Journal of Geriatric Psychiatry and Neurology最新文献

{"title":"Clinical Staging for Personality Disorders in Older Adults.","authors":"Jeroen A P Conjaerts, Arjan C Videler, Roel Schepman, Iman Elfeddali, Erlene Rosowsky, Sebastiaan P J van Alphen","doi":"10.1177/08919887241254467","DOIUrl":"10.1177/08919887241254467","url":null,"abstract":"<p><strong>Objective: </strong>This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults.</p><p><strong>Methods/design: </strong>The study employed an international Delphi methodology with three rounds and involved 21 experts.</p><p><strong>Results: </strong>Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD.</p><p><strong>Conclusion: </strong>The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"32-43"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161932","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":"Neurofilament Light Chain as a Biomarker of Global Cognition in Individuals With Possible Vascular Mild Cognitive Impairment.","authors":"Amish Gaur, Damien Gallagher, Nathan Herrmann, Jinghan Jenny Chen, Susan Marzolini, Paul Oh, Yutaka Amemiya, Arun Seth, Alex Kiss, Krista L Lanctôt","doi":"10.1177/08919887241254469","DOIUrl":"10.1177/08919887241254469","url":null,"abstract":"<p><strong>Background: </strong>Neurofilament Light Chain (NfL) is a biomarker of axonal injury elevated in mild cognitive impairment (MCI) and Alzheimer's disease dementia. Blood NfL also inversely correlates with cognitive performance in those conditions. However, few studies have assessed NfL as a biomarker of global cognition in individuals demonstrating mild cognitive deficits who are at risk for vascular-related cognitive decline.</p><p><strong>Objective: </strong>To assess the relationship between blood NfL and global cognition in individuals with possible vascular MCI (vMCI) throughout cardiac rehabilitation (CR). Additionally, NfL levels were compared to age/sex-matched cognitively unimpaired (CU) controls.</p><p><strong>Method: </strong>Participants with coronary artery disease (vMCI or CU) were recruited at entry to a 24-week CR program. Global cognition was measured using the Montreal Cognitive Assessment (MoCA) and plasma NfL level (pg/ml) was quantified using a highly sensitive enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Higher plasma NfL was correlated with worse MoCA scores at baseline (<i>β</i> = -.352, <i>P</i> = .029) in 43 individuals with vMCI after adjusting for age, sex, and education. An increase in NfL was associated with worse global cognition (<i>b</i>[SE] = -4.81[2.06], <i>P</i> = .023) over time, however baseline NfL did not predict a decline in global cognition. NfL levels did not differ between the vMCI (n = 39) and CU (n = 39) groups (<i>F</i>(1, 76) = 1.37, <i>P</i> = .245).</p><p><strong>Conclusion: </strong>Plasma NfL correlates with global cognition at baseline in individuals with vMCI, and is associated with decline in global cognition during CR. Our findings increase understanding of NfL and neurobiological mechanisms associated with cognitive decline in vMCI.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"62-72"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957231","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":"Two-Year Longitudinal Outcomes of Subjective Cognitive Decline in Hispanics Compared to Non-hispanic Whites.","authors":"Carolina Boza-Calvo, Arline Faustin, Yian Zhang, Anthony Q Briggs, Mark A Bernard, Omonigho M Bubu, Julia A Rao, Lindsey Gurin, Sakina Ouedraogo Tall, Ricardo S Osorio, Karyn Marsh, Yongzhao Shao, Arjun V Masurkar","doi":"10.1177/08919887241263097","DOIUrl":"10.1177/08919887241263097","url":null,"abstract":"<p><strong>Background: </strong>Subjective cognitive decline (SCD), considered a preclinical dementia stage, is less understood in Hispanics, a high-risk group for dementia. We investigated SCD to mild cognitive impairment (MCI) progression risk, as well as baseline and longitudinal features of depressive symptoms, SCD complaints, and objective cognitive performance among Hispanics compared to non-Hispanic Whites (NHW).</p><p><strong>Methods: </strong>Hispanic (n = 23) and NHW (n = 165) SCD participants were evaluated at baseline and 2-year follow-up. Evaluations assessed function, depressive symptoms, SCD, and objective cognitive performance.</p><p><strong>Results: </strong>Hispanics were at increased risk of progression to MCI (OR: 6.10, 95% CI 1.09-34.20, <i>P</i> = .040). Hispanic participants endorsed more depressive symptoms at baseline (<i>P</i> = .048) that worsened more longitudinally (OR: 3.16, 95% CI 1.18-8.51, <i>P</i> = .023). Hispanic participants had increased SCD complaints on the Brief Cognitive Rating Scale (BCRS) (β = .40 SE: .17, <i>P</i> = .023), and in specific BCRS domains: concentration (β = .13, SE: .07, <i>P</i> = .047), past memory (β = .13, SE: .06, <i>P</i> = .039) and functional abilities (β = .10, SE: .05, <i>P</i> = .037). In objective cognitive performance, Hispanic ethnicity associated with decline in MMSE (β = -.27, SE: .13, <i>P</i> = .039), MoCA (β = -.80 SE: .34, <i>P</i> = .032), Trails A (β = 2.75, SE: .89, <i>P</i> = .002), Trails B (β = 9.18, SE: 2.71, <i>P</i> = .001) and Guild Paragraph Recall Delayed (β = -.80 SE: .28, <i>P</i> = .005). <b>Conclusions:</b> Hispanic ethnicity associated with a significantly increased risk of 2-year progression of SCD to MCI compared to NHW. This increased risk associated with increased depressive symptoms, distinctive SCD features, and elevated amnestic and non-amnestic objective cognitive decline. This supports further research to refine the assessment of preclinical dementia in this high-risk group.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"23-31"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751903","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":"Dementia Specialty Care Clinicians' Perspectives on Their Role in the Dementia Diagnostic Process and Diagnostic Disclosure.","authors":"Alissa B Sideman, Krista L Harrison, Sarah B Garrett, Joanna Paladino, Georges Naasan, Christine S Ritchie","doi":"10.1177/08919887241254468","DOIUrl":"10.1177/08919887241254468","url":null,"abstract":"<p><strong>Background: </strong>Delivering a diagnosis of Alzheimer's disease and related dementias (ADRD) can be challenging not just for patients and families, but also for clinicians. Our objective was to understand dementia specialty care clinicians' perspectives on their role in diagnosis and diagnostic disclosure in dementia.</p><p><strong>Methods: </strong>Qualitative interviews with clinicians from a specialty tertiary dementia care center focused on practices, challenges, and opportunities addressing patient and caregiver needs in dementia. Data was analyzed by an interdisciplinary team using thematic analysis.</p><p><strong>Results: </strong>The 16 participants included behavioral neurologists, social workers, neuropsychologists, and nurses. Themes included the value of providing an accurate diagnosis, the timing and challenges of delivering a diagnosis, the central focus on diagnosis alongside the need for more education on care management, and the role of the interdisciplinary team.</p><p><strong>Discussion: </strong>We identified areas for improvement and strengths that can be built upon or adapted to other settings, including providing clinicians in specialty and primary care settings more guidance and support when diagnostic challenges arise, strengthening interdisciplinary teamwork, and making dementia diagnosis and care more accessible.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"3-12"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759142","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":"Physical Exercise for Treating the Anxiety and Depression Symptoms of Parkinson's Disease: Systematic Review and Meta-Analysis.","authors":"Valton Costa, José Mario Prati, Alice de Oliveira Barreto Suassuna, Thanielle Souza Silva Brito, Thalita Frigo da Rocha, Anna Carolyna Gianlorenço","doi":"10.1177/08919887241237223","DOIUrl":"10.1177/08919887241237223","url":null,"abstract":"<p><strong>Background: </strong>Depression and anxiety are non-motor symptoms of Parkinson's disease (PD). Physical exercise is a promising approach to reducing neuropsychological burden. We aimed to comprehensively synthesize evidence regarding the use of exercise for treating depression and anxiety symptoms in PD.</p><p><strong>Methods: </strong>Systematic review and meta-analysis following PRISMA recommendations. Searches on PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) was conducted. The random-effects model was employed for all analyses with the standardized mean difference as the effect estimate.</p><p><strong>Results: </strong>Fifty records were retrieved, but only 17 studies met the criteria for the meta-analyses. A moderate to large effect was observed for depression (-.71 [95% CI = -.96 to -.46], 11 studies, 728 individuals), and a small to moderate effect for anxiety (-.39 [95% CI = -.65 to -.14], 6 studies, 241 individuals), when comparing exercise to non-exercise controls. Subgroup analysis revealed significant effects from aerobic (-.95 [95% CI = -1.60, -.31]), mind-body (-1.85 [95% CI = -2.63, -1.07]), and resistance modalities (-1.61 [95% CI = -2.40, -.83]) for depression, and from mind-body (-.67 [95% CI = -1.19 to -.15]) and resistance exercises (-1.00 [95% CI = -1.70 to -.30]) for anxiety.</p><p><strong>Conclusion: </strong>Physical exercise has a relevant clinical impact on depression and anxiety in PD. We discuss the level of the evidence, the methodological limitations of the studies, and give recommendations.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"415-435"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140039577","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":"Etiological Subclassification of Stroke in Older People ≥80 Years Compared to Younger People: A Systematic Review and Meta-Analysis.","authors":"Johan Sanner, Jakob O Ström, Mia von Euler, Bente Thommessen, Brynjar Fure","doi":"10.1177/08919887241254466","DOIUrl":"10.1177/08919887241254466","url":null,"abstract":"<p><strong>Background: </strong>Due to the rapid growth of the world´s oldest population, the number of older persons with stroke is expected to rise. Knowledge of stroke etiology is essential to offer personalized and equal health care across age groups. The present systematic review aimed to investigate the prevalence of etiological subtypes of ischemic and hemorrhagic stroke in older compared to younger people.</p><p><strong>Methods: </strong>MEDLINE, Embase, Cochrane, Epistemonikos, and Cinahl were systematically searched for studies regarding etiological classification in people ≥80 years compared to those <80 years with ischemic or hemorrhagic stroke.</p><p><strong>Results: </strong>Out of 28 441 identified articles, eight met the inclusion criteria. In total, 8223 individuals were included in meta-analyses, of whom 2997 were 80 years or older. We demonstrated a higher prevalence of cardioembolic stroke in people ≥80 years OR 1.68 (95% CI, 1.12-2.53). Small vessel disease was significantly less common in older people OR .64 (95% CI, .50-.81). Regarding large vessel disease, no statistically significant difference between the two groups was shown OR 1.05 (95% CI, .77-1.43).</p><p><strong>Conclusion: </strong>In people ≥80 years, cardioembolic stroke is more common, and small vessel disease less common compared to people <80 years. Overall, the results have to be interpreted with caution due to few studies. Large studies using validated classification systems are needed.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"436-447"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957230","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":"Parkinson's Disease: Coping Strategies, Cognitive Restructuring and Deep Brain Stimulation.","authors":"Mylène Meyer, Sébastien Montel, Sophie Colnat-Coulbois, Solène Frismand, Pierre-Michel Llorca, Pierre Vidailhet, Raymund Schwan, Elisabeth Spitz","doi":"10.1177/08919887241248831","DOIUrl":"10.1177/08919887241248831","url":null,"abstract":"<p><strong>Objective: </strong>Less is known concerning the evolution of coping strategies before and after deep brain stimulation (DBS) in Parkinson's disease (PD) patients.</p><p><strong>Methods: </strong>In a randomized controlled trial, coping was measured with the neurological version of the CHIP (Coping with Health Injuries and Problem) and the BriefCOPE in PD patients before ( T1: DBS - 2 months) and after (T2: + 3 months, T3: + 6 months) DBS. Patients (N = 50, age 59 ± 5.7 years, disease duration 9.54 ± 3.7 years) were randomised in 3 groups: CRTG (preoperative psychological preparation with cognitive restructuring), PIG (preoperative non structured interviews), and CG (no psychological preparation).</p><p><strong>Results: </strong>Coping strategies are modulated by the time of evaluation. Some strategies are significantly more used preoperatively than postoperatively, as strategies about the research for information (CHIP: F = 16.14; <i>P</i> = .000; η² = .095; BriefCOPE F = 5.71; <i>P</i> = .005; η² = .066), emotional regulation (F = 3.29; <i>P</i> = .042; η² = .029), and well-being searching (F = 4.59; <i>P</i> = .013; η² = .043). Some other strategies appear more used post than preoperatively, as palliative coping (F = 5.57; <i>P</i> = .005; η² = .064), humour (F = 3.35; <i>P</i> = .041; η² = .0.35), and use of substance (F = 4.43; <i>P</i> = .015; η² = .070). No other specific time, group or time per group interaction effect was found.</p><p><strong>Conclusion: </strong>Coping strategies are crucial for PD patients to adapt to the evolution of their parkinsonian state. Their consideration should be more systematic in the neurosurgical process, particularly when neurological symptoms would remain after DBS. More insights are needed concerning the evolution of coping strategies through DBS and the impact of a preoperative psychotherapy over them in preoperative PD patients.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"448-460"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157949","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":"APOE Genotype Disclosure Influences Decisions About Future Planning but not Adoption of Healthy Lifestyle Changes in Cognitively Unimpaired Individuals.","authors":"Dominique L Popescu, Athene K Lee, Edmund Arthur, Louisa I Thompson, Jessica Alber","doi":"10.1177/08919887241237224","DOIUrl":"10.1177/08919887241237224","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown apolipoprotein E (APOE) genotype disclosure to be safe and well-tolerated in cognitively unimpaired (CU) older adults. This study aimed to examine the effect of the disclosure process on decisions about future directives and health behaviors in community-dwelling CU older adults from the Butler Alzheimer's Prevention Registry (BAPR).</p><p><strong>Methods: </strong>CU APOE E4 non-carriers (n = 106) and carriers (n = 80) aged 58-78 completed in-person psychological readiness screening to undergo APOE disclosure. Follow-up assessments were completed online 3 days, 6 weeks, and 6 months post-disclosure. The primary outcomes were future directives, dietary habits, and physical activity scores.</p><p><strong>Results: </strong>Disclosure was associated with decision making on future directives in E4 carriers (<i>t</i> = 3.59, <i>P</i> = .01) at 6 months compared to baseline, but not non-carriers. Family history of memory impairment, SCD endorsement, and education consistently predicted scores on future directives. A significant interaction between E4+ and SCD endorsement on future directive scores was noted (OR = 163.06, 9.5-2,799.8). E4 + carrier status was associated with physical activity (<i>W</i> = 60,148, <i>P</i> = .005) but not dietary habits scores.</p><p><strong>Conclusions: </strong>Our findings indicate that disclosure led to a change in future directives but not protective health behaviors, specifically in E4 carriers. Future work will explore whether pairing disclosure with education about the role of lifestyle factors in AD risk and providing guidelines on making risk-lowering lifestyle modifications as an intervention approach leads to positive change.</p>","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"482-495"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068456","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":"Increased Systemic Immune-Inflammation Index as a Novel Indicator of Alzheimer’s Disease Severity","authors":"Fatma E. Algul, Yuksel Kaplan","doi":"10.1177/08919887241280880","DOIUrl":"https://doi.org/10.1177/08919887241280880","url":null,"abstract":"IntroductionInflammatory processes and neurodegeneration are common features of Alzheimer's disease (AD). The systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are easily accessible, cost-effective prognostic indicators of inflammation status. We assessed the diagnostic value of SII and compared the efficacies of NLR, PLR, and SII in predicting AD severity.Materials and MethodsBetween January 2021 and December 2022, this prospective, cross-sectional clinical study included 175 patients with AD and 61 controls. SII, NLR, and PLR were calculated.ResultsAge, white blood cell and lymphocyte counts, and NLR and PLR values were significantly different between the patient and control groups ( P &lt;.05). Age, hemoglobin, neutrophil, NLR, and SII values were significantly different among dementia severity subgroups ( P &lt;.05). Compared with PLR and SII, NLR was more strongly correlated with dementia severity. In the analysis of adjusted data by gender, it was found that hemoglobin level is significantly negatively associated with dementia severity in males, while in females, age and PLR are significantly positively associated with dementia severity, and lymphocyte count and SII are negatively associated.ConclusionSII, a novel inflammatory marker, was associated with dementia severity in patients with AD. Compared with PLR and SII, NLR was more strongly correlated with dementia severity. In future studies with larger populations, SII and NLR values can be used to determine dementia severity and establish follow-up plans for patients with high dementia risk.","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":"27 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269329","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 Care Needs of Patients With Cognitive Impairment in Late-Stage Parkinson's Disease.","authors":"Jennifer S Pigott, Bastiaan R Bloem, Stefan Lorenzl, Wassilios G Meissner, Per Odin, Joaquim J Ferreira, Richard Dodel, Anette Schrag","doi":"10.1177/08919887231225484","DOIUrl":"10.1177/08919887231225484","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cognitive impairment is common in Parkinson's disease (PD), but care needs and resource use for those with significant cognitive impairment are not well established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;675 participants with PD from the international Care of Late-Stage Parkinsonism (CLaSP) study were grouped into those without (n = 333, 49%) and with cognitive impairment (MMSE &lt; 24/30 or diagnosis of dementia or Mild Cognitive Impairment; n = 342, 51%) and their clinical features, care needs and healthcare utilisation compared. The relationship between cognition and healthcare consultations was investigated through logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Cognitive impairment was associated with more motor and non-motor symptoms, less antiparkinsonian but higher rates of dementia and antipsychotic medication, worse subjective health status and greater caregiver burden. A considerable proportion did not have a pre-established cognitive diagnosis. Care needs were high across the whole sample but higher in the cognitive impairment group. Home care and care home use was higher in the cognitive impairment group. However, use of healthcare consultations was similar between the groups and significantly fewer participants with cognitive impairment had had recent PD Nurse consultations. Worse cognitive impairment was associated with lower frequency of recent PD nurse and multidisciplinary therapy consultation (physiotherapy, massage, occupational therapy, speech training and general nursing).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Those with cognitive impairment have more severe PD, higher care needs and greater social care utilisation than those with normal cognition, yet use of health care services is similar or less. Cognitive impairment appears to be a barrier to PD nurse and multidisciplinary therapy consultations. This challenges current models of care: alternative models of care may be required to serve this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Parkinson's disease is a long-term progressive health condition. Over time, many people with Parkinson's develop problems with thinking and memory, called cognitive impairment. This can negatively impact the daily lives of the person with Parkinson's and their caregiver. It is also thought to be a barrier to accessing healthcare. How people with Parkinson's who have cognitive impairment use healthcare and detail of their care needs is not well known.We analysed data from a large sample of people with advanced Parkinson's from six European countries to investigate their symptoms, care needs and healthcare use. We compared those with cognitive impairment to (342 people) to those without cognitive impairment (333 people).We found that those with cognitive impairment had more severe Parkinson's across a range of symptoms compared to those without cognitive impairment. They also had more care needs, reported their health status to be worse, and their careg","PeriodicalId":16028,"journal":{"name":"Journal of Geriatric Psychiatry and Neurology","volume":" ","pages":"355-367"},"PeriodicalIF":2.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478705","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}