American Journal of Geriatric Psychiatry最新文献

Background: The course of late-life depression is associated with functioning of multiple brain networks. Understanding the brain mechanisms associated with response to psychotherapy can inform treatment development and a personalized treatment approach. This study examined how activation of key regions of the salience network, default mode network and reward systems is associated with response to psychotherapies for late-life depression.

Methods: Thirty-three older adults with major depressive disorder were randomized to 9 weeks of Engage or Problem-Solving Therapy for late-life depression. Participants completed a Probabilistic Reversal Learning task in the MRI at baseline and Week 6. We focused on focal activation in regions of interest selected a priori: the subgenual cingulate cortex (sgACC; DMN); the dorsal anterior cingulate cortex (dACC; salience network and reward system); and the nucleus accumbens (NAcc; reward system). We applied mixed-effects regression models to examine whether brain activation was associated with psychotherapy response.

Results: We found that at baseline, low activation of the dACC and the sgACC was associated with lower depression severity over 6 weeks of psychotherapy. In addition, we observed significant time*activation interactions, such that after 6 weeks of psychotherapy, lower dACC activation and higher NAcc and sgACC activation were each associated with lower depression severity. Further, we found that baseline slower response to negative feedback and faster response to positive feedback was associated with lower depression severity over 6 weeks of psychotherapy.

Conclusions: Our findings suggest that activation of reward, salience, and DMN regions may serve as markers of response during psychotherapy for late-life depression. Engagement of these networks may be linked to treatment outcome. Personalized psychotherapies can target individuals' brain profiles to improve outcomes for older adults with major depression.

Article summary: This study examined whether activation of regions of the reward, salience and default mode networks is associated with response to psychotherapies for late-life depression. We found that baseline low activation of the dACC and the sgACC was associated with lower depression severity during psychotherapy. We also found that at week 6, lower dACC activation and higher NAcc and sgACC activation were linked with lower depression severity. These regions may represent promising brain mechanisms for future personalized interventions.

Objective: Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation.

Design: Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.

Participants: A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).

Intervention: PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.

Measures: Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment.

Results: There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SI at baseline and 5.7% at end of treatment.

Conclusions: Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor manifestations, including alexithymia. This condition is defined by difficulty in recognizing, articulating, and expressing one's emotional states. In this study, we conducted a systematic review and meta-analysis to compare the prevalence of alexithymia in PD patients and a healthy population, and to identify associated demographic and clinical factors. We identified 16 observational studies through Pubmed, EMBASE, PsycINFO, and SCOPUS, selecting articles published since 2002. Data were analyzed using a random-effects model. We conducted additional prevalence meta-analyses and correlation meta-analyses. We found that PD patients exhibit higher levels of alexithymia compared to the general population (combined effect size 0.65 [95% CI = 0.49-0.81; P <0.05]), and moderate but significant heterogeneity (I² = 52.42%, Q = 29.42, P <0.05), partially explained by regional differences, levodopa equivalent dosage (positive regression coefficient of 0.0006 [95% CI = 0.0001; 0.0011, P <0.05]); and cognitive scores (negative regression coefficient of -0.14 [95% CI = -0.24; -0.04, P<0.05]), after adjusting for covariates. The additional meta-analysis reported higher prevalence of alexithymia in PD and a pooled correlation coefficient of 0.496 (95% CI = 0.40-0.59, P <0.05) when we analyzed alexithymia and depression scores. To our knowledge, there are no previous meta-analysis applied to alexithymia in PD patients. Even though we could not determine whether alexithymia is a primary characteristic of PD, we found an association of higher levels of alexithymia with depression and higher levodopa equivalent daily dose. Furthermore, there are not enough studies to draw clear conclusions about the influence of cognitive status.

An increase in will challenges on the grounds of lack of capacity and undue influence is anticipated in the face of an imminent transfer of generational wealth by a growing elderly population with a high prevalence of cognitive impairment. Medical experts will be a necessary element of litigation to help the courts make the best legal determinations involving cognitive and psychiatric functions that may affect mental capacity and vulnerability to influence. We conducted the first systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses ("PRISMA") guidelines in order to identify articles that addressed a comprehensive medico-legal approach to the assessment of testamentary capacity. Only 12 articles met the criteria for the systematic review. Banks v Goodfellow ("Banks") continues to be considered the leading case that defines the criteria for the courts and lawyers in the determination of testamentary capacity. However, quantitative data to support this impression is nowhere to be found. Moreover, unpredictability remains a hallmark of cases involving will challenges. Since calls for increased medico-legal collaboration and updates to the Banks test have not been evaluated, a scoping review of a large number of judicial decisions is required to better understand the current approach to this legal determination. Relevant variables could be used to develop a predictive model that would help lawyers and medical experts in this important societal collaboration.

Objective: The new antiamyloid medications Lecanemab (Leqembi) and donanemab (Kisunla) are the first disease-modifying treatments for Alzheimer's disease (AD) to receive full FDA approval. However, some commentators question whether the drugs' benefits outweigh their risks, burdens, and costs to patients. This study assessed the perceived value of these medications by asking caregivers of persons with AD to compare them to a widely used intervention in AD management: home-based care.

Design: Online survey (March 27th-April 17th, 2024) of 392 AD caregivers recruited via CloudResearch Prime Panels to match the U.S. public in education, household income, race, and ethnicity. The survey used vignettes describing antiamyloid medication and 25 hours/week of home-based care (estimated to be of similar monetary value). After rating the desirability of medication and home-based care, respondents indicated their preference for which intervention they wanted their loved one's insurance to cover.

Results: Respondents expressed a desire for their loved ones to receive both the medication and home-based care. Over half (56.9%) favored home-based care coverage. Those preferring medication coverage were more likely to believe its benefits outweigh its risks and burdens. Preference for medication coverage was also associated with being male, Hispanic, less educated, and correctly answering fewer comprehension questions.

Conclusions: Our findings show most caregivers perceive modest clinical value in the novel antiamyloid therapies, and the decision to use these drugs will be preference-sensitive, pointing to the need for thorough informed consent discussions.

Background: Multimorbidity may increase the risk of depression in older adults, but the global average effect of multimorbidity on depression remains unknown. This research aimed to exclude the regional heterogeneity to quantify the exposure-response association between multimorbidity and depression in older adults worldwide.

Method: We collected 23,947 participants aged 65 years or above from six large prospective cohorts from developed and developing countries, including Mexico, South Korea, Europe, America, China, and England. Multimorbidity was defined as an individual experiencing two or more chronic conditions simultaneously at baseline. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) or the EURO-D scale in each wave. We utilized Stratified Cox proportional hazards models to assess the effects of multimorbidity on depression in each cohort. Meta-analysis was then applied to obtain the average effects across cohorts.

Results: Multimorbidity was significantly associated with depression in each cohort and the pooled HR for depression excluding the heterogeneity among six cohorts was 1.30 (95% CI: 1.25-1.37, Z = 10.28, p < 0.001). Compared with participants without any chronic condition, those with 1, 2, and ≥3 chronic conditions had HRs for depression of 1.15 (95% CI: 1.09-1.21, Z = 5.10, p < 0.001), 1.37 (95% CI: 1.29-1.45, Z = 10.00, p < 0.001), and 1.57 (95% CI: 1.45-1.70, Z = 10.9, p < 0.001), respectively. The effects of multimorbidity on depression were more pronounced in males (HR: 1.40 in males vs. 1.25 in females) and participants aged between 65 and 74 years (HR: 1.36 in 65-74 years vs. 1.22 in 75 years and older).

Conclusion: Older adults with multimorbidity are more likely to suffer depression. Effective strategies should be developed for older adults, including preventing and managing chronic conditions and improving mental health services.