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

Objectives: This study aimed to disentangle the pathways linking mHealth apps usage and well-being through the serial mediation effects of illness perception and anxiety in Chinese older patients with Multiple Chronic Conditions (MCCs).

Methods: Illness perception and anxiety were measured using the Brief Illness Perception Questionnaire (BIPQ) and anxiety subscale (HADS-A), respectively. Well-being was assessed using the Well-Being Index (IWB). Serial mediation analysis was conducted using the PROCESS macro in SPSS (version 3.3).

Results: Of the 575 patients, 80.0% experienced low or moderate levels of well-being. There was a significant direct effect of mHealth apps usage on well-being, with an effect size of 0.211 (95% CI [0.044,0.379]). Three indirect pathways between mHealth apps usage and well-being were identified: illness perception (effect size = 0.029, 95% CI [0.001,0.063]); and anxiety (effect size = 0.125, 95% CI [0.071,0.185]) was two significant mediators on the association between mHealth apps usage and well-being; moreover, there was a serial mediation of illness perception and anxiety (effect value = 0.013, 95% CI [0.004,0.027]) on the association between mHealth apps usage and well-being.

Conclusions: The findings suggest that mHealth apps usage may promote well-being among older patients with MCCs by positively altering illness perception and reducing anxiety. These findings underscore the potential of mHealth apps as an intervention strategy to enhance psychological well-being in the older population with MCCs within the community.

Objective: To develop and validate the Testamentary Capacity Assessment Screening Tool (TCAST) for older adults, addressing the absence of standardised instruments for testamentary capacity (TC) assessment in Japan.

Methods: The TCAST was developed through an iterative process including literature review, interdisciplinary expert consultation, and user testing with older adults. It comprises three subtests: (1) Hypothetical will-making Scenario, (2) Basic financial concepts, and (3) Legal vocabulary. Internal consistency, test-retest reliability, and construct validity were examined using Cronbach's α, intraclass correlation coefficients (ICC), and correlations with the Hasegawa Dementia Scale-Revised (HDS-R), the Executive Interview (EXIT25), and the Geriatric Depression Scale (GDS-15). Group comparisons and receiver operating characteristic (ROC) analyses were conducted to evaluate discriminatory performance.

Results: A total of 118 participants-68 cognitively healthy older adults and 50 with dementia-completed the TCAST. Internal consistency was good for Parts 1 and 2 (α = 0.88, 0.70) and lower for Part 3 (α = 0.58). Test-retest reliability was excellent for Parts 1 and 2 (ICC = 0.87, 0.89) and moderate for Part 3 (ICC = 0.58). Construct validity was supported by moderate to strong correlations with HDS-R and EXIT25, but not with GDS-15. All subtests correlated negatively with age and positively with education, and significantly differentiated healthy and dementia groups (p < 0.001). ROC analyses showed strong discriminatory capacity (AUC = 0.86, 0.97, and 0.79 for Parts 1-3).

Conclusions: The TCAST is a reliable and valid screening tool for assessing TC in older Japanese adults. It is not designed to categorically determine incapacity, but to highlight domains relevant to testamentary reasoning and support person-centered evaluations. The tool may aid clinicians and legal professionals in identifying both retained abilities and areas needing support, underscoring its potential utility in interdisciplinary approaches to capacity assessment in aging societies.

Background: Timely diagnosis and initiation of care are essential for improving the quality of life of people with dementia and their families. In Japan, advocacy groups have drawn attention to the 'blank period', a phase of isolation before and after diagnosis, yet few quantitative studies have examined its determinants. This study explored factors associated with delayed diagnosis and delayed care access using the blank period framework.

Methods: This exploratory, cross-sectional study surveyed family caregivers of outpatients with dementia recruited from 78 hospitals and 27 dementia support physicians in Japan. The blank period was divided into two phases: Blank Period I (BP1, from dementia awareness to diagnosis) and Blank Period II (BP2, from diagnosis to initiation of long-term care insurance services). Participants whose BP duration exceeded the 75th percentile were categorised as having delayed diagnosis or delayed care access. Logistic regression analyses followed the purposeful variable selection strategy proposed by Bursac et al. and Zhang.

Results: A total of 216 questionnaires were analysed. The mean durations of BP1 and BP2 were 13.5 and 16.9 months, respectively. Delayed diagnosis was associated with female caregiver (OR = 4.51, 95% CI 1.72-11.92, p = 0.002) and patient hesitation to see a doctor (OR = 4.52, 95% CI 2.07-9.87, p < 0.001). Delayed care access (BP2) was significantly associated with patient under 65 at the time of diagnosis (OR 7.44, 95% CI 1.93-28.66, p = 0.004) and living together (OR 3.78, 95% CI 0.85-16.91, p = 0.082).

Conclusions: This study identified that social factors, cultural factors and pathological factors associated with delays in diagnosis and care among people with dementia in Japan.

Introduction: This study aimed to longitudinally examine the association between social participation and disability onset among older adults with varying incomes.

Methods: We conducted an observational prospective population-based cohort study involving 4494 older adults (55.9% female, mean age 73.8 ± 5.4 years) enrolled in the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes (NCGG-SGS). Income was assessed using household income, and social participation was evaluated through seven items.

Results: During a 2-year follow-up, 235 participants (5.2%) were newly certified with a disability. In analyses that considered both income level and the number of social participation items, the low-income and high-social participation group had a lower risk than the low-income and low-social participation group (HR = 0.68, 95% CI = 0.49-0.94). Importantly, the types of activities associated with reduced risk differed by income group: in the high-income group, 'Visit friends' (HR = 0.54, 95% CI = 0.33-0.89) and 'Shopping' (HR = 0.27, 95% CI = 0.11-0.68) and in the low-income group, 'Visit friends' (HR = 0.59, 95% CI = 0.40-0.88), 'Exercise circle' (HR = 0.49, 95% CI = 0.33-0.72) and 'Advice' (HR = 0.40, 95% CI = 0.26-0.64) were relevant.

Conclusion: These findings indicate that maintaining social participation, particularly through familiar and accessible activities, may contribute to a lower risk of disability among older adults, even among those with limited income.

Background: Observational investigations have reported correlations between brain imaging-derived phenotypes (IDPs) and dementia, as well as dysfunctions in brain resting-state functional networks in dementia patients. However, the causal nature of these relationships remains largely unknown.

Methods: Herein we applied bidirectional two-sample Mendelian randomisation analysis to infer the causal relationships between 587 IDPs (N = 33 224) and 191 brain resting-state functional networks (n = 34 691) with dementia and its sub-types (AD, PDD, FTD and DLB; n = 3024-216 771) using genetic variants-single nucleotide polymorphism (SNPs) as instrumental variables.

Results: The forward MR identified 14 IDP phenotypes that are causally related to the risk of dementia, including frontotemporal dementia (FTD) and Lewy body dementia (DLB). For example, a decrease in the thickness of the right rostral middle frontal cortex was strongly associated with an increased risk of dementia. The reverse MR analysis revealed significant associations between 153 IDP phenotypes and the risk of FTD and DLB and between 73 rs-fMRI phenotypes and the risk of dementia and AD. For instance, a higher risk of DLB was associated with a decrease in FA in the right posterior thalamic radiation. Additionally, the risk of Alzheimer's disease dementia is causally associated with reduced connectivity in the default mode and salience networks.

Conclusions: We identified 14 IDPs causally associated with dementia or its subtypes. We also identified potential causal effects of FTD and DLB on 153 IDPs and dementia and AD on 73 rs-fMRI phenotypes. Our findings provide insights into the aetiology of dementia and highlight structural brain changes and functional network impairments throughout the disease process. Furthermore, these results contribute to the identification of potential imaging-based predictors and therapeutic targets for dementia.

The growing prevalence of cognitive impairments and dementia in older people has prompted research into new approaches to enhance their quality of life. Virtual reality-reminiscence intervention (VR-RI) is one recent non-pharmacological intervention that has shown efficacy in promoting mental health in patients with dementia or cognitive impairment. The review aims to synthesise the research findings of the feasibility and acceptability of VR-RI in individuals with dementia or cognitive impairment. Whittemore and Knafl's five-step method was adopted as a framework to guide this review. PubMed, SCOPUS, MEDLINE, Web of Science, and PsycINFO were all extensively searched. The articles were critically evaluated, data were extracted, and eligibility criteria were reviewed. Eleven studies met the inclusion criteria for this integrative review. The synthesis of these studies revealed two general sections: (a) feasibility of VR-RI among older adults with dementia or cognitive impairment and (b) acceptability of VR-RI among older adults with dementia or cognitive impairment. The included studies generally reported that VR-RI's feasibility and acceptability for older adults with dementia or cognitive impairment are promising. However, the strength of evidence remains limited due to small sample sizes, heterogeneity in study designs and reminiscence approaches, and a lack of consideration of dementia type, content familiarity, and personalised VR content based on participants' past experiences.

Aim: No effective agents currently exist for treating loss of appetite and apathy in patients with dementia. This multicentre, randomised, comparative study aimed to evaluate the effect and safety of Ninjin'yoeito (NYT) for these symptoms in patients with Alzheimer's disease (AD) or dementia with Lewy Bodies (DLB).

Methods: A total of 16 sites, including clinics and hospitals, participated in this study. The primary outcome measure was the 12-week change in the loss of appetite score in the 'eating behaviour' subcategory of the Neuropsychiatric Inventory-12 (NPI-12). Secondary outcome measures included changes in food intake, the NPI-12 score, the Japanese Version of the Zarit Caregiver Burden Interview, Vitality Index, Mini-Mental State Examination, Frontal Assessment Battery, body weight, red blood cell count, haemoglobin, albumin, and Controlling Nutritional Status Score.

Results: Regarding the efficacy evaluation, 24 and 25 patients were assigned to the NYT and control groups, respectively. Regarding the primary outcome-the change in the loss of appetite score-no significant difference was observed between the two groups at 12 weeks after the start of administration. Among the secondary outcomes, food intake showed a significant increase in the NYT group compared to the control group at both 4 and 12 weeks. In the NYT group, significant decreases were recorded in the NPI-12 total score at 4 and 8 weeks; in depression at 12 weeks; in apathy at 4, 8, and 12 weeks; and in eating behaviour at 4, 8, and 12 weeks. However, these changes were not different from those in the control group. In a post hoc subgroup analysis of participants with a loss of appetite score of ≥ 6, significant decreases from baseline at 8 and 12 weeks were observed in the NYT group compared to the control group.

Conclusions: Although the primary endpoint did not reach statistical significance, likely due to insufficient sample size, the NYT group showed a significant improvement in food intake, a secondary outcome measure. Furthermore, exploratory post hoc subgroup analysis suggested that NYT may improve appetite in patients with more severe appetite loss at baseline. These findings indicate the potential role of NYT in appetite improvement in patients with AD or DLB, warranting further investigation.

Background: Quality of life (QOL) in elderly individuals with severe mental illness (SMI) is understudied, despite the growing size of this vulnerable population. While psychiatric symptomatology has been frequently examined, the role of treatment adherence and treatment characteristics in determining QOL remains unclear.

Aim: This study aimed to examine the association between QOL and treatment adherence, treatment characteristics and psychiatric symptomatology in the elderly with SMI living in the community.

Method: Sixty-eight community-dwelling patients aged 60 and over with schizophrenia spectrum disorder or bipolar disorder were recruited from a community mental health centre. QOL was assessed using the World Health Organization Quality of Life Scale Brief Form (WHOQOL-BREF), and treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). Psychiatric symptomatology and cognitive status of the patients were examined with standardised scales.

Results: Our results indicated that treatment adherence was positively correlated with QOL in the physical health (r = 0.245) and environment (r = 0.303) subdomains of QOL. The association between treatment adherence and environmental QOL was also significant in the multivariable regression models (β = 0.253). While depressive symptoms were consistently associated with poorer QOL across all domains, negative symptoms predicted QOL in physical health (β = -0.552) and environmental (β = -0.297), and positive symptoms with physical health domains (β = -0.345). Although antipsychotic dosage initially correlated with physical QOL (r = -0.360), this association lost significance in the multivariable model.

Conclusion: In the community-dwelling elderly individuals with SMI, treatment adherence and symptom burden, particularly depressive and negative symptoms, emerge as key correlates of QOL. These findings highlight the importance of addressing treatment adherence and symptom management through integrated community-based mental health services to improve the QOL of individuals with SMI.

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.