International Journal of Geriatric Psychiatry最新文献

{"title":"Does Frailty Predict Cognitive and Functional Deficits After Nine Years?","authors":"Beatriz Raz Franco de Santana,&nbsp;Daniela de Assumpção,&nbsp;Flávia Silva Arbex Borim,&nbsp;Ivan Aprahamian,&nbsp;Ligiana Pires Corona,&nbsp;Samila Sathler Tavares Batistoni,&nbsp;Deusivania Vieira da Silva Falcão,&nbsp;Meire Cachioni,&nbsp;Ruth Caldeira de Melo,&nbsp;Anita Liberalesso Neri,&nbsp;Monica Sanches Yassuda","doi":"10.1002/gps.70104","DOIUrl":"https://doi.org/10.1002/gps.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To identify the variables at baseline, including physical frailty, that might predict cognitive and functional deficits in a 9-year follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This investigation included participants from the FIBRA study in Campinas city and Ermelino Matarazzo, subdistrict of São Paulo city, with complete data collected at baseline and follow-up for the variables sex, age, education, frailty phenotype, number of chronic diseases, and tobacco and alcohol use. Of the initial 1284 participants at baseline, 98 that exhibited cognitive impairment were excluded. At follow-up, 451 participants were located and reinterviewed and 85 scored below the cut-off on the Mini-Mental State Exam (MMSE), of which 45 also presented functional deficit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The follow-up subsample comprised predominantly participants that were female (68.1%), aged 65–74 years (71.6%), and had low education (0–4 years of education, 75.6%). At baseline, 35.5% were non-frail, 57.0% pre-frail and 7.5% frail, whereas at follow-up, 29.4% were non-frail, 62.3% pre-frail and 8.3% frail. Logistic regression showed that age and education but not frailty at baseline were associated with cognitive and functional deficits at follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher age and lower education at baseline were predictors of cognitive and functional deficits after 9 years, whereas frailty was not. Further longitudinal studies should be conducted to elucidate the factors predicting cognitive and functional decline in low-and middle-income countries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating Treatment-Resistant Depression With and Without Parkinsonism in the Elderly From a Psychiatric Perspective by 99mTc-TRODAT-1 SPECT Imaging","authors":"Tung-Ping Su,&nbsp;Chiu-Jung Huang,&nbsp;Wei-Chung Mao,&nbsp;Yu-Hsien Chiu,&nbsp;Ren-Shyan Liu,&nbsp;Li-Fen Chen","doi":"10.1002/gps.70102","DOIUrl":"https://doi.org/10.1002/gps.70102","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Late-life depression often overlaps with neurodegenerative diseases leading to diagnostic and treatment challenges for neuropsychiatrists. This study aimed to differentiate elderly treatment-resistant depression (TRD) comorbid with parkinsonism from elderly TRD without Parkinsonism as well as elderly healthy controls using striatum dopamine transporter (DAT) imaging by &lt;sup&gt;99m&lt;/sup&gt;Tc TRODAT-1 SPECT.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Three groups were enrolled, including patients with TRD, patients with TRD comorbid with parkinsonism, and healthy controls. To obtain the DAT availability, the specific uptake ratios of the bilateral striatum were evaluated. Linear regression analyses were performed to evaluate the relationship between age and DAT level in the subregions of the striatum. Machine learning was applied to categorize the three groups with 10-fold cross-validation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study enrolled 32 patients with TRD (&lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mrow&gt;\u0000 &lt;mn&gt;66.15&lt;/mn&gt;\u0000 &lt;mo&gt;±&lt;/mo&gt;\u0000 &lt;mn&gt;6.82&lt;/mn&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;annotation&gt; $66.15pm 6.82$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt;), 36 TRD patients with parkinsonism (&lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mrow&gt;\u0000 &lt;mn&gt;70.27&lt;/mn&gt;\u0000 &lt;mo&gt;±&lt;/mo&gt;\u0000 &lt;mn&gt;5.63&lt;/mn&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;annotation&gt; $70.27pm 5.63$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt;), and 74 healthy elderly (&lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mrow&gt;\u0000 &lt;mn&gt;66.95&lt;/mn&gt;\u0000 &lt;mo&gt;±&lt;/mo&gt;\u0000 &lt;mn&gt;10.59&lt;/mn&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;annotation&gt; $66.95pm 10.59$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt;). A normative DAT concentration by age was established, providing a reference for clinical use. DAT levels differed among groups (all pairwise &lt;i&gt;p&lt;/i&gt; &lt; 0.01), with healthy controls exhibiting the highest levels, followed by patients with TRD, and then TRD patients with parkinsonism. Further, the Fine k-NN classifier emerged as the top performer to achieve 85.7% accuracy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Besides clinical assessment, dopaminergic as","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Caregiver Burden With Insomnia and Malnutrition in Caregivers of Older Hospitalized Patients","authors":"Nisa Ozen Aydin,&nbsp;Irem Tanriverdi,&nbsp;Ozge Pasin,&nbsp;Betul Sumbul Sekerci,&nbsp;Lee Smith,&nbsp;André Hajek,&nbsp;Pinar Soysal","doi":"10.1002/gps.70106","DOIUrl":"https://doi.org/10.1002/gps.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to investigate among caregivers of older hospitalized patients, the relationship between caregiver burden, caregivers' nutrition, and the two most common sleep disorders—excessive daytime sleepiness and insomnia—as well as the interplay between these factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The study universe consisted of informal caregivers of older inpatients at an university hospital in Turkiye. The sample included 100 caregivers selected through purposive sampling between March 2024-/January 2025. Data were collected on personal information, caregiver burden (assessed using the Multidimensional Caregiver Burden Inventory [MCBI]), nutritional status (evaluated using the Mini Nutritional Assessment Test [MNA] and the Healthy Eating Attitude Scale), sleep status (assessed using the Epworth Sleepiness Scale and the Insomnia Severity Index [ISI]), and muscle strength (measured by a handgrip dynamometer).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>A total of 100 caregivers (79% female, with a mean age of 50.5 years). Females comprised 61% of the patient population, and the mean age was 78.5 years. A significant positive correlation was found between the MCBI score and caregiving duration, ISI score, and patient age (<i>p</i> &lt; 0.005). In contrast, the MCBI score showed a significant negative correlation with the MNA score and muscle strength (<i>p</i> ≤ 0.005). The adjusted linear regression analysis revealed that the MNA score had a significant negative effect on MCBI, while the ISI score had a significant positive effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the present study caregiver burden was associated with poor nutrition and sleep disturbances. Thus, reducing caregiver burden may improve insomnia and malnutrition. Moreover, addressing sleep and nutrition problems in caregivers suffering from insomnia or malnutrition may contribute to a reduction in overall caregiver burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the Emergency Department Visits Among the Older Adults With Dementia Before, and After the Nationwide Social Distancing Measures: An Interrupted Time Series Analysis","authors":"Jeongmin Moon,&nbsp;Kyung-Shin Lee,&nbsp;Ho Kyung Sung,&nbsp;Seonji Kim","doi":"10.1002/gps.70100","DOIUrl":"https://doi.org/10.1002/gps.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions in social interactions and raising concerns about unforeseen impacts on vulnerable populations, particularly older individuals with dementia. This study examines the impact of extended social isolation on dementia patients receiving emergency care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide study of emergency department (ED) visits among dementia patients aged 65+ during various phases of pandemic-related social distancing. Segmented quasi-Poisson regression models were used to determine changes in ED visits during and after social distancing compared to pre-social distancing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2017 to 2022, there were 203,772 ED visits by patients with dementia among older patients. The proportion of ED visits by patients with dementia decreased from 17% pre-pandemic to 15% during social isolation. Interrupted time series analysis revealed a decline in ED visits during social distancing (step change: 0.849, 95% confidence interval [CI] 0.804–0.897; slope change: 1.000, 95% CI 0.996–1.003) followed by a rebound after restrictions were lifted (step change: 1.076, 95% CI 1.024–1.131; slope change: 1.009, 95% CI 0.994–1.025). However, monthly admission and mortality rates increased during social distancing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study observed a decline in ED visits by patients with dementia among older patients during social distancing, followed by a rebound after restrictions were lifted. However, the social distancing period was associated with increased hospitalization and mortality. These findings underscore the importance of maintaining healthcare accessibility for vulnerable older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualising the Role of Dementia Champions Across Health and Social Care: A Qualitative Study Informed by Theory of Change (The DemChamp Study)","authors":"Tiffeny James,&nbsp;Monica Leverton,&nbsp;Kritika Samsi,&nbsp;Christina Newton","doi":"10.1002/gps.70101","DOIUrl":"https://doi.org/10.1002/gps.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>People who work in health and social care frequently come into contact with people living with dementia, highlighting the need for a dementia aware and competent workforce. Some health and care services have implemented ‘Dementia Champions’ (DCs) to address this, but the role is rarely seen in domiciliary homecare services. We aim to conceptualise the DC role across health and social care to learn how it is implemented in practice and consider how it can be applied to homecare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted 30 semi-structured interviews with health and social care workers who either work as DCs or have experience/knowledge of working with them. We used framework analysis to analyse the data, informed by a Theory of Change (ToC) approach which involved identifying the ‘inputs’ involved in the role (tasks and responsibilities); and the short, medium, and long-term mechanisms required to implement, embed, and maintain the role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified key tasks and responsibilities of a DC which varied between and within sectors and services. The was a lack of role clarity and rarely a role description, which was considered a barrier to the role's success. The DC role is typically voluntary with no remuneration and performed on top of existing roles with no protected time for specific DC tasks. DCs typically take on the role due to a passion for good dementia care and a desire to make a difference, meaning feedback and feeling valued were important. The DC role provides an opportunity for career development, which was considered essential to retaining DCs, and health and social care workers generally. We present these findings as five themes which map onto our ToC framework to explore how the DC role is implemented, embedded, and maintained in practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Across all services, there is need for role clarity, with a DC role description at the outset to set out the tasks, responsibilities, and boundaries of the role. The DC role needs protected time for workers to implement it and undertake training. We will use these findings to develop and refine our ToC framework to reflect its applicability for the homecare sector.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and Sensitivity to Change of a Self-Report Quality of Life Measure in Patients With Korsakoff's Syndrome","authors":"Yvonne C. M. Rensen,&nbsp;Corrie de Waal - Gordijn,&nbsp;Roy P. C. Kessels","doi":"10.1002/gps.70103","DOIUrl":"https://doi.org/10.1002/gps.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Assessing (self-reported) quality of life (QoL) in patients with Korsakoff's syndrome (KS) is important to gain insight into these patients' well-being and to optimize their care in long-term care facilities. In this study, we describe the development of the QUALIKO-Self Report (QUALIKO-SR), an instrument for objectifying self-reported QoL in patients with KS. Next, we compared the QUALIKO-SR scores with the scores on the QUALIKO-Proxy Version (QUALIKO-PV) and examined changes in QoL over time. Finally, we assessed the convergent validity and investigated whether QUALIKO-SR scores were related to the severity of the cognitive impairments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study took place in specialized long-term care facilities providing care for patients with KS. 116 patients with alcoholic KS participated in this study. The QUALIKO-SR was developed and validated against the QUALIKO-PV, the Manchester Short Assessment of Quality of Life (MANSA-16), and the Montreal Cognitive Assessment 8.1 (MoCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences were found between self- and proxy reported QoL on the subscales Negative Affect, Social Isolation, and Feeling at Home. No significant differences were found on the other subscales. QUALIKO-SR scores did not significantly vary over time. However, caregivers reported significant improvements in Care Relationships, Autonomy, Restless Tense Behavior, Social Isolation, and Feeling at Home over time. A significant, positive association was found between the QUALIKO-SR and the MANSA-16. No significant correlations were found between the QUALIKO-SR and the MoCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study describes the development and validation of a self-report instrument for objectifying QoL in patients with KS living in 24-h care facilities, the QUALIKO-SR. Measuring QoL in patients with severe cognitive impairments, such as patients with KS, is complex and we advise to include both self-report and proxy-report measures in future studies as well as in clinical practice. The availability of the QUALIKO-SR and QUALIKO-PV encourages researchers and clinicians to do so in patients with KS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clozapine Treatment in Patients With a Neurocognitive Disorder","authors":"A. Triest,&nbsp;Rob M. Kok","doi":"10.1002/gps.70099","DOIUrl":"https://doi.org/10.1002/gps.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi² = 14.47, df = 2, <i>p</i> &lt; 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Dementia in European, Chinese and Indian/Fijian-Indian Populations in Aotearoa New Zealand: A Protocol","authors":"Sarah Cullum,&nbsp;Xiaojing Wu,&nbsp;Claudia Rivera-Rodriguez,&nbsp;Rita Krishnamurthi,&nbsp;Jackie Broadbent,&nbsp;Susan Yates,&nbsp;Adrian Martinez-Ruiz,&nbsp;Lynette Tippett,&nbsp;Nick Garrett,&nbsp;Oliver Menzies,&nbsp;Braden Te Ao,&nbsp;Joanna Hikaka,&nbsp;Fuafiva Fa'alau,&nbsp;Etuini Ma'u,&nbsp;Emme Chacko,&nbsp;Amy Chan,&nbsp;Makarena Dudley,&nbsp;Richard Faull,&nbsp;Mathew Croucher,&nbsp;Ngaire Kerse,&nbsp;Gary Cheung","doi":"10.1002/gps.70089","DOIUrl":"https://doi.org/10.1002/gps.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Aotearoa New Zealand (NZ) is a bicultural nation (Māori and European) with a growing population of Asian and Pacific peoples. Recent analysis of national routinely collected data suggests dementia prevalence is higher in Māori and Pacific peoples when compared with European and Asian, and that inequities in dementia care for Māori, Asian, and Pacific people with dementia exist. A population-based dementia prevalence study is needed to confirm these findings. The aim of this protocol is to describe a dementia prevalence study focussing on the European, Chinese and Indian populations in NZ. The findings will be compared to a separate study on Māori populations using a similar study design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a cross-sectional screen-interview survey of people aged ≥ 65 from European, Chinese and Indian/Fijian-Indian backgrounds in sampled meshblocks within two regions of NZ. Stage 1 involves screening eligible participants at the door using the brief cognitive scale of the Community Screening Instrument for Dementia (CSI-D). Stage 2 involves interviewing random samples of screen positive and negative participants using the 10/66 dementia protocol. With a margin of error of approximately 3%, and a confidence level of 5%, a total of 485 European, 410 Chinese and 425 Indian/Fijian-Indian people will be interviewed with the 10/66 protocol. Age-standardised prevalence estimates of 10/66 dementia will be back-weighted for study design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study will provide evidence for suspected ethnic inequalities in dementia, inform new culturally appropriate dementia management strategies, and contribute to improved outcomes for people with dementia in NZ.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Disease-Modifying Therapies Challenge Dementia Care Continuity in Japan: From Promise to Paradox","authors":"Kae Ito,&nbsp;Akira Hatakeyama,&nbsp;Tsuyoshi Okamura","doi":"10.1002/gps.70098","DOIUrl":"https://doi.org/10.1002/gps.70098","url":null,"abstract":"&lt;p&gt;Management of Alzheimer's disease has entered a new phase with the advent of disease-modifying therapies (DMTs). Anti-amyloid beta antibodies used in DMTs—such as aducanumab, lecanemab, and donanemab—differ from earlier medications in that they slow cognitive decline by reducing amyloid plaque accumulation in the brain [&lt;span&gt;1&lt;/span&gt;]. As Belder noted, the introduction of DMTs is expected to increase the demand for clinical services, necessitating systems that ensure timely and equitable access to these therapies [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite the demonstrated efficacy of DMTs, there are concerns remain regarding their cost-effectiveness. Their adoption has been limited in the United States, and they have not yet been approved in the European Union. In contrast, the Japanese government has taken a proactive stance toward promoting the use of DMTs. Japan's universal health insurance system allows patients to access treatment with minimal out-of-pocket costs if they meet specified criteria [&lt;span&gt;3&lt;/span&gt;]. However, implementing DMTs within this system requires careful planning to avoid disruptions and ensure equitable delivery.&lt;/p&gt;&lt;p&gt;Our institution was tasked with advising the Tokyo Metropolitan Government to establish a delivery system for DMTs. We initially anticipated that expanding therapeutic options would lead to earlier diagnoses, thereby increasing the number of patients requiring post-diagnostic support. However, we have encountered an unintended consequence: the implementation of DMTs is, in some cases, impeding the provision of post-diagnostic support. We share this experience with the global scientific community.&lt;/p&gt;&lt;p&gt;The philosophy underlying Tokyo's DMT delivery system is based on the following principles [&lt;span&gt;4&lt;/span&gt;]: diagnosis and treatment require confirmation of amyloid pathology and the capacity to monitor and manage amyloid-related imaging abnormalities (ARIA) throughout an 18-month treatment course. Therefore, only hospitals equipped with PET and MRI scanners and staffed by certified neurologists were designated as DMT-initiating hospitals. When primary care physicians (typically based in clinics) suspect that a patient is eligible for DMT, they refer the patient to an initiating hospital. In Tokyo, medical centers for dementia (MCDs), government-certified hubs for dementia care, serves as either DMT-initiating hospitals or as collaborating hospitals that support DMT-initiating institutions.&lt;/p&gt;&lt;p&gt;With the increasing number of patients starting DMTs, hospitals have exceeded their capacity. Consequently, patients are transferred after 6 months to less-equipped “DMT-continuing clinics,” usually smaller institutions or clinics. These continuing clinics take over day-to-day care while DMT-initiating hospitals remain responsible for periodic MRIs, cognitive assessments, and managing serious side effects, such as ARIA. Thus, a two-tiered system (Figure 1) was established to balance the need for specialized care with unive","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors of Postoperative Delirium in Elderly Patients Following Hip Fracture Surgery: A Nationwide Retrospective Cohort Study in Taiwan","authors":"Chien-An Shih,&nbsp;Deng-Chi Yang,&nbsp;Wei-Ming Wang,&nbsp;Yi-Lin Wu,&nbsp;Yi-Ching Yang,&nbsp;Han-Chang Ku","doi":"10.1002/gps.70094","DOIUrl":"https://doi.org/10.1002/gps.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended hospital stays, increased mortality risk, and higher nursing costs. In postoperative hip fracture patients, delirium results in a higher complication rate, poorer functional recovery, increased readmission rates, repeat surgeries, and elevated mortality. Despite these serious consequences, the literature provides limited information on the incidence of postoperative delirium following hip fracture surgeries in Asians. Additionally, there is a lack of long-term, comprehensive nationwide population-based studies, highlighting an important area for future research. This study aims to understand the incidence and risk factors of postoperative delirium in hip fracture patients using representative population data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort consisted of 118,682 patients aged 65 years or older who were diagnosed with hip fractures. The delirium incidence was observed per 1000 person-years. The Cox proportional hazards model was used to investigate the incidence of delirium among hip fracture patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of the first episode of delirium after hip surgery in the elderly was 1.87 events per 1000 PYs. Factors associated with delirium included being female (adjusted hazard ratio [aHR]: 0.59; 95% confidence interval [CI]: 0.53–0.64), age ≥ 95 years (aHR: 3.52; 95% CI: 2.74–4.51), comorbid dementia (aHR: 2.63; 95% CI: 2.38–2.92), and ICU stay 2–3 days (aHR: 2.85; 95% CI: 1.28–6.37). The occurrence of delirium was significantly associated with an ICU stay of ≥ 4 days, dementia, as well as 30-day, 90-day, and 1-year mortality (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the relatively low incidence of postoperative delirium in elderly hip fracture patients in Taiwan. Key risk factors identified include advanced age, female gender, comorbid dementia, and prolonged ICU stays. These findings underscore the need for targeted prevention and early intervention strategies to improve patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}