Pub Date : 2025-07-14DOI: 10.1016/j.jagp.2025.04.005
Shilpa Srinivasan , Brad Cole MBA FACMPE , James McMahon APRN , Takia Woods BA, CCHW , Amberly Osteen BS, CST , Alice Bruce MD , Leonardo Bonilha MD, PhD , Julius Fridriksson PhD
<div><h3>Introduction</h3><div>Approximately 6.9 million older Americans are living ith Alzheimer’s dementia (AD) and other dementias, ith prevalence increasing with age, affecting 5.0% of people ages 65-74 years, 13.2% of people ages 75-84 years, and 33.4% of people above age 85. While the diagnosis of Mild Cognitive Impairment (MCI) or dementia can facilitate access to treatment and interventions, delays in timely diagnosis, as well as coordination of care across caregivers and community resources serve as barriers, especially in primary care settings, where the majority of older adults receive their medical care. Such barriers include volume of primary care provider (PCP) visits with brief durations for each, lack of sufficient access to collateral informants, and variable confidence and expertise of PCPs to screen, diagnose and subsequently manage patients with cognitive disorders. With the advent of biomarkers for detection, disease-modifying therapies for the treatment of MCI and AD, and the growing focus on prevention and health promotion in midlife, responding to innovative approaches in diagnostics and therapeutics is a critical yet imminent challenge for PCPs and dementia specialists.</div><div>In response to these challenges and needs, the University of South Carolina (USC) Brain Health Network (BHN) was developed as a permanent, State-funded initiative with the main mission of ensuring statewide access to advanced, collaborative cognitive care, and to provide community support throughout South Carolina. Responding to needs assessment and focus groups of caregivers statewide, the BHN represents a collaborative, interdisciplinary partnership with health system providers (Primary Care, Geriatric Psychiatry, Neurology, etc.) to set up a seamless and integrated process to support front-line providers (PCPs) and aim to ensure persons with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers receive support and obtain a clear understanding of their health care system and care navigation in their community.</div><div>This poster describes the development and operational processes of the BHN, highlighting the interdisciplinary aspects of dementia care, as well as the interprofessional role of community health workers (CHW), through relationships with organizations and formal partnerships with the Alzheimer's Association and the Area Agency on Aging/Council of Government, including Area Agency on Aging departments statewide, to facilitate patient engagement and caregiver support state-wide to promote health and enhance care navigation across the continuum of dementia care.</div></div><div><h3>Methods</h3><div>The BHN partners with health systems to achieve 3 main goals: (1) provide greater access and coordinated care for patients and caregivers, (2) provide further support and education for individuals diagnosed (and their caregivers), and (3) provide access to innovations in treatment and diagnostics, especially in under-serve
{"title":"2. GOING FURTHER TOGETHER: INTERDISCIPLINARY, COLLABORATIVE UNIVERSITY OF SOUTH CAROLINA BRAIN HEALTH NETWORK TO EMPOWER PATIENT-CENTERED APPROACHES TO INNOVATIVE DEMENTIA CARE","authors":"Shilpa Srinivasan , Brad Cole MBA FACMPE , James McMahon APRN , Takia Woods BA, CCHW , Amberly Osteen BS, CST , Alice Bruce MD , Leonardo Bonilha MD, PhD , Julius Fridriksson PhD","doi":"10.1016/j.jagp.2025.04.005","DOIUrl":"10.1016/j.jagp.2025.04.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately 6.9 million older Americans are living ith Alzheimer’s dementia (AD) and other dementias, ith prevalence increasing with age, affecting 5.0% of people ages 65-74 years, 13.2% of people ages 75-84 years, and 33.4% of people above age 85. While the diagnosis of Mild Cognitive Impairment (MCI) or dementia can facilitate access to treatment and interventions, delays in timely diagnosis, as well as coordination of care across caregivers and community resources serve as barriers, especially in primary care settings, where the majority of older adults receive their medical care. Such barriers include volume of primary care provider (PCP) visits with brief durations for each, lack of sufficient access to collateral informants, and variable confidence and expertise of PCPs to screen, diagnose and subsequently manage patients with cognitive disorders. With the advent of biomarkers for detection, disease-modifying therapies for the treatment of MCI and AD, and the growing focus on prevention and health promotion in midlife, responding to innovative approaches in diagnostics and therapeutics is a critical yet imminent challenge for PCPs and dementia specialists.</div><div>In response to these challenges and needs, the University of South Carolina (USC) Brain Health Network (BHN) was developed as a permanent, State-funded initiative with the main mission of ensuring statewide access to advanced, collaborative cognitive care, and to provide community support throughout South Carolina. Responding to needs assessment and focus groups of caregivers statewide, the BHN represents a collaborative, interdisciplinary partnership with health system providers (Primary Care, Geriatric Psychiatry, Neurology, etc.) to set up a seamless and integrated process to support front-line providers (PCPs) and aim to ensure persons with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers receive support and obtain a clear understanding of their health care system and care navigation in their community.</div><div>This poster describes the development and operational processes of the BHN, highlighting the interdisciplinary aspects of dementia care, as well as the interprofessional role of community health workers (CHW), through relationships with organizations and formal partnerships with the Alzheimer's Association and the Area Agency on Aging/Council of Government, including Area Agency on Aging departments statewide, to facilitate patient engagement and caregiver support state-wide to promote health and enhance care navigation across the continuum of dementia care.</div></div><div><h3>Methods</h3><div>The BHN partners with health systems to achieve 3 main goals: (1) provide greater access and coordinated care for patients and caregivers, (2) provide further support and education for individuals diagnosed (and their caregivers), and (3) provide access to innovations in treatment and diagnostics, especially in under-serve","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S1-S3"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614360","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.020
Amy Grooms , Margaret May-Martin , Lou Ann Eads , George James , Laura Dunn
<div><h3>Introduction</h3><div>Among older adults with major depressive disorder who receive pharmacologic treatment, it has been estimated that at least one-third do not respond to at least two adequate trials of antidepressants—i.e., the definition of treatment-resistant depression currently used by the FDA when considering indications for new therapies. Although electroconvulsive therapy (ECT) is a highly effective intervention for severe depression or depression with psychotic features, its use in older adults can be limited due to concerns for adverse side effects, including anterograde and retrograde amnesia, and increased risks in individuals with cardiovascular or neurologic comorbidities.</div><div>Repetitive transcranial magnetic stimulation (rTMS), particularly in the form of intermittent theta-burst stimulation (iTBS), has emerged as a promising non-invasive alternative for treatment of depression. The novel Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which recently received FDA clearance, consists of ten daily high-dose sessions of iTBS targeting the left dorsolateral prefrontal cortex (DLPFC), which enables treatment time to be condensed into five days, rather than the typical four to six week course of conventional rTMS. The protocol also utilizes functional connectivity (fcMRI)-guided, personalized, algorithmic targeting of the region of the left DLPFC that is identified as being the most anticorrelated with the subgenual anterior cingulate cortex.</div><div>In the initial clinical trials, the SAINT protocol demonstrated impressive results, with over 80% of patients achieving remission in the open-label trial, and 50-80% meeting remission criteria at some point during the four week follow-up period in the randomized sham-controlled trial. However, studies evaluating the efficacy of SAINT in the geriatric population remain absent. Furthermore, real-world patient populations need to be treated to better gauge the effectiveness of this treatment outside of clinical trials.</div></div><div><h3>Methods</h3><div>The University of Arkansas for Medical Sciences (UAMS), through its Interventional Psychiatry Program, was the first site in the United States to offer SAINT to patients in a clinical setting. We received patient referrals from all over the United States, as well as, locally, with the majority being self-referrals. After a comprehensive psychiatric evaluation, patients were offered SAINT TMS if they met criteria for treatment resistant MDD without psychotic features and had no contraindications for the MRI or procedure. A resting-state fMRI was obtained for each patient in the Brain Research Institute housed within the psychiatry department at UAMS. The fMRI data was then uploaded to Magnus Medical to develop a personalized treatment target within the left DLPFC for each patient.</div><div>Each patient received ten sessions a day for 5 consecutive days. Each session lasted 10min and there was a min
{"title":"17. SAINT FOR TREATMENT-RESISTANT DEPRESSION: REAL WORLD FINDINGS","authors":"Amy Grooms , Margaret May-Martin , Lou Ann Eads , George James , Laura Dunn","doi":"10.1016/j.jagp.2025.04.020","DOIUrl":"10.1016/j.jagp.2025.04.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Among older adults with major depressive disorder who receive pharmacologic treatment, it has been estimated that at least one-third do not respond to at least two adequate trials of antidepressants—i.e., the definition of treatment-resistant depression currently used by the FDA when considering indications for new therapies. Although electroconvulsive therapy (ECT) is a highly effective intervention for severe depression or depression with psychotic features, its use in older adults can be limited due to concerns for adverse side effects, including anterograde and retrograde amnesia, and increased risks in individuals with cardiovascular or neurologic comorbidities.</div><div>Repetitive transcranial magnetic stimulation (rTMS), particularly in the form of intermittent theta-burst stimulation (iTBS), has emerged as a promising non-invasive alternative for treatment of depression. The novel Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which recently received FDA clearance, consists of ten daily high-dose sessions of iTBS targeting the left dorsolateral prefrontal cortex (DLPFC), which enables treatment time to be condensed into five days, rather than the typical four to six week course of conventional rTMS. The protocol also utilizes functional connectivity (fcMRI)-guided, personalized, algorithmic targeting of the region of the left DLPFC that is identified as being the most anticorrelated with the subgenual anterior cingulate cortex.</div><div>In the initial clinical trials, the SAINT protocol demonstrated impressive results, with over 80% of patients achieving remission in the open-label trial, and 50-80% meeting remission criteria at some point during the four week follow-up period in the randomized sham-controlled trial. However, studies evaluating the efficacy of SAINT in the geriatric population remain absent. Furthermore, real-world patient populations need to be treated to better gauge the effectiveness of this treatment outside of clinical trials.</div></div><div><h3>Methods</h3><div>The University of Arkansas for Medical Sciences (UAMS), through its Interventional Psychiatry Program, was the first site in the United States to offer SAINT to patients in a clinical setting. We received patient referrals from all over the United States, as well as, locally, with the majority being self-referrals. After a comprehensive psychiatric evaluation, patients were offered SAINT TMS if they met criteria for treatment resistant MDD without psychotic features and had no contraindications for the MRI or procedure. A resting-state fMRI was obtained for each patient in the Brain Research Institute housed within the psychiatry department at UAMS. The fMRI data was then uploaded to Magnus Medical to develop a personalized treatment target within the left DLPFC for each patient.</div><div>Each patient received ten sessions a day for 5 consecutive days. Each session lasted 10min and there was a min","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S13-S14"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614464","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.009
Jack Kaufman , Sara Weisnebach
<div><h3>Introduction</h3><div>The presence of childhood trauma in the geriatric population is as high, if not higher than those in middle age or young adulthood, where many estimates range from 15-45%. This is likely especially true among those with history of depression (LLD). Still, geriatricians, psychiatrists, and psychologists often remain focused on the acute aspects of worsening mood and possible depression tied to typical aging (e.g., functional limitations, declining physical health, and interpersonal losses, etc.) neglecting two important aspects of a person’s depressive past and current presentation: childhood trauma and baseline personality characteristics. We sought to investigate if, and to what extent, neuroticism – the personality variable most implicated in psychopathology – and childhood trauma relate to a person’s history of depression.</div></div><div><h3>Methods</h3><div>99 adults aged 55-79 (M age = 65, SD = 6.5) were administered the Structured Clinical Interview for DSM-5 (SCID-5) and categorized as 61 never-depressed (N-DEP) and 38 with at least one depressive episode (DEP) with a first onset before the age of 35 (including active and remitted). All participants were administered the NEO Personality Inventory (NEO-PI) and the Childhood Trauma Questionnaire (CTQ). There were two primary outcomes: to describe the prevalence and make-up of childhood trauma in a sample of older adults and to investigate its relationship with personality variables to an individual’s history of depression. Exploratory analyses were conducted to see if the type of childhood trauma uniquely predicted depressive episodes. Linear mixed models, including hierarchical regression were used to for this analysis and were adjusted for age, sex, and education.</div></div><div><h3>Results</h3><div>In our sample with a majority of never-depressed participants, 54% scored over 35, the typical threshold for clinical significance on the CTQ, with the sexual abuse subscale receiving the lowest amount of suprathreshold scores (22%) and emotional neglect being the highest amount (55%). Further, when comparing between N-DEP and DEP groups, we found nearly three and a half times as much emotional abuse and nearly three times as much physical abuse in the DEP group. Neuroticism facet scores (entered in the second block) were predictive of depression history (p LESS THAN .001), but childhood trauma scores (entered in the third block) were not. Finally, of the five subscales, only emotional abuse was a significant contributor to the model (block three, replacing overall CTQ scores; p = 01) when entered in their own model steps.</div></div><div><h3>Conclusions</h3><div>The majority of the sample reporting scores considered clinically meaningful confirmed our hypothesis that these experiences are likely more common than previously suspected. Further, our results highlight the importance of giving trait-based variables – principally, the facet of personality labeled neu
{"title":"6. LATENT ASPECTS OF LATE-LIFE DEPRESSION: EXPLORING THE ROLE OF CHILDHOOD TRAUMA AND PERSONALITY","authors":"Jack Kaufman , Sara Weisnebach","doi":"10.1016/j.jagp.2025.04.009","DOIUrl":"10.1016/j.jagp.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The presence of childhood trauma in the geriatric population is as high, if not higher than those in middle age or young adulthood, where many estimates range from 15-45%. This is likely especially true among those with history of depression (LLD). Still, geriatricians, psychiatrists, and psychologists often remain focused on the acute aspects of worsening mood and possible depression tied to typical aging (e.g., functional limitations, declining physical health, and interpersonal losses, etc.) neglecting two important aspects of a person’s depressive past and current presentation: childhood trauma and baseline personality characteristics. We sought to investigate if, and to what extent, neuroticism – the personality variable most implicated in psychopathology – and childhood trauma relate to a person’s history of depression.</div></div><div><h3>Methods</h3><div>99 adults aged 55-79 (M age = 65, SD = 6.5) were administered the Structured Clinical Interview for DSM-5 (SCID-5) and categorized as 61 never-depressed (N-DEP) and 38 with at least one depressive episode (DEP) with a first onset before the age of 35 (including active and remitted). All participants were administered the NEO Personality Inventory (NEO-PI) and the Childhood Trauma Questionnaire (CTQ). There were two primary outcomes: to describe the prevalence and make-up of childhood trauma in a sample of older adults and to investigate its relationship with personality variables to an individual’s history of depression. Exploratory analyses were conducted to see if the type of childhood trauma uniquely predicted depressive episodes. Linear mixed models, including hierarchical regression were used to for this analysis and were adjusted for age, sex, and education.</div></div><div><h3>Results</h3><div>In our sample with a majority of never-depressed participants, 54% scored over 35, the typical threshold for clinical significance on the CTQ, with the sexual abuse subscale receiving the lowest amount of suprathreshold scores (22%) and emotional neglect being the highest amount (55%). Further, when comparing between N-DEP and DEP groups, we found nearly three and a half times as much emotional abuse and nearly three times as much physical abuse in the DEP group. Neuroticism facet scores (entered in the second block) were predictive of depression history (p LESS THAN .001), but childhood trauma scores (entered in the third block) were not. Finally, of the five subscales, only emotional abuse was a significant contributor to the model (block three, replacing overall CTQ scores; p = 01) when entered in their own model steps.</div></div><div><h3>Conclusions</h3><div>The majority of the sample reporting scores considered clinically meaningful confirmed our hypothesis that these experiences are likely more common than previously suspected. Further, our results highlight the importance of giving trait-based variables – principally, the facet of personality labeled neu","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S5"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613896","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.017
Ryan Pate , Christine Gould , Ira Yenko , Maryam Makowski , Oceanna Li , Vanessa Silva , Feng Vankee Lin , Dolores Gallagher-Thompson , Erin Cassidy-Eagle
<div><h3>Introduction</h3><div>The number of older adults seeking psychiatric care is increasing exponentially and the pressure is on to create interventions that can increase the access of support for older adults and reach as many patients as possible. Positive psychological interventions that focus on the psychological wellbeing of older adults present an opportunity to address a range of factors that can impact the lives of older adults. Group interventions foster social connections while reducing cost and limited access to clinicians; the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of patient values and priorities, including the What Matters Most tool, in older adults was performed.</div></div><div><h3>Methods</h3><div>This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their personal values and goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three goals matter the most above all.</div></div><div><h3>Results</h3><div>Older adults (N=19) were enrolled in the psychological wellness group, including 9 males and 10 females. Nine of the participants reported that they lived alone. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than several aspects of physical functionality. The following representative direct patient quotes encapsulate this sentiment well with one subject’s list “1. Connecting deeply with people. 2. Having confidence I can handle whatever comes my way. 3. I’d like to remove the fear that currently has a grip on me so that I am comfortable getting out and about without anxiety.” “[Be] able to take care of myself, have a clear mind
{"title":"14. VALUES AND PRIORITIES OF OLDER ADULTS: CREATING COLLABORATIVE GOALS IN PSYCHIATRIC CARE","authors":"Ryan Pate , Christine Gould , Ira Yenko , Maryam Makowski , Oceanna Li , Vanessa Silva , Feng Vankee Lin , Dolores Gallagher-Thompson , Erin Cassidy-Eagle","doi":"10.1016/j.jagp.2025.04.017","DOIUrl":"10.1016/j.jagp.2025.04.017","url":null,"abstract":"<div><h3>Introduction</h3><div>The number of older adults seeking psychiatric care is increasing exponentially and the pressure is on to create interventions that can increase the access of support for older adults and reach as many patients as possible. Positive psychological interventions that focus on the psychological wellbeing of older adults present an opportunity to address a range of factors that can impact the lives of older adults. Group interventions foster social connections while reducing cost and limited access to clinicians; the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of patient values and priorities, including the What Matters Most tool, in older adults was performed.</div></div><div><h3>Methods</h3><div>This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their personal values and goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three goals matter the most above all.</div></div><div><h3>Results</h3><div>Older adults (N=19) were enrolled in the psychological wellness group, including 9 males and 10 females. Nine of the participants reported that they lived alone. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than several aspects of physical functionality. The following representative direct patient quotes encapsulate this sentiment well with one subject’s list “1. Connecting deeply with people. 2. Having confidence I can handle whatever comes my way. 3. I’d like to remove the fear that currently has a grip on me so that I am comfortable getting out and about without anxiety.” “[Be] able to take care of myself, have a clear mind ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S10-S11"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613904","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.047
Sadeq Kawsar , Katharine Brewster , Mark Nathanson , Margaret Hamilton , Mahfuzur Rahman
Introduction
There is a national shortage of psychiatrists in the field of geriatric psychiatry, particularly in underserved areas. The main goals of the New York Statewide / Columbia University Geriatric Psychiatry Fellowship are to 1) develop geriatric psychiatrists who are national leaders; (2) disseminate expertise in geriatric psychiatry to underserved urban and rural areas; and (3) foster the development of a geriatric mental health workforce in NY State.
The program provides educational experiences in a variety of academic and federally designated medically underserved urban and rural settings, from its academic base at the Columbia University Irving Medical Center to hospital centers in underserved areas such as Greater Binghamton Health Center and Rockland Psychiatric Center. All fellows, in both the NYC and Binghamton tracks, rotate at a wide range of clinical sites in NYC, Upstate NY, and Rockland County and have been entitled to many resources. However, while the NYC track consistently fills its fellowship slots, our Upstate NY track is often underfilled. We hypothesize that the diversity of training opportunities in the program and availability of many academic and clinical resources are a main draw to the fellowship Columbia Geriatric Psychiatry Fellowship, but we do not know whether completion of the fellowship has helped contribute to a geriatric mental health workforce and developed leaders in the field of geriatric psychiatry in NY State. The survey also asks about graduates’ experiences in the fellowship and suggestions to improve recruitment into rural fellowship programs nationwide.
Methods
We have identified over 30 email addresses of graduates of the Columbia Geriatric Psychiatry Fellowship since 2001 and we aim to send out a 12-question confidential survey to the fellowship graduates asking about their experience in the fellowship, how it has influenced their career trajectory, as well as their current work settings and patient population.
Results
We have developed the 12-question survey, and we aim to send it out to fellowship graduates after receiving IRB approval. We will send the survey out in December 2024, collect all data by January 2025, and publish the results in March 2025 for the AAGP annual meeting.
Conclusions
We will hypothesize if the fellowship’s unique collaboration between an urban academic medical center and rural state-run hospitals, working with underserved population in NY State, utilization of resources and teach geriatric psychiatry to a wide range of learners has helped facilitate leadership opportunities in geriatric psychiatry in the United States.
{"title":"45. DEVELOPING NATIONAL LEADERS IN GERIATRIC PSYCHIATRY WORKFORCE; A SURVEY OF GERIATRIC PSYCHIATRY. FELLOWSHIP GRADUATES WHO WERE TRAINED IN UNDERSERVED AREAS OF NEW YORK STATE.","authors":"Sadeq Kawsar , Katharine Brewster , Mark Nathanson , Margaret Hamilton , Mahfuzur Rahman","doi":"10.1016/j.jagp.2025.04.047","DOIUrl":"10.1016/j.jagp.2025.04.047","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a national shortage of psychiatrists in the field of geriatric psychiatry, particularly in underserved areas. The main goals of the New York Statewide / Columbia University Geriatric Psychiatry Fellowship are to 1) develop geriatric psychiatrists who are national leaders; (2) disseminate expertise in geriatric psychiatry to underserved urban and rural areas; and (3) foster the development of a geriatric mental health workforce in NY State.</div><div>The program provides educational experiences in a variety of academic and federally designated medically underserved urban and rural settings, from its academic base at the Columbia University Irving Medical Center to hospital centers in underserved areas such as Greater Binghamton Health Center and Rockland Psychiatric Center. All fellows, in both the NYC and Binghamton tracks, rotate at a wide range of clinical sites in NYC, Upstate NY, and Rockland County and have been entitled to many resources. However, while the NYC track consistently fills its fellowship slots, our Upstate NY track is often underfilled. We hypothesize that the diversity of training opportunities in the program and availability of many academic and clinical resources are a main draw to the fellowship Columbia Geriatric Psychiatry Fellowship, but we do not know whether completion of the fellowship has helped contribute to a geriatric mental health workforce and developed leaders in the field of geriatric psychiatry in NY State. The survey also asks about graduates’ experiences in the fellowship and suggestions to improve recruitment into rural fellowship programs nationwide.</div></div><div><h3>Methods</h3><div>We have identified over 30 email addresses of graduates of the Columbia Geriatric Psychiatry Fellowship since 2001 and we aim to send out a 12-question confidential survey to the fellowship graduates asking about their experience in the fellowship, how it has influenced their career trajectory, as well as their current work settings and patient population.</div></div><div><h3>Results</h3><div>We have developed the 12-question survey, and we aim to send it out to fellowship graduates after receiving IRB approval. We will send the survey out in December 2024, collect all data by January 2025, and publish the results in March 2025 for the AAGP annual meeting.</div></div><div><h3>Conclusions</h3><div>We will hypothesize if the fellowship’s unique collaboration between an urban academic medical center and rural state-run hospitals, working with underserved population in NY State, utilization of resources and teach geriatric psychiatry to a wide range of learners has helped facilitate leadership opportunities in geriatric psychiatry in the United States.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S33-S34"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613906","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.030
Leslie Citrome , Sanjeda R. Chumki , Pedro Such , David Wang , Anton M. Palma , Zhen Zhang , Alireza Atri , Alireza Atri
<div><h3>Introduction</h3><div>Agitation is a prevalent, highly distressing and burdensome neuropsychiatric symptom of Alzheimer’s disease. In this vulnerable patient population, it is especially critical to maximize benefits, minimize risks, and understand expected treatment outcomes. This analysis delineates the clinical benefit and risk profile of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease, using number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).</div></div><div><h3>Methods</h3><div>Data are pooled from two fixed-dose pivotal clinical trials of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease (NCT01862640 [Trial 283], NCT03548584 [Trial 213]), and analyzed for brexpiprazole 2 or 3 mg/day (FDA-approved recommended-to-maximum dose) versus placebo. In both trials, the Cohen-Mansfield Agitation Inventory (CMAI) was the primary efficacy measure. For this post hoc analysis, the main efficacy outcome was agitation response rate, defined as ≥20-point reduction in CMAI Total score from baseline to Week 12. Previous analyses indicate that a 20-point within-person CMAI reduction reflects a clinically meaningful benefit in this population. The main safety outcome was incidence of discontinuation due to treatment-emergent adverse events (TEAEs). Other efficacy and safety outcomes were also analyzed. For the identified outcomes, NNT, NNH and LHH were calculated. NNT and NNH indicate how many patients would need to be treated with brexpiprazole versus placebo in order for one additional patient to experience a benefit (NNT) or a harm (NNH). LHH is the ratio of NNH to NNT. Lower NNT values, and higher NNH and LHH values, are more supportive of brexpiprazole versus placebo.</div></div><div><h3>Results</h3><div>Response rates (≥20-point CMAI Total reduction) were 50.1% (182/363) for brexpiprazole, and 37.7% (93/247) for placebo, yielding a NNT of 9 (95% confidence internal [CI]: 5, 22). The incidence of discontinuation due to TEAEs was 4.9% (18/366) for brexpiprazole, and 4.8% (12/251) for placebo, yielding a NNH of 730 (95% CI: not significant). Together, these specific outcomes result in a LHH of 81.</div></div><div><h3>Conclusions</h3><div>Brexpiprazole is 81 times more likely to result in treatment response (as defined by a ≥20-point reduction in CMAI Total score) than discontinuation because of a TEAE. This analysis provides meaningful clinical interpretation of benefits and risks of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease. These data expand the evidence-base for brexpiprazole, and underscore the favorable efficacy and safety profile that supports the use of brexpiprazole in this patient population.</div><div>This abstract was submitted at the late-breaker deadline to allow sufficient time to discuss the methodology, and ultimately ensure that clinically relev
{"title":"28. BREXPIPRAZOLE FOR AGITATION ASSOCIATED WITH DEMENTIA DUE TO ALZHEIMER’S DISEASE: NUMBER NEEDED TO TREAT, NUMBER NEEDED TO HARM, AND LIKELIHOOD TO BE HELPED OR HARMED","authors":"Leslie Citrome , Sanjeda R. Chumki , Pedro Such , David Wang , Anton M. Palma , Zhen Zhang , Alireza Atri , Alireza Atri","doi":"10.1016/j.jagp.2025.04.030","DOIUrl":"10.1016/j.jagp.2025.04.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Agitation is a prevalent, highly distressing and burdensome neuropsychiatric symptom of Alzheimer’s disease. In this vulnerable patient population, it is especially critical to maximize benefits, minimize risks, and understand expected treatment outcomes. This analysis delineates the clinical benefit and risk profile of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease, using number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).</div></div><div><h3>Methods</h3><div>Data are pooled from two fixed-dose pivotal clinical trials of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease (NCT01862640 [Trial 283], NCT03548584 [Trial 213]), and analyzed for brexpiprazole 2 or 3 mg/day (FDA-approved recommended-to-maximum dose) versus placebo. In both trials, the Cohen-Mansfield Agitation Inventory (CMAI) was the primary efficacy measure. For this post hoc analysis, the main efficacy outcome was agitation response rate, defined as ≥20-point reduction in CMAI Total score from baseline to Week 12. Previous analyses indicate that a 20-point within-person CMAI reduction reflects a clinically meaningful benefit in this population. The main safety outcome was incidence of discontinuation due to treatment-emergent adverse events (TEAEs). Other efficacy and safety outcomes were also analyzed. For the identified outcomes, NNT, NNH and LHH were calculated. NNT and NNH indicate how many patients would need to be treated with brexpiprazole versus placebo in order for one additional patient to experience a benefit (NNT) or a harm (NNH). LHH is the ratio of NNH to NNT. Lower NNT values, and higher NNH and LHH values, are more supportive of brexpiprazole versus placebo.</div></div><div><h3>Results</h3><div>Response rates (≥20-point CMAI Total reduction) were 50.1% (182/363) for brexpiprazole, and 37.7% (93/247) for placebo, yielding a NNT of 9 (95% confidence internal [CI]: 5, 22). The incidence of discontinuation due to TEAEs was 4.9% (18/366) for brexpiprazole, and 4.8% (12/251) for placebo, yielding a NNH of 730 (95% CI: not significant). Together, these specific outcomes result in a LHH of 81.</div></div><div><h3>Conclusions</h3><div>Brexpiprazole is 81 times more likely to result in treatment response (as defined by a ≥20-point reduction in CMAI Total score) than discontinuation because of a TEAE. This analysis provides meaningful clinical interpretation of benefits and risks of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease. These data expand the evidence-base for brexpiprazole, and underscore the favorable efficacy and safety profile that supports the use of brexpiprazole in this patient population.</div><div>This abstract was submitted at the late-breaker deadline to allow sufficient time to discuss the methodology, and ultimately ensure that clinically relev","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S20"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613979","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.039
Oluranti Omolara Babalola , Adebobola Imeh-Nathaniel (PhD) , Addison Niles (MD) , Richard L. Goodwin (PhD) , Laurie Theriot Roley (MD) , Ohmar Win (MD) , Thomas I. Nathaniel (PhD)
Introduction
Despite tauhe significant burden of Alzheimer's Dementia (AD) with Normal Pressure Hydrocephalus (NPH) and Mild Cognitive Impairment (MCI), placed on the aging population, their loved ones, and healthcare systems, these conditions remain under-researched. The overlap of NPH and MCI symptoms in persons with AD presents challenges for diagnosis, however, timely and effective management of these comorbidities can help prevent the progression to severe dementia. This study aims to examine the relationship between sociodemographic factors and psychotropic medication use in AD patients diagnosed with NPH and MCI, using the Social Determinants of Health (SDH) model.
Methods
The study analyzed 33,735 patients diagnosed with MCI (n=33,064) or NPH (n=671) between February 2016 and August 2021 at Prisma Health-Upstate South Carolina. Multivariable logistic regression identified key factors associated with NPH and MCI, including age, race, and medication use.
Results
NPH patients were older (69.38 ± 16.42 vs. 63.19 ± 21.78 years) and predominantly White (92.1% vs. 80.7%). Tobacco use (OR = 1.175, 95% CI, 1.004-1.375) and buspirone use (OR = 1.415, 95% CI, 1.116-1.794) were positively associated with NPH while being Black (OR = 0.388, 95% CI, 0.277-0.542) and risperidone use (OR = 0.217, 95% CI, 0.103-0.459) were associated with MCI. Sex-stratified analyses revealed that men with NPH were more likely to use SSRIs, while women were more likely to use memantine and buspirone.
Conclusions
The SDH framework highlighted disparities in diagnosis, revealing that White patients with AD are more likely to be diagnosed with NPH, potentially due to better access to healthcare. These findings emphasize the need for targeted interventions that address social factors, improve access to psychotropic medications, and reduce healthcare disparities to enhance outcomes for AD patients with NPH and MCI.
{"title":"37. EXAMINING PSYCHOTROPIC MEDICATION, SOCIAL FACTORS, NORMAL PRESSURE HYDROCEPHALUS AND MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH ALZHEIMER DEMENTIA: A RETROSPECTIVE COHORT ANALYSIS.","authors":"Oluranti Omolara Babalola , Adebobola Imeh-Nathaniel (PhD) , Addison Niles (MD) , Richard L. Goodwin (PhD) , Laurie Theriot Roley (MD) , Ohmar Win (MD) , Thomas I. Nathaniel (PhD)","doi":"10.1016/j.jagp.2025.04.039","DOIUrl":"10.1016/j.jagp.2025.04.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite tauhe significant burden of Alzheimer's Dementia (AD) with Normal Pressure Hydrocephalus (NPH) and Mild Cognitive Impairment (MCI), placed on the aging population, their loved ones, and healthcare systems, these conditions remain under-researched. The overlap of NPH and MCI symptoms in persons with AD presents challenges for diagnosis, however, timely and effective management of these comorbidities can help prevent the progression to severe dementia. This study aims to examine the relationship between sociodemographic factors and psychotropic medication use in AD patients diagnosed with NPH and MCI, using the Social Determinants of Health (SDH) model.</div></div><div><h3>Methods</h3><div>The study analyzed 33,735 patients diagnosed with MCI (n=33,064) or NPH (n=671) between February 2016 and August 2021 at Prisma Health-Upstate South Carolina. Multivariable logistic regression identified key factors associated with NPH and MCI, including age, race, and medication use.</div></div><div><h3>Results</h3><div>NPH patients were older (69.38 ± 16.42 vs. 63.19 ± 21.78 years) and predominantly White (92.1% vs. 80.7%). Tobacco use (OR = 1.175, 95% CI, 1.004-1.375) and buspirone use (OR = 1.415, 95% CI, 1.116-1.794) were positively associated with NPH while being Black (OR = 0.388, 95% CI, 0.277-0.542) and risperidone use (OR = 0.217, 95% CI, 0.103-0.459) were associated with MCI. Sex-stratified analyses revealed that men with NPH were more likely to use SSRIs, while women were more likely to use memantine and buspirone.</div></div><div><h3>Conclusions</h3><div>The SDH framework highlighted disparities in diagnosis, revealing that White patients with AD are more likely to be diagnosed with NPH, potentially due to better access to healthcare. These findings emphasize the need for targeted interventions that address social factors, improve access to psychotropic medications, and reduce healthcare disparities to enhance outcomes for AD patients with NPH and MCI.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S27"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614141","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.103
Vivek Mathesh , Kayla Murphy , Mashal Ali , Christopher Clark , Natalie Provenzale , Abhisek Khandai , Mustafa Husain
Introduction
Background: It is estimated that only 1/3rd of US adults will detail an Advance Directive in their lifetime. Advance directive completion is associated with a decreased risk of hospitalization, higher concordance between the individual’s end-of-life wishes with the provided care, and amelioration of the caregiver’s stress (Sedini et al., 2022). However, little is known about the intersection of psychiatric diagnoses, including neurocognitive disorders, on MAD usage. Thus, the goal of this study is to establish a robust framework on MAD usage through a novel EMR analysis of a large metroplex city population and elucidate how the adoption of MADs is influenced by psychiatric diagnoses.
Methods
Methods: A retrospective analysis of electronic record encounters for all adults (age > = 18 years) with a 2022 inpatient admission (n = 41,421) at Parkland Memorial hospital was conducted. To identify the presence of an Advance Directive, these records were queried for attachments with MAD-related titles. MAD adoption rates among patients with and without psychiatric diagnoses were compared.
Results
Results: 41,421 patients were included in the study (age= 43.75 ± 17.53 years, mean ± SD) from which 15,143 patients identified as male, and 26,278 patients identified as female. Across all patients, the adoption of medical advance directives was 8.75%. Among those who had a psychiatric diagnosis, 14.0% of patients utilized a form of advance directive while, among those who did not have a psychiatric diagnosis, only 6.1% had an advance directive (p < 0.001). Compared to the population without a psychiatric diagnosis, those that had diagnoses related to neurocognitive disorders had a 25.7% higher use rate of advance directives (p < 0.001). Similarly, comparing patients from other psychiatric disorder groups to the general population, the Anxiety/Depression, Substance Use Disorder, and Schizophrenia/Bipolar, had a 17.6%, 11.7%, and 10.5% increase in MAD usage, respectively (p < 0.001 for all three comparisons).
Conclusions
Conclusion: Despite known healthcare disparities for patients with psychiatric disorders, our results indicated that MAD usage is greater amongst those who have a psychiatric diagnosis compared to patients who do not. In particular, patients with neurocognitive disorders had higher rates of MAD usage, especially in comparison to patients with other psychiatric diagnoses. Further studies will investigate the potential confounding effects of age, race, and gender on MAD usage in patients with psychiatric comorbidities. Particularly given the health disparities faced by patients with neurocognitive disorders and other psychiatric diagnoses, medical centers must create systems-level interventions to promote inclusive and empowering MAD usage amongst older adults.
{"title":"101. EFFECTS OF PSYCHIATRIC DIAGNOSIS ON MEDICAL DIRECTIVE USAGE IN OLDER ADULTS: A LARGE DATASET EMR ANALYSIS AT A SAFETY-NET METROPLEX HOSPITAL","authors":"Vivek Mathesh , Kayla Murphy , Mashal Ali , Christopher Clark , Natalie Provenzale , Abhisek Khandai , Mustafa Husain","doi":"10.1016/j.jagp.2025.04.103","DOIUrl":"10.1016/j.jagp.2025.04.103","url":null,"abstract":"<div><h3>Introduction</h3><div>Background: It is estimated that only 1/3rd of US adults will detail an Advance Directive in their lifetime. Advance directive completion is associated with a decreased risk of hospitalization, higher concordance between the individual’s end-of-life wishes with the provided care, and amelioration of the caregiver’s stress (Sedini et al., 2022). However, little is known about the intersection of psychiatric diagnoses, including neurocognitive disorders, on MAD usage. Thus, the goal of this study is to establish a robust framework on MAD usage through a novel EMR analysis of a large metroplex city population and elucidate how the adoption of MADs is influenced by psychiatric diagnoses.</div></div><div><h3>Methods</h3><div>Methods: A retrospective analysis of electronic record encounters for all adults (age > = 18 years) with a 2022 inpatient admission (n = 41,421) at Parkland Memorial hospital was conducted. To identify the presence of an Advance Directive, these records were queried for attachments with MAD-related titles. MAD adoption rates among patients with and without psychiatric diagnoses were compared.</div></div><div><h3>Results</h3><div>Results: 41,421 patients were included in the study (age= 43.75 ± 17.53 years, mean ± SD) from which 15,143 patients identified as male, and 26,278 patients identified as female. Across all patients, the adoption of medical advance directives was 8.75%. Among those who had a psychiatric diagnosis, 14.0% of patients utilized a form of advance directive while, among those who did not have a psychiatric diagnosis, only 6.1% had an advance directive (p < 0.001). Compared to the population without a psychiatric diagnosis, those that had diagnoses related to neurocognitive disorders had a 25.7% higher use rate of advance directives (p < 0.001). Similarly, comparing patients from other psychiatric disorder groups to the general population, the Anxiety/Depression, Substance Use Disorder, and Schizophrenia/Bipolar, had a 17.6%, 11.7%, and 10.5% increase in MAD usage, respectively (p < 0.001 for all three comparisons).</div></div><div><h3>Conclusions</h3><div>Conclusion: Despite known healthcare disparities for patients with psychiatric disorders, our results indicated that MAD usage is greater amongst those who have a psychiatric diagnosis compared to patients who do not. In particular, patients with neurocognitive disorders had higher rates of MAD usage, especially in comparison to patients with other psychiatric diagnoses. Further studies will investigate the potential confounding effects of age, race, and gender on MAD usage in patients with psychiatric comorbidities. Particularly given the health disparities faced by patients with neurocognitive disorders and other psychiatric diagnoses, medical centers must create systems-level interventions to promote inclusive and empowering MAD usage amongst older adults.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S75"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614270","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.056
Courtney Lee , Yutong Zhu , Heather Doherty , Oded Bein , Nili Solomonov
<div><h3>Introduction</h3><div>Older adults with depression experience deficits in processing socially rewarding experiences. These deficits include blunted reward anticipation – reduced expectation that pleasurable social experiences will occur in the future. Reduced reward anticipation is associated with greater anhedonia severity and lower tendency to seek rewarding experiences. We leveraged latent-cause inference, a computational and conceptual framework for cognitive learning processes, to investigate social reward deficits in late-life depression. We hypothesized that blunted reward anticipation might result from clustering rewarding and non-rewarding events together, instead of accurately distinguishing them. This clustering in turn could lead to anticipation of negative or neutral, rather than positive, social experiences in the future. We aimed to investigate whether depressed older adults, compared to healthy controls, show poorer social reward learning (i.e. reduced segregation between rewarding and non-rewarding social stimuli).</div></div><div><h3>Methods</h3><div>Fifty-eight participants (mean age: 64.2 years [SD: 7.0], 42 female [72.4%]) were included in the study: 25 older adults with late-life depression (mean age: 65.0 [SD: 7.0] years, 23 female [92.0%]) and 33 healthy controls (mean age: 63.6 [SD: 7.0] years, 19 female [57.6%]). Participants completed our novel “Social Task for Assessment of Reward” (STAR) task four times over 9 weeks (baseline, week 3, 6, and 9). The task consisted of 70 trials: 35 social reward trials (a cue of anticipating social reward feedback); 35 non-reward trials (a cue of anticipating no social reward feedback). We applied mixed-level linear models to investigate differential effects of cue response over time in depressed older adults vs. healthy controls.</div></div><div><h3>Results</h3><div>We found that both depressed and healthy control individuals showed faster reaction times for anticipated social reward vs. non-reward trials (F1, 13288 = 7.89, p = 0.004989). Further, the depressed group, vs. healthy controls, showed smaller differences in reaction times between social reward and non-reward trials (F1, 13288 = 6.13, p = 0.01333). This effect did not change over time (F1, 13288 = 0.665, p = 0.5737), suggesting persistent diminished segregation of social reward and non-reward trials.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that depressed older adults, compared to healthy controls, show reduced segregation between rewarding and non-rewarding social stimuli. This lower segregation might indicate poorer social reward learning in late-life depression, specifically reduced anticipation of socially rewarding outcomes. Our results can inform the development of interventions to restore adaptive segregation between rewarding and non-rewarding events to improve social reward learning. Specifically, future work will investigate whether psychotherapy for increasing engagement in socially
{"title":"54. REWARD LEARNING IN LATE-LIFE DEPRESSION: A NOVEL LATENT-CAUSE INFERENCE APPROACH","authors":"Courtney Lee , Yutong Zhu , Heather Doherty , Oded Bein , Nili Solomonov","doi":"10.1016/j.jagp.2025.04.056","DOIUrl":"10.1016/j.jagp.2025.04.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Older adults with depression experience deficits in processing socially rewarding experiences. These deficits include blunted reward anticipation – reduced expectation that pleasurable social experiences will occur in the future. Reduced reward anticipation is associated with greater anhedonia severity and lower tendency to seek rewarding experiences. We leveraged latent-cause inference, a computational and conceptual framework for cognitive learning processes, to investigate social reward deficits in late-life depression. We hypothesized that blunted reward anticipation might result from clustering rewarding and non-rewarding events together, instead of accurately distinguishing them. This clustering in turn could lead to anticipation of negative or neutral, rather than positive, social experiences in the future. We aimed to investigate whether depressed older adults, compared to healthy controls, show poorer social reward learning (i.e. reduced segregation between rewarding and non-rewarding social stimuli).</div></div><div><h3>Methods</h3><div>Fifty-eight participants (mean age: 64.2 years [SD: 7.0], 42 female [72.4%]) were included in the study: 25 older adults with late-life depression (mean age: 65.0 [SD: 7.0] years, 23 female [92.0%]) and 33 healthy controls (mean age: 63.6 [SD: 7.0] years, 19 female [57.6%]). Participants completed our novel “Social Task for Assessment of Reward” (STAR) task four times over 9 weeks (baseline, week 3, 6, and 9). The task consisted of 70 trials: 35 social reward trials (a cue of anticipating social reward feedback); 35 non-reward trials (a cue of anticipating no social reward feedback). We applied mixed-level linear models to investigate differential effects of cue response over time in depressed older adults vs. healthy controls.</div></div><div><h3>Results</h3><div>We found that both depressed and healthy control individuals showed faster reaction times for anticipated social reward vs. non-reward trials (F1, 13288 = 7.89, p = 0.004989). Further, the depressed group, vs. healthy controls, showed smaller differences in reaction times between social reward and non-reward trials (F1, 13288 = 6.13, p = 0.01333). This effect did not change over time (F1, 13288 = 0.665, p = 0.5737), suggesting persistent diminished segregation of social reward and non-reward trials.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that depressed older adults, compared to healthy controls, show reduced segregation between rewarding and non-rewarding social stimuli. This lower segregation might indicate poorer social reward learning in late-life depression, specifically reduced anticipation of socially rewarding outcomes. Our results can inform the development of interventions to restore adaptive segregation between rewarding and non-rewarding events to improve social reward learning. Specifically, future work will investigate whether psychotherapy for increasing engagement in socially ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S40"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614397","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.058
Karisma Pathak , Ricardo Salazar
Introduction
Neurobiological studies to date suggest that psychosis in AD and related dementias may be associated with distinct imaging, genetic, neuropathological, and CSF biomarkers. Notably, most of the neurobiological studies to date have focused on patients with established dementia, given that psychotic symptoms are much rarer in prodromal states and may be confused with primary psychiatric pathology. Further study of psychosis-associated biomarkers in patients with prodromal conditions is clearly required.
Methods
We describe the case of a previously healthy woman in her middle 70s with new-onset and prominent visual hallucinations referred for neuropsychiatric evaluation after an extensive medical work-up by neurology to rule out organic causes. A thorough psychiatric, neurological, and cognitive evaluation was conducted. We conducted an FDG-PET evaluation to further elucidate the underlying pathophysiology.
Results
We report for the first time in the literature a case of the Phantom Boarder Phenomenon (PB), in which animals (snakes) and insects (spiders) have entered or are living in the patient's home despite evidence to the contrary. The patient experiences fear, anxiety, social isolation, living alone with no interpersonal relationships, and personal loss. Extensive medical, neurological, ophthalmological, and psychiatric workup and evaluation was completely normal, except for the FDG-PET findings that demonstrated early signs of synaptic dysfunction on bilateral temporal lobes.
Conclusions
Our case report supports the notion found in other studies that identified the temporal lobes as the neurobiological substrate of positive BPSD and FDG-PET as a potential instrument to predict their development.
{"title":"56. BACK TO THE FUTURE: VISUAL HALLUCINATIONS CAPTURED ON FDG-PET IN ADVANCE OF GROSS COGNITIVE IMPAIRMENT: A CASE FOR ETIOPATHOLOGICAL REDEFINITION OF ALZHEIMER'S DISEASE.","authors":"Karisma Pathak , Ricardo Salazar","doi":"10.1016/j.jagp.2025.04.058","DOIUrl":"10.1016/j.jagp.2025.04.058","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurobiological studies to date suggest that psychosis in AD and related dementias may be associated with distinct imaging, genetic, neuropathological, and CSF biomarkers. Notably, most of the neurobiological studies to date have focused on patients with established dementia, given that psychotic symptoms are much rarer in prodromal states and may be confused with primary psychiatric pathology. Further study of psychosis-associated biomarkers in patients with prodromal conditions is clearly required.</div></div><div><h3>Methods</h3><div>We describe the case of a previously healthy woman in her middle 70s with new-onset and prominent visual hallucinations referred for neuropsychiatric evaluation after an extensive medical work-up by neurology to rule out organic causes. A thorough psychiatric, neurological, and cognitive evaluation was conducted. We conducted an FDG-PET evaluation to further elucidate the underlying pathophysiology.</div></div><div><h3>Results</h3><div>We report for the first time in the literature a case of the Phantom Boarder Phenomenon (PB), in which animals (snakes) and insects (spiders) have entered or are living in the patient's home despite evidence to the contrary. The patient experiences fear, anxiety, social isolation, living alone with no interpersonal relationships, and personal loss. Extensive medical, neurological, ophthalmological, and psychiatric workup and evaluation was completely normal, except for the FDG-PET findings that demonstrated early signs of synaptic dysfunction on bilateral temporal lobes.</div></div><div><h3>Conclusions</h3><div>Our case report supports the notion found in other studies that identified the temporal lobes as the neurobiological substrate of positive BPSD and FDG-PET as a potential instrument to predict their development.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S42"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614399","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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