Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society最新文献

Background: Alzheimer's Disease (AD) is characterised by impairments across several neurocognitive domains, including memory and executive function. The study explored the effectiveness of a 3-month individual Cognitive Stimulation (iCS) program in older adults with mild AD.

Methods: A multicenter randomised controlled trial was conducted with 62 Portuguese older adults with mild AD. Participants were randomly assigned to either iCS (n = 33; 53%) or treatment as usual (TAU, n = 29; 47%). Cognitive outcomes were assessed at baseline, post-intervention, and 12-week follow-up using standardised tests for global cognition, memory and executive function.

Results: The iCS group showed a significant improvement in memory and executive function compared to the TAU group. The analysis of subscales revealed significant improvements in encoding and semantic memory (Memory Alteration Test) and free delayed recall (Free and Cued Selective Reminding Test). Adherence and engagement with the intervention were high.

Conclusions: A 3-month iCS program showed preliminary benefits in specific cognitive domains (memory and executive function) in older adults with mild AD, warranting further research with larger samples and longer follow-up.

Trail registration: Clinicaltrials.gov ID: NCT05433493; Effect of Individual Cognitive Stimulation on Memory and Executive Function in Older Adults With Alzheimer's Disease.

Introduction: Movement disorders, especially hyperkinetic movement disorders, can present in emergency services in an acute and/or severe form and are aetiologically heterogeneous. Because limited data exist on the epidemiology and clinical presentation of hyperkinetic movement disorders in China, a retrospective study was performed to investigate the spectrum of various hyperkinetic movement disorder emergencies and their underlying causes.

Objective: To reveal the spectrum of hyperkinetic movement disorder emergencies from a retrospective study and investigate their underlying causes to aid in their management.

Methods: In total, 74 adults presenting with hyperkinetic movement disorders were recruited between January 2023 and September 2024, and data related to clinical information, cranial CT/MRI scans, and blood tests and other necessary examinations were collected.

Results: The frequency of hyperkinetic movement disorder emergencies accounted for 0.125% (74/59 354) of the total patients in the emergency room during this period. The most common type of hyperkinetic movement disorder emergency was myoclonus (44.6%), followed by tremors (37.8%), dystonia (16.2%) and chorea (1.4%). The time delay to medical consultation was divided into three phases: ≤ 24 h (67.6%), 24 h-28 days (23.0%), and > 28 days (9.5%). In addition to the undetermined aetiological factors (31.1%), six aetiological groups were recognised: metabolic disease (16.2%), infection and inflammation (16.2%), psychogenesis (9.5%), drug-induced disorders (9.5%), neurodegenerative diseases (9.5%), and stroke (8.1%). During the 2-year follow-up period, the morbidity rate in our study was 5.4% (4/74).

Conclusions: This study provides a landscape of adult patients presenting to neurology emergency services with hyperkinetic movement disorders in China.

Background: Loneliness in old age is linked to various negative outcomes, including poor subjective health, depression and cognitive decline, including dementia onset, and its prevention is crucial. This study examines the communication factors associated with loneliness by focusing on the relationship between communication partners, communication methods, and the qualitative and quantitative aspects of communication among middle-aged and older adults.

Methods: An online survey of 560 participants (376 men, 184 women; mean age = 68.4 ± 10.7 years) was conducted in November 2022. It assessed the frequency of, and satisfaction with communication across various relationships, including spouses, friends and family members. Loneliness served as the dependent variable, whereas social support and social networks were included as covariates.

Results: Multiple regression analysis revealed that satisfaction with communication with a son or daughter (β = -0.10, p = 0.009), son- or daughter-in-law (β = -0.11, p = 0.030), friends (β = -0.18, p < 0.001), parents (β = -0.13, p = 0.037) and other relationships (β = -0.23, p = 0.001) was associated with loneliness.

Conclusions: The findings highlight the importance of qualitative aspects of communication, particularly satisfaction within relationships, in mitigating loneliness among older populations.

Older adults often experience rapid cognitive decline following hospitalization, especially those with severe illness and extended stays. Despite known links between increasing patient age and cognitive decline, 30% of older adults without major pre-existing conditions prior to medical admission show potential undiagnosed cognitive decline. This scoping review aims to map the prevalence, assessment methods, and associated factors of cognitive decline among hospitalized older adults. We conducted an exploratory review in accordance with the Joanna Briggs Institute (JBI) methodological framework and the PRISMA-ScR guidelines. The review targeted studies published between January 2018 and March 2025 in English or Spanish that reported in-hospital cognitive assessments in individuals aged 65 years and older. 'Cognitive decline' was operationally defined as performance below established cut-off scores on validated tools, such as the Mini-Mental State Examination (MMSE ≤ 23) or the Montreal Cognitive Assessment (MoCA < 26), administered during hospitalization. Databases consulted included PubMed, Web of Science, and ScienceDirect. A narrative synthesis was undertaken to organise findings by study design, cognitive instruments, prevalence rates, and associated factors. A total of thirty studies met the inclusion criteria. Most employed cross-sectional or prospective cohort designs, with wide variability in hospital settings, timing of assessments, and cognitive tools used. The reported prevalence of cognitive impairment ranged from 10% to 85%, depending on the assessment tools and population characteristics. MMSE and MoCA were the most frequently used tools. Associated factors included advanced age, comorbidities, pre-existing cognitive decline, and frailty. Methodological heterogeneity hindered meta-analysis, but it also revealed important limitations in the comparability of the studies. This review identifies substantial heterogeneity in the assessment and reporting of cognitive decline among hospitalized older adults. The findings highlight the need for standardized screening protocols and improved methodological consistency to optimise the detection, cross-study comparability, and clinical relevance of cognitive assessments in hospital settings.

Constipation is highly prevalent (30%-60%) in older adults taking atypical antipsychotics (AAPs), a rate insufficiently explained by anticholinergic effects alone. This paper proposes an integrated model centered on the impaired defecation reflex, which weakens with age and is further compromised by AAP-induced multi-neurotransmitter imbalance. AAPs interfere with the descending pain inhibitory pathway, disrupting the central dopamine (DA) and serotonin (5-HT) systems vital for initiating the defecation reflex via the sacral parasympathetic nuclei (SPN). Furthermore, enhanced GABAergic inhibition is implicated, potentially contributing to observed sex differences. This central impairment is compounded by gut dysbiosis-common in this population-which is hypothesized to damage neural circuits and weaken the reflex via the gut-brain axis. We advocate for a holistic management approach beyond traditional laxatives. Targeting the gut microbiota with specific butyrate-producing probiotics represents a novel, hypothesis-generating strategy. This intervention may restore central dopaminergic function, thereby strengthening the compromised defecation reflex. This integrated framework-addressing monoaminergic and gut microbiota mechanisms-provides a more complete understanding for future research and clinical strategies.

Background: This study aimed to evaluate Hasegawa Dementia Scale-Revised (HDS-R) cutoff scores that correspond to Mini-Mental State Examination (MMSE) thresholds for identifying candidates for anti-amyloid β (Aβ) therapies. Additionally, we conducted exploratory analyses to examine the cognitive subdomains associated with Aβ status.

Methods: This retrospective cross-sectional study included consecutive patients with amnesia who underwent neuropsychological examinations and Aβ assessment through cerebrospinal fluid analysis or positron emission tomography. Diagnostic accuracy for MMSE thresholds (≥ 20, ≥ 22 and ≥ 24) was assessed, and two HDS-R cutoffs (high-sensitivity, high-specificity) were determined for each threshold. We examined differences in cognitive subdomains between Aβ-positive and Aβ-negative patients with MMSE score ≥ 20.

Results: Of 234 patients, 143 (61.1%) were Aβ-positive. The area under the receiver operating characteristic curve for predicting MMSE score ≥ 20, ≥ 22 and ≥ 24 was 0.92, 0.90 and 0.91, respectively. High-sensitivity cutoffs, defined as scores that maximised specificity while maintaining sensitivity ≥ 80%, were HDS-R score ≥ 16, ≥ 17 and ≥ 18. Conversely, high-specificity cutoffs, defined as scores that maximised sensitivity while maintaining specificity ≥ 80%, were HDS-R score ≥ 19, ≥ 20 and ≥ 21, respectively. Subdomain analysis of MMSE and HDS-R showed Aβ-positive patients had lower scores in delayed recall and higher scores in calculation than Aβ-negative patients (all p < 0.01). In HDS-R subdomains, visual memory scores were also lower in Aβ-positive patients than in Aβ-negative patients (p < 0.01).

Conclusions: The identified HDS-R cutoff scores were associated with MMSE-defined cognitive thresholds and may serve as a potential reference for identifying patients who could be eligible for anti-Aβ therapies. The cognitive profile observed in Aβ-positive patients was characterised by deficits in delayed recall and in visual memory and by relatively preserved calculation ability, suggesting a selective vulnerability pattern in early Alzheimer's disease.

Background: Social participation in work-related activities can improve the mental well-being of individuals with dementia or mild cognitive impairment (MCI). However, research on the effects of work-related activities on the mental well-being of individuals with dementia or MCI is limited. This study aimed to investigate the influence of participation in work-related activities on mental well-being and the associated factors in individuals with dementia or MCI.

Methods: This was a multicentre cross-sectional study. We administered questionnaires and measurements to participants who were users of a day care service and had dementia or MCI. We used the World Health Organization-Five Well-Being Index (WHO-5) as the main outcome and its confounders. These data were compared between the work-related activity and usual care groups, and multiple regression analysis was performed with WHO-5 as the dependent variable and the presence or absence of participation in work-related activities and WHO-5 covariates as independent variables.

Results: A total of 128 participants were compared between the two groups. The work-related activity group exhibited better mental well-being (p < 0.001) than the usual care group. The same results were obtained after adjusting for the participants' backgrounds using propensity score matching. Multiple regression analysis identified participation in work-related activities (p < 0.001) and physical pain (p < 0.05) as factors that potentially influence mental well-being.

Conclusions: Participation in work-related activities positively influenced the mental well-being of individuals with dementia or MCI. Longitudinal studies are needed to investigate the effects of work-related activities on the mental well-being of individuals with dementia or MCI.

Background: Social restrictions during the novel coronavirus 2019 disease (COVID-19) pandemic negatively impacted the mental health of older adults. This study aimed to examine the associations of loneliness and depression with sociodemographic characteristics and internet use among older adults during the COVID-19 pandemic.

Methods: This cross-sectional study included 330 geriatric patients between September 1, 2021, and June 1, 2022. Data were collected through face-to-face interviews using a questionnaire consisting of a personal information form, the Loneliness Scale for Elderly, and the Geriatric Depression Scale Short Form-15 (GDS-15).

Results: The participants had a mean age of 71.3 years, 60.3% were female, and regarding internet use, 52.4% reported never using it, 18.8% used it occasionally, and 28.8% used it daily. The most common internet activities were video calls with relatives/friends (39.4%) and sharing messages, photos, or videos via messaging apps (38.2%). In the multivariate linear regression analysis, being married, having low income, living alone, having fewer than five friends, and not using the internet at all were significantly associated with higher levels of loneliness, while higher depression scores were observed among females compared to males and among individuals with low income compared to those with middle or high income.

Conclusions: The findings suggest that internet use may have a protective role against loneliness in older adults; however, its effect on reducing depression appears to be limited.

To critically appraise, compare and summarise the measurement properties of existing instruments that assess dementia fear among older adults (≥ 60 years). Structured searches in six English electronic databases and two Chinese databases. Additionally, ProQuest Dissertations and Theses, DART Europe, and Google Scholar were searched from their inception to August 2024. Two researchers independently identified eligible studies. They assessed the methodological quality of the studies (rated 'very good', 'adequate', 'doubtful' and 'inadequate') and quality of measurement properties (rated 'sufficient', 'insufficient' or 'indeterminate') using the COSMIN guidelines. Among the 4104 studies identified, eight studies reported on the psychometric properties of five identified patient-reported outcome measures. The methodological quality of content validity for relevance, comprehensiveness, and comprehensibility of all instruments in this review was doubtful or inadequate. The methodological quality of structural validity in the majority of the studies was adequate, whereas the quality of hypothesis testing for construct validity was doubtful. The internal consistency was assessed by calculating Cronbach's alpha coefficient in all studies. The measurement properties that were not conducted were measurement invariance, measurement error and responsiveness. This study suggests that existing research and evidence supporting the selection of dementia fear instruments suitable for older adults are insufficient. All included instruments have the potential to be recommended, whereas none of the identified dementia fear instruments for older adults appears to be generally superior to the others. Therefore, further research is needed to validate the measurement properties of existing dementia fear instruments for older adults, with a particular focus on content validity as guided by COSMIN.