Journal of Geriatric Psychiatry and Neurology最新文献

{"title":"Safety Profile of Istradefylline in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials and Disproportionality Analysis Using FAERS.","authors":"Beema T Yoosuf, Suhani Jain, Muhammed Favas Kt, Dipika Bansal","doi":"10.1177/08919887251343608","DOIUrl":"https://doi.org/10.1177/08919887251343608","url":null,"abstract":"<p><p>BackgroundIstradefylline, a selective adenosine A2A receptor antagonist, is used as an adjunct therapy to levodopa to improve motor symptoms in Parkinson's disease (PD) patients, particularly those experiencing wearing-off phenomena. This study integrates safety data on istradefylline for the treatment of PD from randomized controlled trials (RCTs) and the FDA Adverse Event Reporting System (FAERS).MethodsWe performed a systematic search of PubMed, EMBASE, Ovid, MEDLINE, and ClinicalTrials.gov for RCTs on istradefylline safety in PD patients up to September 2024. A random-effects meta-analysis estimated the Peto odds ratio (OR) with 95% confidence intervals (CIs). FAERS data were analyzed through disproportionality measures, including the proportional reporting ratio (PRR) and reporting odds ratio (ROR), with signal refinement to primary suspect cases.ResultsThe safety meta-analysis, encompassing data from 8 RCTs, reveals a significant association between istradefylline treatment and an increased risk of dyskinesia (odds ratio [OR] 1.77, 95% CI 1.32-2.36; <i>P</i> = 0.01), hallucinations (OR 2.08, 95% CI 1.11-3.90; <i>P</i> = 0.02), and nausea, when compared with placebo. In the FAERS database, 2597 patients were identified with adverse events (AEs) linked to istradefylline. Disproportionality analysis of istradefylline revealed 39 AEs strongly associated with its use, all of which were substantiated through signal refinement. The most commonly reported AEs were primarily associated with nervous system and psychiatric disorders.ConclusionThis study highlights distinct AE patterns for istradefylline in trials vs real-world data, underscoring the importance of post-marketing surveillance to detect underreported AEs and validate new safety signals effectively.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251343608"},"PeriodicalIF":2.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Better Assessment of Illness Study (BASIL) II for Delirium Severity: Study Design, Variables, and Methods.","authors":"Tammy T Hshieh, Benjamin A Chapin, Wingyun Mak, Guoquan Xu, Eva M Schmitt, Edward R Marcantonio, Hannah Shanes, Cole Heine, Jordan Helfand, Catherine Price, Kenneth S Boockvar, Eran D Metzger, Tamara G Fong, Richard N Jones, Sharon K Inouye","doi":"10.1177/08919887251343604","DOIUrl":"https://doi.org/10.1177/08919887251343604","url":null,"abstract":"<p><p>PurposeDelirium is a common yet preventable complication of hospitalization, surgery and illness that is associated with poor outcomes. Older adults with Alzheimer's Disease and Related Dementias (ADRD) are especially vulnerable to delirium and experience greater delirium severity, yet no existing assessment tool is specifically designed to evaluate this vulnerable population. This study will validate two new delirium severity instruments, the Delirium Severity (DEL-S) rating for all older adults and the Delirium Severity Rating in ADRD (DEL-S-AD) for patients with dementia.Design/Setting and ParticipantsThe Better ASsessment of ILlness II (BASIL II) study is an innovative prospective cohort study that measures cognitive function, delirium, delirium severity, demographics, clinical and functional variables and clinical outcomes. Participants include older adults from 3 unique yet complementary clinical sites: medical inpatients, elective surgery inpatients, or skilled nursing facility residents.MethodsPerformance of DEL-S and DEL-S-AD items in older adults with cognition ranging from no impairment to moderate impairment will be determined. Analyses will include psychometric characteristics of DEL-S and DEL-S-AD items, harmonization of the two scales and validation against reference standard diagnoses.Conclusions and ImplicationsResults from this study will help accurately measure delirium severity, a critically important, graded outcome. The DEL-S-AD instrument holds broad applications in persons with and without ADRD to monitor delirium severity in clinical settings, and as an outcome measure in future clinical treatment trials and pathophysiologic studies. Ultimately, the DEL-S and DEL-S-AD have the potential to improve health care for the vulnerable, growing population of older adults with cognitive impairment worldwide.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251343604"},"PeriodicalIF":2.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twelve Weeks of Resistance Training is Equally as Effective at Improving Cardiovascular Risk Factors in Older Women With and Without History of Depression: A Cross-Over Trial.","authors":"Paolo M Cunha, André O Werneck, Felipe B Schuch, Liye Zou, Jin Kuang, Edilaine Fungari Cavalcante, Luís Alves de Lima, Letícia Trindade Cyrino, Pâmela de Castro-E-Souza, Max D Oliveira, Décio S Barbosa, Danielle Venturini, Brendon Stubbs, Edilson S Cyrino","doi":"10.1177/08919887251343603","DOIUrl":"https://doi.org/10.1177/08919887251343603","url":null,"abstract":"<p><p>BackgroundWe aimed to evaluate the effects of 12 weeks of resistance training (RT) on cardiovascular disease (CVD) risk factors in older women with and without history of depression.MethodsWe included 79 older women, 52 without depression and 27 with a history of depression. 79 participants formed the waitlist control group and were instructed to maintain their habitual routine. The participants were reevaluated and attended 12 weeks of RT. The Beck Anxiety Inventory (BAI) and Patient Health Questionnaire-9 (PHQ-9). The serum levels of high-sensitivity C-reactive protein (CRP), glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density cholesterol (LDL-c), and triglycerides (TG) were used as cardiovascular risk factors. The Linear Mixed Model (LMM) was used to compare between groups.ResultsThe average age of the sample was 69.3 ± 5.7 and the body mass index was 28.5 ± 4.5. The 12 weeks of RT resulted in a reduction in BAI (-3.9 [-7.1; -0.6], <i>P</i> < 0.05) and PHQ-9 scores (-1.4 [-3.2; -0.5] <i>P</i> < 0.05) in the Training group with depressive disorders. In the training group with depressive disorders, it was observed an improvement in TG (-17.1 [-43.0; -8.8]), TC (-18.6 [-35.9; -1.3]), LDL-c (-10.3 [-26.8; -6.2]), and CRP (-0.4 [-1.3; -0.5]). Similar results were found for TG, TC, and LDL-c in the Training group without depressive symptoms. No difference between RT groups was observed.ConclusionOur results suggest that RT is effective in improving CVD risk factors, anxiety, and depressive symptoms in older women with history of depression.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251343603"},"PeriodicalIF":2.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Descriptive Statistical Analysis of Neuropsychiatric Symptom Pair Prevalence.","authors":"Timofey L Galankin, Jina Swartz, Hans J Moebius, Anton Y Bespalov","doi":"10.1177/08919887251341574","DOIUrl":"https://doi.org/10.1177/08919887251341574","url":null,"abstract":"<p><p>Neuropsychiatric symptoms (NPS) are very common and associated with high levels of distress, both in dementia patients and their caregivers. Especially at more advanced dementia disease stages, NPS rarely occur in isolation and the presence of two or more NPS may affect disease severity as well as the response to therapy. There is limited quantitative information on prevalence of specific symptom combinations in the general population, as well as in the populations recruited for symptom-specific investigations. We performed cross-sectional analyses of data from two longitudinal studies (Aging, Demographics, and Memory Study (ADAMS) and the National Alzheimer's Coordinating Center data (NACC)). In both studies and all Mini Mental State Examination (MMSE) strata, we observed every possible pair combination, from commonly recognized and discussed associations (e.g., hallucinations and delusions) to what might be seen as rather counter-intuitive patterns (e.g., apathy and agitation). In conclusion, prevalence of symptom pairs cannot be readily predicted based on prevalence of individual symptoms. Further, the presence of cognitive deficit and degree of cognitive impairment is associated with increased prevalence of all symptoms and symptom pairs, albeit to different degrees. The present study illustrates that, while there is the possibility of any combination of neuropsychiatric symptoms presenting during the course of dementia, their co-occurrence cannot be readily predicted based on the prevalence of individual symptoms. Thus, our study results serve as a source of reference information to inform the design and recruitment strategies for future clinical studies and epidemiological research on neuropsychiatric symptoms in people with dementia.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251341574"},"PeriodicalIF":2.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Suicidal Ideation and Anhedonic Symptoms in Obstructive Sleep Apnea Patients with Insomnia.","authors":"Hayun Choi, Gia Han Le, Kayla M Teopiz, Rodrigo B Mansur, Joshua D Rosenblat, Sabrina Wong, Seonjeong Byun, Roger S McIntyre","doi":"10.1177/08919887251338262","DOIUrl":"https://doi.org/10.1177/08919887251338262","url":null,"abstract":"<p><p>ObjectiveInsomnia and obstructive sleep apnea (OSA) are prevalent in the geriatric population, with co-morbid insomnia and sleep apnea (COMISA) increasing the risk of suicidal ideation. Anhedonia, a core depression feature, is associated with suicidal ideation. This study aimed to explore the relationship between COMISA and suicidality including the mediating effect of anhedonic symptoms.MethodsFrom August 2021 to December 2023, 243 participants from South Korea were enrolled in a prospective case-control study at a Veterans' hospital. Participants underwent interviews, self-report measures, and polysomnography. 214 untreated OSA participants were categorized into COMISA and OSA-only groups. Anhedonic symptoms and their correlates were investigated.Results69 participants (32.2%) had an Insomnia Severity Index score >15, forming the COMISA group. Suicidal ideation was more prevalent in the COMISA group (43.1% vs 23.4%, <i>P</i> = 0.007). After adjusting for covariates such as age, gender, body mass index, alcohol and smoking consumption, caffeine intake, hypertension, diabetes mellitus, and sleep-related factors, the odds of suicidal ideation were higher in the COMISA group (OR = 2.42, 95% CI = 1.14 - 5.11). However, after adjusting for anhedonic symptoms, this association was no longer significant. Anhedonic symptoms mediated the relationship between insomnia and suicidal ideation (OR = 1.045, 95% CI = 1.013-1.074).ConclusionsThe findings of this study underscore the emergence of suicidal ideation among individuals with COMISA. Understanding the mechanisms of anhedonic symptoms underlying the relationship between COMISA and suicidal ideation is crucial for developing targeted interventions to mitigate suicidality in this population.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251338262"},"PeriodicalIF":2.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional Recognition: A Comparative Study of People with Mild Cognitive Impairment and Alzheimer's Disease Self-Report with Caregiver Perspectives.","authors":"Rogeria Cristina Rangel, Tatiana T Belfort, Michelle Mattoso Brandt, Marcela Lima Nogueira, Marcia C N Dourado","doi":"10.1177/08919887251338266","DOIUrl":"https://doi.org/10.1177/08919887251338266","url":null,"abstract":"<p><p><b>Objective</b>: This study compared emotional recognition in participants with mild cognitive impairment (MCI) and mild to moderate Alzheimer 's disease (AD) against caregivers' perceptions of these participants' emotional states, while exploring the influence of clinical variables. <b>Methods</b>: We included 141 participants (32 with MCI, 50 with mild AD, and 59 with moderate AD) and their primary caregivers. We employed tasks assessing emotional decoding, identification, and correspondence, along with objective evaluations. <b>Results</b>: Participants across all groups showed significant differences in cognition and functionality. However, emotional recognition abilities did not significantly differ between MCI and mild or moderate AD groups. Most cognitive and neuropsychiatric variables had no significant impact on emotion recognition or social functioning. No differences emerged in patients' self-evaluations of social and emotional functioning. Caregiver assessments revealed significant differences only between the MCI and moderate AD groups. <b>Conclusion</b>: Participants with MCI and AD displayed expected clinical progression while retaining some emotional recognition and social functioning capabilities.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251338266"},"PeriodicalIF":2.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Non-Randomized Pilot Trial of Brain-WISE: A Group-Based Program for Brain Health and Dementia Risk Reduction in Community Settings.","authors":"Matthew L Cohen, Kimberly Van Buren, Mindy J Myers, James M Ellison, Christopher R Martens, Alyssa M Lanzi","doi":"10.1177/08919887251339591","DOIUrl":"https://doi.org/10.1177/08919887251339591","url":null,"abstract":"<p><p>BackgroundAddressing modifiable risk factors can potentially prevent 45% of cases of dementia. Here, we present the development of Brain-WISE, a low-intensity, group-based intervention to improve brain health in community settings. We conducted preliminary testing to refine intervention materials and procedures, assess acceptability and adherence, and evaluate preliminary effects.Methods143 community-dwelling adults aged 56-93 completed the non-randomized pilot trial. The 6-session intervention included psychoeducation, discussion/activities, and health screenings. Adherence was measured by attendance and acceptability was measured with questionnaires. Brain health knowledge and motivation to improve brain health were assessed before and after the program.ResultsAcross 6 cohorts, attendance was 80% - 97% and 96% of participants agreed that the program was worthwhile. Knowledge (d = 0.83, <i>P</i> < .001) and motivation (d = 0.43, <i>P</i> < .001) increased significantly.ConclusionsThe Brain-WISE program displayed good adherence and acceptability and evidence of an effect on knowledge and motivation. Further testing is warranted.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251339591"},"PeriodicalIF":2.9,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Wellbeing and its Determinants in People with Parkinson's Disease in Ethiopia: A Mixed-Method Study.","authors":"Arefayne Alenko, Sudhakar Morankar, Legese Chelkeba, Seblewongel Asmare Seyoum, Yohannes Yaya Uka, Ines Keygnaert","doi":"10.1177/08919887251339836","DOIUrl":"https://doi.org/10.1177/08919887251339836","url":null,"abstract":"<p><p>Globally, the prevalence of Parkinson's disease (PD) is increasing at an unprecedented rate. Therefore, it is imperative to provide evidence on the mental well-being of individuals with PD and identify context-specific determinants in sub-Saharan Africa to inform future interventions. An explanatory sequential mixed-methods design was employed, recruiting 304 individuals with PD who were receiving follow-up treatment. The prevalence of poor mental well-being among participants was 72.5%. Psychiatric manifestations included depression with suicidal ideation, anxiety, poor sleep quality, cognitive impairment, psychotic symptoms, and emotional and behavioral changes. Stigma was significantly associated with poor mental well-being, with an adjusted odds ratio of 1.13 (95% CI: 1.07-1.203, <i>P</i> < 0.001). A framework illustrating the vicious cycle of PD-related stigma, discrimination, and its impact on mental well-being was developed. Routine screening and treatment of mental disorders, along with community awareness campaigns to reduce stigma, are strongly recommended.Plain language summaryParkinson's disease (PD) exerts a significant impact on mental well-being due to its disease process and associated social and economic consequences. Therefore, assessing the prevalence of poor mental well-being, identifying manifestations of mental illness, and examining context-specific determinants in sub-Saharan Africa are essential to informing current practices and future research. Findings from this study reveal that nearly three-fourths of individuals with PD experience poor mental well-being in Ethiopia. Additionally, they exhibit a range of psychiatric manifestations, including severe conditions such as hopelessness and suicidal ideation. PD-related stigma is an independent determinant of mental well-being. People with PD face significant stigma and discrimination, largely driven by societal misconceptions about the causes of the disease. Routine screening and treatment of mental disorders, alongside the integration of mental health care into routine PD management, are essential to addressing the mental health needs of individuals with PD. Community awareness initiatives on the causes of PD are critically needed to reduce stigma and promote mental well-being. Given the high burden of mental disorders and the impact of stigma and discrimination, mental health and psychosocial interventions should prioritize individuals with PD.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251339836"},"PeriodicalIF":2.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Licochalcone A Ameliorates Cognitive Dysfunction in an Alzheimer's Disease Model by Inhibiting Endoplasmic Reticulum Stress-Mediated Apoptosis.","authors":"Yun Fan, Yun Ling, Xibin Zhou, Kai Li, Chunxiang Zhou","doi":"10.1177/08919887241295730","DOIUrl":"10.1177/08919887241295730","url":null,"abstract":"<p><p>BackgroundEndoplasmic reticulum (ER) stress-induced neurodegeneration has been considered an underlying cause of Alzheimer disease (AD). Here, we investigated the beneficial effects of licochalcone A (Lico A), a valuable flavonoid of the root of the Glycyrrhiza species, against cognitive impairment in AD by regulating ER stress.MethodsThe triple transgenic mouse AD models were used and were administrated 5 or 15 mg/kg Lico A. Cognitive deficits, Aβ deposition, ER stress, and neuronal apoptosis were determined using Morris Water Maze test, probe trial, immunofluorescence staining, western blotting, and TUNEL staining. To investigate the mechanisms of how Lico A exerts anti-AD effects, primary hippocampal neurons were isolated from the AD model mice and treated with Lico A, salubrinal, an eIF2α phosphatase inhibitor, ML385, a Nrf2 inhibitor, or LY294002, an inhibitor of PI3K. Pharmacokinetics and toxicity of Lico A (15 mg/kg) in AD mice were evaluated.ResultsWe found that Lico A improved cognitive impairment, decreased Aβ plaques, inhibited ER stress, and reduced neuronal apoptosis in the hippocampus and cortex of AD mice. Treatment with Lico A in primary hippocampal neurons exerted the same effects as it did <i>in vivo</i>. Additionally, cotreatment with ML385 or LY294002 significantly impeded the effects of Lico A against ER stress. Moreover, 15 mg/kg Lico A had a good bioavailability and low toxicity in AD mice.ConclusionOur results demonstrated that Lico A ameliorates ER stress-induced neuronal apoptosis by inhibiting PERK/eIF2α/ATF4/CHOP signaling, suggesting the therapeutic potential of Lico A in AD treatment.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"201-213"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Proposed Algorithm for the Pharmacological Treatment of Generalized Anxiety Disorder in the Older Patient.","authors":"Anderson Chen, Eran Metzger, Soyoung Lee, David Osser","doi":"10.1177/08919887241289533","DOIUrl":"10.1177/08919887241289533","url":null,"abstract":"<p><p>BackgroundThis is a new algorithm from the Psychopharmacology Algorithm Project at the Harvard South Shore Program, focused on generalized anxiety disorder (GAD) in older adults. Pertinent articles were identified and reviewed.ResultsSelective serotonin reuptake inhibitors (SSRIs) are considered to be first-line medications, with a preference for sertraline or escitalopram. If avoiding sexual side effects is a priority, buspirone is an option for the relatively healthy older adult. If response is inadequate, the second recommended trial is with a different SSRI or one of the serotonin-norepinephrine update inhibitors (SNRIs), venlafaxine or duloxetine. For a third medication trial, additional alternatives added to the previous options now include pregabalin/gabapentin, lavender oil, and agomelatine. If there is an unsatisfactory response to the third option chosen, quetiapine may be considered. We recommend caution with the following for acute treatment in this population: benzodiazepines and hydroxyzine. Other agents given low priority but having some supportive evidence were vilazodone, vortioxetine, mirtazapine, and cannabidiol. Acknowledging that the median age of onset of GAD is in early adulthood, many patients with GAD will have been started on benzodiazepines (or other medications that require caution in the elderly) for GAD at a younger age. These medications may be continued with regular observation to see if the potential harms are starting to exceed the benefits and a switch to other recommended agents may be justified.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"155-171"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}