American Journal of Geriatric Psychiatry最新文献

Background: Primary healthcare institutions find identifying individuals with dementia particularly challenging. This study aimed to develop machine learning models for identifying predictive features of older adults with normal cognition to develop dementia.

Methods: We developed four machine learning models: logistic regression, decision tree, random forest, and gradient-boosted trees, predicting dementia of 1,162 older adults with normal cognition at baseline from the Hubei Memory and Aging Cohort Study. All relevant variables collected were included in the models. The Shanghai Aging Study was selected as a replication cohort (n = 1,370) to validate the performance of models including the key features after a wrapper feature selection technique. Both cohorts adopted comparable diagnostic criteria for dementia to most previous cohort studies.

Results: The random forest model exhibited slightly better predictive power using a series of auditory verbal learning test, education, and follow-up time, as measured by overall accuracy (93%) and an area under the curve (AUC) (mean [standard error]: 088 [0.07]). When assessed in the external validation cohort, its performance was deemed acceptable with an AUC of 0.81 (0.15). Conversely, the logistic regression model showed better results in the external validation set, attaining an AUC of 0.88 (0.20).

Conclusion: Our machine learning framework offers a viable strategy for predicting dementia using only memory tests in primary healthcare settings. This model can track cognitive changes and provide valuable insights for early intervention.

Objective: Antidepressants are the first-line treatment for depression among older adults. While antidepressants are associated with increased risk of falls and fractures in older adults, their effect on outcomes after fall-related injuries such as hip fracture, and whether these effects differ by sex, is unknown. Thus, the purpose of this study was to examine the association between prefracture antidepressant use and hospital length of stay (LOS) among hip fracture survivors, and related sex differences.

Methods: Participants included 17,936 community-dwelling Medicare fee-for-service beneficiaries with depression and hospitalization claim for hip fracture surgery between 2010 and 2017. Ordinal logistic regression estimated the association between prefracture antidepressant use and hospital LOS in days, categorized into three groups (1-4, 5-8, and 8+ days) during the 30-day postfracture period, adjusting for demographic, medical, facility, and geographic factors. A sex-by-antidepressant use interaction term was included to examine effect heterogeneity by sex.

Results: Prefracture antidepressant users (47%, n = 8,350) were more likely to be younger, White females. The adjusted ordinal logistic regression showed beneficiaries who used antidepressants had 8% higher odds of being in a shorter hospital LOS category compared to non-users (OR = 1.08; 95% CI = 1.02, 1.14; p=0.01). The sex-by-antidepressant use interaction was not statistically significant (p=0.92).

Conclusions: Among older adults with depression who subsequently experienced a hip fracture, antidepressant use of >30 days in the 6 months prior to fracture was associated with a shorter hospital LOS. These findings indicate that use of antidepressants does not prolong early recovery from hip fracture and may be protective.

Objective: Tinnitus has been linked to mental health concerns, including suicidal ideation. This study, using data from the National Health and Nutrition Examination Survey (NHANES), investigates the association between tinnitus and suicidal ideation in postmenopausal women, aiming to identify tinnitus as a potential risk factor for suicidal thoughts in this population.

Method: A total of 1,792 postmenopausal women were included after excluding males, premenopausal women, and participants with missing data on tinnitus, suicidal ideation, or key covariates. Multivariable logistic regression models were used to examine the relationship between tinnitus and suicidal ideation, with adjustments for relevant confounders. Data were drawn from the NHANES database, specifically from the 2011 to 2012, 2015 to 2016, and 2017 to 2018 survey cycles.

Results: Of the 1,792 postmenopausal women, 4.41% reported suicidal ideation. Tinnitus prevalence was significantly higher in women with suicidal ideation (P = 0.007). Weighted multivariable logistic regression revealed that women with tinnitus had 2.43 times higher odds of reporting suicidal ideation compared to those without tinnitus (OR: 2.43, 95% CI: 1.07-5.52, P = 0.035).

Conclusion: Tinnitus appears to be a significant factor associated with suicidal ideation in postmenopausal women. These findings underscore the importance of considering tinnitus in mental health assessments, especially among individuals at risk for suicidal thoughts.

Objectives: To investigate the associations between accelerometer-measured physical activity and sedentary behavior with depression and anxiety.

Methods: We used accelerometer data from the UK biobank. Time spent in moderate-to-vigorous physical activity (MVPA) was classified into four categories: very-low (0-74.9 min/week), low (75-149.9 min/week), moderate (150-299.9 min/week), and high (≥300 min/week). Associations were examined using Cox proportional hazard regression models. Restricted cubic splines were used to evaluate dose-response associations.

Results: A total of 71556 adults (mean [SD] age, 62.11 [7.83] years; 54.5% were female) were included. When stratified by MVPA, 10562 participants were in the very-low group (14.8%), 11578 were in the low group (16.2%), 20700 were in the moderate group (28.9%), and 28716 were in the high group (40.1%). Both MVPA and total physical activity showed nonlinear associations with the risk of depression and anxiety. Compared with very-low level MVPA, moderate MVPA might reduce the risk of depression (HR, 0.71; 95% CI, 0.63-0.79) and anxiety (HR, 0.80; 95% CI, 0.71-0.90). High MVPA was associated with a 30% lower risk of depression (HR, 0.70; 95% CI, 0.62-0.78) and anxiety (HR, 0.70; 95% CI, 0.62-0.79). For sedentary behavior, quartile 4 (≥10.60 h/d) was associated with a 19% higher risk of depression (HR, 1.19; 95% CI, 1.05-1.35) compared to quartile 1 (<8.21 h/d).

Conclusion: The WHO guideline of 150-300 min/week of MVPA may reduce the risk of depression by 29% and anxiety by 20% compared to less than 75 min/week. Prolonged sedentary behavior was associated with a higher risk of depression.

Objectives: To improve assessment of neuropsychiatric symptoms (NPS) by expanding the measurement properties of the Neuropsychiatric Inventory Questionnaire (NPI-Q).

Design: Multicenter, longitudinal observational study.

Setting: Several Alzheimer's Disease Research Centers (ADRCs).

Participants: Individuals (n = 45,274) who presented to an ADRC with a collateral and completed the NPI-Q.

Measurements: The NPI-Q total severity score, four NPI-Q subscales, dementia stage, expert NPS rating, consensus rating of dementia syndrome, global cognitive screening, collateral rating of daily functioning, and self-rating of depression.

Results: There was strong evidence of criterion validity with both dementia stage and expert NPS rating for the NPI-Q total severity index, which informed cutoffs and interpretive ranges. Furthermore, subscales had adequate classification of dementia syndromes and appropriate convergent relationships with cognition, daily functioning, and mood. There was good-to-excellent evidence of reliability for the NPI-Q total severity index over several years, and subscales had adequate-to-good reliability.

Conclusions: This is the first study to provide empirically established cutoffs, interpretive ranges, and evidence of reliability over a period longer than a month on the NPI-Q and its subscales. This will improve assessment of NPS in clinical and research contexts.

Article summary: Neuropsychiatric symptoms of neurodegeneration are increasingly understood as early disease markers with tremendous functional impact later in disease, but are often missed or misdiagnosed. The most common measure of these symptoms, the Neuropsychiatric Inventory Questionnaire (NPI-Q), does not have clinically actionable guidance, which this article provided. We established cutscores for several conditions and test-retest reliability over longer periods for the total score and subscales using a multicenter database.

Objectives: Vietnam faces an unprecedented increase in people living with dementia but lacks evidence-based family dementia caregiver interventions. We tested the efficacy of a culturally adapted family caregiver intervention (REACH VN) in Northern Vietnam.

Methods: In this randomized controlled trial, clusters (communes) were assigned to¹ REACH VN (a multicomponent intervention consisting of 4-6 one-hour sessions delivered over 1-3 months) or² enhanced control (one session of dementia education). Primary outcomes were caregiver perceived psychological distress (PHQ-4) and burden (ZBI-12). Secondary outcomes were caregiver perceived stress (PSS-10) and somatic symptoms (PHQ-15). Mixed effects analysis was performed with 3-month and 6-month assessments as the outcomes and baseline assessment as a covariate.

Results: Overall, 350 caregivers from 40 clusters (21 intervention, 19 enhanced control) enrolled and 330 (94.3%) completed 3-month assessments. At 3 months, the REACH VN intervention group had lower PHQ-4 (p <0.001) but not ZBI-12 (p = 0.05) scores compared to control. At 6 months, the intervention group had lower ZBI-12 (p = 0.002) but not PHQ-4 (p = 0.5) scores. PSS-10 and PHQ-15 scores were also improved at 3 months (p = 0.007, p <0.001 respectively) for the REACH VN intervention group compared with control but not at 6 months.

Conclusions: REACH VN improved outcomes in family caregivers in Vietnam at 3 months although improvement was not sustained for most outcomes at 6 months.