药物干预对轻度认知障碍和痴呆症患者总体认知能力的影响。非药物干预分为有氧运动、力量运动、多成分体育锻炼、其他体育锻炼、太极拳、身心锻炼、传统认知康复、基于计算机的认知康复、职业疗法、音乐疗法、物理认知康复和回忆疗法。结果发现，物理认知康复是提高不明认知障碍和痴呆症患者总体认知能力的最有效非药物干预措施，而以双任务干预为重点的职业疗法则是治疗轻度认知障碍的最有效非药物干预措施。

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引用次数: 0

Explanatory Note - CiteScore Versus Impact Factor 解释性说明--CiteScore 与影响因子的比较

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-04 DOI: 10.1016/j.jagp.2024.07.001

引用次数: 0

Beta-to-Theta Entropy Ratio of EEG in Aging, Frontotemporal Dementia, and Alzheimer's Dementia 衰老、额颞叶痴呆和阿尔茨海默氏症患者脑电图的 Beta 与 Theta 熵比。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-04 DOI: 10.1016/j.jagp.2024.06.009

Background

Aging, frontotemporal dementia (FTD), and Alzheimer's dementia (AD) manifest electroencephalography (EEG) alterations, particularly in the beta-to-theta power ratio derived from linear power spectral density (PSD). Given the brain's nonlinear nature, the EEG nonlinear features could provide valuable physiological indicators of aging and cognitive impairment. Multiscale dispersion entropy (MDE) serves as a sensitive nonlinear metric for assessing the information content in EEGs across biologically relevant time scales.

Objective

To compare the MDE-derived beta-to-theta entropy ratio with its PSD-based counterpart to detect differences between healthy young and elderly individuals and between different dementia subtypes.

Methods

Scalp EEG recordings were obtained from two datasets: 1) Aging dataset: 133 healthy young and 65 healthy older adult individuals; and 2) Dementia dataset: 29 age-matched healthy controls (HC), 23 FTD, and 36 AD participants. The beta-to-theta ratios based on MDE vs. PSD were analyzed for both datasets. Finally, the relationships between cognitive performance and the beta-to-theta ratios were explored in HC, FTD, and AD.

Results

In the Aging dataset, older adults had significantly higher beta-to-theta entropy ratios than young individuals. In the Dementia dataset, this ratio outperformed the beta-to-theta PSD approach in distinguishing between HC, FTD, and AD. The AD participants had a significantly lower beta-to-theta entropy ratio than FTD, especially in the temporal region, unlike its corresponding PSD-based ratio. The beta-to-theta entropy ratio correlated significantly with cognitive performance.

Conclusion

Our study introduces the beta-to-theta entropy ratio using nonlinear MDE for EEG analysis, highlighting its potential as a sensitive biomarker for aging and cognitive impairment.

背景：衰老、额颞叶痴呆症（FTD）和阿尔茨海默氏痴呆症（AD）表现为脑电图（EEG）的改变，尤其是线性功率谱密度（PSD）得出的β-θ功率比。鉴于大脑的非线性特性，脑电图的非线性特征可以为衰老和认知障碍提供有价值的生理指标。多尺度离散熵（MDE）是一种敏感的非线性指标，可用于评估脑电图在生物相关时间尺度上的信息含量：比较 MDE 导出的 beta 与 Theta 的熵比及其基于 PSD 的对应指标，以检测健康的年轻人和老年人之间以及不同痴呆亚型之间的差异：头皮脑电图记录来自两个数据集：1）老年数据集：2）痴呆数据集：29名年龄匹配的健康对照组（HC）、23名FTD患者和36名AD患者。对这两个数据集进行了基于 MDE 与 PSD 的β-θ 比率分析。最后，还探讨了 HC、FTD 和 AD 患者的认知表现与β-θ比率之间的关系：结果：在老龄化数据集中，老年人的β-θ熵比明显高于年轻人。在痴呆症数据集中，该比率在区分HC、FTD和AD方面优于β-θ PSD方法。痴呆症患者的β-θ熵比明显低于FTD患者，尤其是在颞区，这与基于PSD的相应比率不同。β-θ熵比与认知能力有明显的相关性：我们的研究采用非线性 MDE 对脑电图进行分析，引入了β-θ熵比，突出了其作为衰老和认知障碍的敏感生物标志物的潜力。

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引用次数: 0

Long-Acting Injectable Antipsychotics in the Geriatric Population: A longitudinal Study 老年群体中的长效注射抗精神病药物：纵向研究

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-04 DOI: 10.1016/j.jagp.2024.06.007

Objective

This study compares demographic, clinical characteristics, and outcomes in older adults on long-acting injectable antipsychotics (LAI-AP) vs. oral antipsychotics (PO-AP).

Design

This observational study with a retrospective cohort utilized the electronic medical record's search engine to review charts of geriatric patients on LAI-AP for a two-year period. A convenience sample on PO-AP formed the comparison group. LAI-AP patients were subcategorized into discontinuation and continuation groups.

Setting

Conducted at an urban, psychiatric outpatient clinic, using charts from October 2020 to 2022.

Participants

Patients at least 60 years-old with psychotic or mood disorders on antipsychotics for at least 3-months during the study period.

Measurements

Demographic and clinical variables, including diagnosis, medication type, side effects, medical comorbidities, neurocognitive status, and secondary medications, were collected for both PO-AP and LAI-AP groups. Outcome variables included missed appointments, psychiatric and medical hospitalizations, and emergency room visits. Correlates of discontinuation of LAI-AP were also assessed.

Results

LAI-AP had a higher proportion than PO-AP of primary psychotic disorders (87.8% vs. 64.3%). During the study, PO-AP had higher rates of missed appointments (median 18% vs. 13% for LAI-AP) and psychiatric admissions (mean 0.019/month vs. 0.006/month for LAI-AP;); Female sex was a risk factor for discontinuation of LAI-AP (86.7% of discontinuation group vs. 55.2% of continuation group).

Conclusions

The LAI-AP group showed reduced hospitalizations, better treatment engagement, and comparable tolerability to PO-AP. Preliminary data suggests gender may influence LAI-AP discontinuation rates. This study adds to the sparse literature investigating the efficacy and tolerability of LAI-AP in geriatric patients.

目的：本研究比较了使用长效注射型抗精神病药物（LAI-AP）和口服型抗精神病药物（PO-AP）的老年人的人口统计学特征、临床特征和治疗效果：本研究比较了使用长效注射型抗精神病药物（LAI-AP）和口服型抗精神病药物（PO-AP）的老年人的人口统计学、临床特征和治疗效果：设计：这项回顾性队列观察研究利用电子病历搜索引擎查阅了两年内服用 LAI-AP 的老年患者的病历。使用 PO-AP 的方便样本组成对比组。LAI-AP患者被细分为停药组和继续用药组：在一家城市精神科门诊进行，使用 2020 年 10 月至 2022 年的病历：研究期间至少服用 3 个月抗精神病药物的 60 岁以上精神病或情绪障碍患者：收集PO-AP组和LAI-AP组的人口统计学和临床变量，包括诊断、药物类型、副作用、医疗合并症、神经认知状态和辅助药物。结果变量包括失约、精神和医疗住院以及急诊就诊。此外，还评估了停用LAI-AP的相关因素：与 PO-AP 相比，LAI-AP 患有原发性精神病的比例更高（87.8% 对 64.3%）。在研究期间，PO-AP的失约率（中位数为18%，而LAI-AP为13%）和精神病入院率（平均为0.019/月，而LAI-AP为0.006/月）均高于LAI-AP；女性性别是停用LAI-AP的风险因素（停用组为86.7%，而继续使用组为55.2%）：结论：LAI-AP治疗组减少了住院次数，治疗参与度更高，耐受性与PO-AP相当。初步数据表明，性别可能会影响LAI-AP的停药率。这项研究为研究老年患者LAI-AP疗效和耐受性的稀少文献增添了新的内容。

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引用次数: 0

Information for Subscribers 订户须知

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-04 DOI: 10.1016/S1064-7481(24)00366-X

引用次数: 0

Response to the Editorial by Dr. Nelson and Dr. Delucchi 对纳尔逊博士和德卢奇博士社论的回应。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-03 DOI: 10.1016/j.jagp.2024.06.008

引用次数: 0

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American Journal of Geriatric Psychiatry

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