Journal of Geriatric Psychiatry and Neurology最新文献

{"title":"Efficacy and Safety of Escitalopram and Citalopram for Agitation in Alzheimer's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Anderson Matheus Pereira da Silva, Luciano Falcão, Filipe Virgilio Ribeiro, Kenzo Ogasawara Donato, Pedro Lucas Machado Magalhães, Maria da Vitória Santos Nascimento, Marianna Leite, Mariana Lee Han, Daniel Gonçalves Quiroga, Eryvelton de Souza Franco, Maria Bernadete de Sousa Maia","doi":"10.1177/08919887251369893","DOIUrl":"https://doi.org/10.1177/08919887251369893","url":null,"abstract":"<p><p>BackgroundAgitation is a frequent and distressing neuropsychiatric symptom in patients with Alzheimer's disease (AD), often leading to increased caregiver burden, institutionalization, and healthcare costs. While antipsychotics are commonly prescribed, their use is limited by safety concerns. Selective serotonin reuptake inhibitors (SSRIs), such as citalopram and escitalopram, have emerged as alternative treatments with a more favorable safety profile. This study aimed to evaluate the efficacy and safety of these agents in the management of agitation in AD.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing citalopram or escitalopram with placebo or other pharmacological treatments in older adults with AD and clinically defined agitation. Primary outcomes included changes in agitation severity, assessed by the Neuropsychiatric Inventory-Clinician Rating (NPI-C) and the Neurobehavioral Rating Scale (NBRS). Secondary outcomes included cognitive function (MMSE), anxiety symptoms, and adverse events. Standardized mean difference (SMD) and risk ratio (RR) were pooled using a random-effects model.ResultsFour RCTs comprising 502 patients were included. Pooled analysis showed no significant improvement in agitation severity (SMD -0.67; 95% CI -2.58, 1.25; I² = 98.3%) or cognitive outcomes (SMD 2.43; 95% CI -2.55, 7.41). Rates of serious adverse events (RR 0.85; 95% CI 0.50, 1.45) and treatment discontinuation (RR 1.05; 95% CI 0.80, 1.37) were similar between groups. However, SSRI use was associated with an increased risk of falls (RR 1.78; 95% CI 1.15, 2.75; I² = 0%).ConclusionEscitalopram and citalopram do not significantly reduce agitation in AD but are generally well tolerated. Increased fall risk warrants cautious clinical use.Registration PROSPERO protocol numberCRD420251055237.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251369893"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957074","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":"Understanding Effects of Late-Life Depressive Symptoms on Event-Related Oscillations in Cognitively Unimpaired Seniors and Individuals With Mild Cognitive Impairment.","authors":"Yağmur Özbek, Görsev G Yener","doi":"10.1177/08919887251370398","DOIUrl":"https://doi.org/10.1177/08919887251370398","url":null,"abstract":"<p><p>BackgroundLate-life depression often co-occurs with neurological disorders such as dementia, significantly impacting cognitive function and overall well-being. Mild cognitive impairment represents a critical stage between normal aging and dementia, often accompanied by depressive symptoms. Electroencephalography (EEG) offers a non-invasive method to investigate underlying neural mechanisms associated with depressive symptoms and cognitive dysfunction.MethodsThis study included 80 participants categorized into four groups: MCI without depressive symptoms (MCI), MCI with depressive symptoms (MCI-d), cognitively unimpaired individuals without depressive symptoms (CU), and cognitively unimpaired individuals with depressive symptoms (CU-d). Participants underwent neuropsychological evaluations and EEG recordings during a visual oddball paradigm. Event-related oscillations (EROs) in delta, theta, alpha, and beta frequencies were analyzed in frontal, central, parietal, temporal, and occipital electrode locations.ResultsDelta ERO showed a significant decrease in amplitude in CU-d, MCI, and MCI-d groups compared to CU in frontal, central, and parietal regions. In the temporal area, MCI-d exhibited lower delta amplitudes compared to both CU and CU-d, while MCI showed lower amplitudes compared to CU. No significant differences were observed in theta, alpha, and beta frequencies. Correlation analyses revealed moderate to strong associations between frontal, central, parietal, and temporal delta amplitudes with various neuropsychological test scores, indicating a link between delta oscillations and cognitive function.DiscussionOur findings suggest that delta oscillations may serve as potential marker for cognitive dysfunction, particularly in individuals with MCI and depressive symptoms. Notably, lower delta amplitudes were observed in cognitively unimpaired individuals with depressive symptoms compared to those without, underlining the impact of depressive symptoms on cognitive function in healthy elderly individuals. Further studies can bring out that neurophysiological measures may help revealing the effect of depressive symptoms on cognition that was undetected by cognitive testing.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251370398"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957023","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 Scoping Review of Clinical Utility from the Montreal Cognitive Assessment Memory Index Score.","authors":"Oscar R Kronenberger, Alyssa N Kaser, Jeff Schaffert, Vishal J Thakkar, William Goette, Christian LoBue, Laura H Lacritz","doi":"10.1177/08919887251366698","DOIUrl":"https://doi.org/10.1177/08919887251366698","url":null,"abstract":"<p><p>ObjectiveThe Montreal Cognitive Assessment (MoCA) Memory Index Score (MIS) is a supplemental assessment of memory composed of word list delayed free-recall followed by step-down category cued- and multiple-choice cued-recall. This paper reviews the MIS literature within Alzheimer's and other neurodegenerative dementias to synthesize evidence regarding its clinical utility, identify gaps, and inform future research directions.MethodWe searched electronic databases of OVID Medline, Embase, PsycINFO, and PubMed from 2014, when the MIS was first described, to July 2025. Peer-reviewed studies that reported data on the diagnostic or prognostic utility of the MIS in assessing neurodegenerative dementia populations were included.ResultsWe screened 278 articles, and 14 were included in the review. The current literature includes limited reporting on the diagnostic or prognostic utility of the MIS and is characterized by minimal diversity of samples and non-rigorous validation methods. Initial findings are promising and suggestive of incremental validity over the MoCA total score for identifying episodic memory impairment and therefore aiding in differentiation of suspected dementia etiology. However, evidence is insubstantial for the MIS as a tool for predicting progression and additional research is needed to evaluate the incremental validity of the MIS over the conventional MoCA five-word recall score.ConclusionsLarge literature gaps exist regarding the clinical utility of the MIS within neurodegenerative dementias. Additional research exploring the psychometric properties of the MIS using diverse samples with rigorous validation methods is needed to better inform its application.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251366698"},"PeriodicalIF":2.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873509","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":"Enhancing Alzheimer Disease Detection Using Neuropsychiatric Symptoms: The Role of Mild Behavioural Impairment in the Revised NIA-AA Research Framework.","authors":"Rebeca Leon, Maryam Ghahremani, Dylan X Guan, Eric E Smith, Henrik Zetterberg, Zahinoor Ismail","doi":"10.1177/08919887251366634","DOIUrl":"https://doi.org/10.1177/08919887251366634","url":null,"abstract":"<p><p>BackgroundAs the prevalence of Alzheimer disease (AD) rises, early identification of at-risk individuals is essential for effective intervention. Mild behavioral impairment (MBI), which captures emergent and persistent neuropsychiatric symptoms (NPS) in later life, may enhance early detection of AD; however, its associations with 2024 NIA-AA Core 1 biomarkers remain unexplored. We investigated associations between MBI and cerebrospinal fluid (CSF) amyloid β-42 (Aβ42) and phosphorylated tau-181 (p-tau181).MethodBaseline data from 1327 dementia-free Alzheimer's Disease Neuroimaging Initiative (ADNI) participants were analyzed. Participants were classified as MBI, non-MBI NPS, or no NPS. Gaussian mixture modeling defined biomarker positivity. Logistic and multinomial logistic regressions modeled associations between NPS status and biomarker positivity or biomarker profiles, adjusting for age, sex, education, and cognition.ResultsMBI was associated with Aβ42+ (aOR = 2.26; 95% CI = 1.71-2.99), p-tau181+ (aOR = 1.72; 95% CI = 1.30-2.28), and AD continuum profile (aOR = 2.33; 95% CI = 1.73-3.14), but not with non-AD pathology. Non-MBI NPS showed no associations.ConclusionMBI may serve as a behavioral marker of AD pathology.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251366634"},"PeriodicalIF":2.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847121","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":"Predicting Cognition and Affective Changes in Newly Diagnosed Parkinson's Disease Through Longitudinal Data-Driven Clustering.","authors":"Benjamin Ellul, Angus McNamara, Stephan Laurenz, Irina Baetu, Mark Jenkinson, Lyndsey E Collins-Praino","doi":"10.1177/08919887251366638","DOIUrl":"https://doi.org/10.1177/08919887251366638","url":null,"abstract":"<p><p><b>Background:</b> Although primarily characterised as a motor disorder, Parkinson's Disease (PD) also presents with non-motor symptoms, including cognitive decline and affective dysfunction, which are major predictors of quality of life and mortality for individuals. However, factors associated with these non-motor symptom trajectories remain under-characterised. <b>Purpose:</b> This study aimed to investigate predictors of cognitive and affective function over a 5-year follow-up period using data from the Progressive Parkinson's Marker Initiative. <b>Results:</b> Fuzzy C-means clustering analysis of year-5 cognitive and affective function scores showed two clusters. The second group (n = 96) were older and had worse cognition, affective, and motor functioning at year-5 follow-up compared to the first (n = 213). Predictors of cluster membership was assessed in n = 113 individuals for whom data on all variables of interest were available (cluster 1/2 = 79/34). Cluster membership at 5-year follow-up was significantly predicted by baseline cognitive and affective function, as well as decreased levels of CSF amyloid-beta and increased CSF concentrations of phosphorylated-tau at baseline. Alternative non-linear supervised machine learning model (support vector regressor) using the same predictors improved classification accuracy by 5%. <b>Conclusion:</b> Our analysis highlights that including established biomarkers of other neurocognitive disorders (namely, amyloid-beta and phosphorylated-tau) also has utility for predicting cognitive and affective trajectory in PD. This suggests that assessing a multi-modal panel of prognostic markers, beyond clinical symptom presentation alone, may have utility for informing prognosis of cognitive and affective outcomes in PD. This is significant, potentially allowing for the earlier development of personalised therapeutic interventions for those at highest risk of impairment within these non-motor domains.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251366638"},"PeriodicalIF":2.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821558","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":"The Effects of Deep TMS on QEEG Measures in Co-Occurring Major Depressive Disorder and Early-Stage Alzheimer's Disease: A Pilot Study.","authors":"Nathaniel A Shanok, Brittany Derbin, Sabrina Muzac, Enis Cabeza, Samuel Leven, Raul Rodriguez","doi":"10.1177/08919887251366637","DOIUrl":"https://doi.org/10.1177/08919887251366637","url":null,"abstract":"<p><p>Major Depressive Disorder (MDD) and Alzheimer's disease (AD) represent two of the most prevalent diseases worldwide. Notably, it is estimated that 30%-50% of individuals with AD have co-occurring MDD and there are overlapping symptoms across numerous domains. In this pilot study, a Deep TMS protocol (targeting the left frontal and bilateral temporal regions) was delivered for 36 sessions to patients with co-occurring MDD and early-stage AD (N = 12). All participants received the treatment and there was no control condition. The treatment yielded a response rate of 83.33% (defined by a ≥50% reduction in depressive symptoms on the Patient Health Questionnaire-9 [PHQ-9]) and a remission rate of 50.00% (PHQ-9 score of 4 or less following treatment). Further, participants displayed reductions in left prefrontal and right temporal delta power using QEEG analysis pre- and -post treatment. Alpha coherence was also enhanced in key areas. The observed shift in neurophysiological measures suggested reduced cortical slowing and dysconnectivity, which are hallmark traits in MDD and AD. This proof-of-concept study suggests that further research on the application of Deep TMS (paired with QEEG) for early-stage AD is warranted.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251366637"},"PeriodicalIF":2.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794613","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":"Suicidal Behavior in Mild Cognitive Impairment and Dementia in the Old Adults: A Systematic Review and Meta-Analysis.","authors":"Eric Mormont, Denis Jacques, Marie de Saint-Hubert, Aurore Sourdeau, Charlotte Beaudart","doi":"10.1177/08919887251366639","DOIUrl":"https://doi.org/10.1177/08919887251366639","url":null,"abstract":"<p><p>ObjectivesTo address the prevalence and risk factors of suicidal outcomes in people with mild cognitive impairment or dementia.MethodsFour databases were searched for studies reporting data on the prevalence or the risk of a suicidal event, in people with a clinical diagnosis of MCI or dementia. The research was conducted according to PRISMA guidelines. A narrative synthesis was used to report the main findings. A random effect model was used across all analyses to calculate the prevalence and the odds ratio of suicidal outcomes in people with dementia.ResultsFifty-nine studies were included. The pooled prevalence of suicidal outcomes in people with dementia were as follows: suicidal ideation: 9.7% (95%CI 6.7-13.9), suicide attempt: 0.8% (95%CI 0.3-2.4), and suicidal death: 0.2% (95%CI 0.1-0.4). People with dementia had an increased risk of suicidal ideation (OR 1.87, 95%CI 1.21-2.88) and suicide attempt (OR 2.4, 95%CI 1.24-4.65) but no significant increase in the risk of suicidal death. The heterogeneity was high for each outcome. The risk factors for suicidal death in dementia were younger age, recent diagnosis, previous mental health disorder, and frontotemporal dementia. The prevalence of suicidal ideation in MCI ranged from 5 to 17.6%, with a moderate increase in suicide attempts (HR 1.34, 95%CI 1.09-1.65) and no increase in suicidal death.ConclusionsPeople with dementia frequently have suicidal thoughts and are at an increased risk of suicide attempts. Clinicians should be careful to identify those at higher risk in order to offer them supportive care and restrict their access to lethal means.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251366639"},"PeriodicalIF":2.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789314","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":"Brain Structures Associated with Depression in Older Adults in the National Alzheimer's Coordinating Center Uniform Data Set.","authors":"Shanna L Burke, Adrienne Grudzien, Tan Li, Natalie Goulett, Christopher P Barnes, Kevin Hanson, Steven T DeKosky","doi":"10.1177/08919887251361101","DOIUrl":"10.1177/08919887251361101","url":null,"abstract":"<p><p>PurposeThis study examined relations between four late-life depression subgroups (recent, >2 years ago, chronic, no depression) and regional brain volumes using structural MRI data from the National Alzheimer's Coordinating Center (n=1,551).Data AnalysisMultiple linear regressions evaluated the effects of depression on 30 MRI biomarkers, while moderation analyses assessed how APOE ε4 and depression shape the connections between cognitive status and brain structure volumes.ResultsAfter adjusting for covariates and applying Hochberg's method, recent depression (< 2 years) was associated with reduced total cerebrum cranial volume and left frontal lobe cortical gray matter volume. Chronic depression correlated with larger right lateral ventricle volume.ConclusionThese findings suggest that recent depression is linked to brain atrophy across specific regions and ventricular enlargement. Future research should investigate age-related impacts on these associations and whether restoration of brain volume occurs after depressive symptoms subside.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251361101"},"PeriodicalIF":2.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Network Analysis of Depressive Symptoms and Cognitive Functions Among Older Adults Distressed by Body Pain: Findings From a National China Survey.","authors":"Wei Zhang, He-Li Sun, Yuan Feng, Sha Sha, Zhaohui Su, Teris Cheung, Gabor S Ungvari, Todd Jackson, Qinge Zhang, Yu-Tao Xiang","doi":"10.1177/08919887251360261","DOIUrl":"https://doi.org/10.1177/08919887251360261","url":null,"abstract":"<p><p>BackgroundBody pain is common among older adults who often experience comorbid depressive symptoms and cognitive impairments. This study examined differences in depressive symptoms and cognitive functions between older adults distressed with body pain and those without pain and explored symptom interrelationships in the pain-distressed group.MethodsData from the 2020 China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale-10 (CESD-10). Cognitive function was evaluated using standardized measures. Network analysis identified both central and bridge symptoms in the pain group.ResultsThis study included 3938 participants of whom 1969 comprised the group distressed by body pain. Depressive symptoms were more prevalent among those with body pain (39.1%; 95% CI: 36.95%, 41.25%]) compared to controls (21.4%; 95% CI: 19.59%, 23.21%], <i>P</i> < 0.01). Conversely, cognitive function scores did not differ between the two groups. In the network model for the pain-distressed group, \"feeling depressed\" (CESD3) was the most central symptom (strength = 1.01), followed by \"everything was an effort\" (CESD4) (strength = 0.98) and \"inability to get going\" (CESD10) (strength = 0.88). \"Orientation\" (Bridge strength = 1.44) was the most influential bridge symptom linking depressive symptom and cognitive function communities, followed by \"memory\" (Bridge strength = 1.13) and \"attention\" (Bridge strength = 0.72).ConclusionFindings highlighted a higher prevalence of depressive symptoms among older adults with body pain compared to their pain-free peers. Results suggest interventions targeting key central and bridge symptoms warrant consideration in future treatment studies.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251360261"},"PeriodicalIF":2.5,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775577","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":"Influential Factors when Making Decisions About Dementia Medications in Memory Assessment Services; a Focused Ethnography and Interview Study.","authors":"Rachael Kelley, Claire A Surr, Gregor Russell, George Crowther, Rebecca Dickinson, Jemima Dooley, Alys W Griffiths, Peter Knapp, Sarah J Smith","doi":"10.1177/08919887251362465","DOIUrl":"https://doi.org/10.1177/08919887251362465","url":null,"abstract":"<p><p>BackgroundDiscussing pharmaceutical treatment for dementia is challenging because of variation in disease progression, lack of curative treatments, and communication difficulties. Research in the context of dementia suggests shared decision making is limited, this study examined how dementia medications are discussed in practice.MethodsFocused video/audio ethnography of clinical appointments (n = 14), semi-structured interviews with patients/supporters (n = 23) and clinicians (n = 5) were employed to examine communication practices.ResultsTwo themes developed; <i>Framing and understanding of information in the context of uncertainty</i> explores how uncertainties around risks and benefits are understood. <i>'Not worth the risk'</i> or '<i>nothing to lose</i>' presents how patients/supporters and clinicians balance individuals' contexts/perceived risks/benefits. In the absence of certainty around potential benefits, risk often informed decision-making, particularly for frailer or more vulnerable patients.ConclusionsClinicians should be aware of their influence on decision-making and be cognisant of the way that they frame opinions, which are largely based on clinical experience. Prescribers would benefit from a standardised information source which enables them to describe the likelihood and magnitude of benefits and side effects in a universal way. Accessible information for patients and relatives about the same is also recommended. Patients and relatives make their decisions to take medications in the context of relative uncertainty about the likelihood of benefits, with risk playing a pivotal role in decision making for some.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"8919887251362465"},"PeriodicalIF":2.5,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768665","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}