The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry最新文献

{"title":"Systemic Failure Modes of Large Language Models in Geriatric Psychiatric Assessment: A Scoping Review.","authors":"Yu-Shiou Lin, Yun-Ting Lee","doi":"10.1016/j.jagp.2026.08.016","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.016","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) show strong performance on medical examinations, yet their reliability in real-world psychogeriatric assessment is uncertain, where delirium, dementia, and late-life depression often coexist amid frailty, polypharmacy, and long clinical histories. We aimed to map empirically evaluated LLM failure modes most relevant to geriatric psychiatric assessment and risk management.</p><p><strong>Methods: </strong>We conducted a systematic scoping review of empirical evaluations published between January 1, 2023, and December 31, 2025. We searched biomedical and technical sources and included studies that tested LLMs on clinically relevant tasks, including diagnostic reasoning, longitudinal history integration, safety and medication reasoning, and bias-related outcomes. Evidence was charted and synthesized qualitatively to derive a pragmatic taxonomy of recurrent failure patterns.</p><p><strong>Results: </strong>Forty-seven studies met inclusion criteria. Four convergent failure modes emerged: (1) diagnostic instability in longitudinal reasoning, including degraded retrieval within long contexts and loss of mid-history cues; (2) adversarial vulnerability, with elevated hallucination under misleading inputs and flawed rationales despite correct final answers; (3) multimodal temporal sparsity in video-based models that can omit brief safety-critical events such as falls; and (4) systemic ageism and value misalignment that can distort clinical narratives, risk estimation, and care recommendations.</p><p><strong>Conclusions: </strong>Current LLM architectures remain insufficient for autonomous geriatric psychiatric assessment. Near-term use should be limited to low-risk support functions with human oversight, structured cognitive forcing safeguards, and evaluation protocols that stress-test longitudinal complexity, adversarial conditions, multimodal safety events, and bias.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily Functioning in Low-Income Older Adults With Hoarding Disorder.","authors":"Jarrod Williams, Kylie A Baer, Mary E Dozier, Jessica Zakrzewski, James O E Pittman, David H Sommerfeld, Catherine R Ayers","doi":"10.1016/j.jagp.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.014","url":null,"abstract":"<p><strong>Objectives: </strong>Hoarding disproportionately affects older adults and has been linked with functional and cognitive impairment. However, existing work investigating is limited by methodological issues (e.g., absence of diagnostic interviewing) and little attention to low-income individuals or older adults. The present study sought to address these limitations in a large sample of low-income older adults diagnosed with hoarding disorder.</p><p><strong>Methods: </strong>We administered measures of functional disability, hoarding severity, and cognitive functioning to 169 low-income older adults with hoarding disorder.</p><p><strong>Results: </strong>We observed high rates of clinically significant functional impairment (49%) and mild cognitive impairment (31%). Greater hoarding severity was significantly associated with functional impairment across several domains of functioning.</p><p><strong>Conclusion: </strong>Our findings replicate those of previous studies demonstrating the association between hoarding and functional disability in older adults. Results highlight the high prevalence of cognitive impairment within this population and the need for multiple assessments when assessing functional disability in older adults with hoarding.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Cognitive Behavioral Therapy Delivery Formats on Anxiety, Depression, and Quality of Life in Parkinson's Disease: A Network Meta-Analysis.","authors":"Tengfei Li, Shuangli Zhang, Xiaotong Ding, Mingyue Zhu, Hongli Chen, Zhongchen Luo, Wanrui Wei, Zheng Li","doi":"10.1016/j.jagp.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.015","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and depression are common in Parkinson's disease (PD), but the optimal cognitive behavioral therapy (CBT) delivery format remains unclear. We aimed to compare the relative effectiveness of CBT delivery formats for anxiety, depression, and quality of life.</p><p><strong>Methods: </strong>We searched databases from inception to January 2026 and included randomized controlled trials (RCTs) of CBT for PD. Two reviewers independently conducted the study inclusion, data extraction, and risk of bias assessments. We conducted random-effects frequentist network meta-analyses to summarize the evidence and used the GRADE approach to rate the certainty of evidence.</p><p><strong>Results: </strong>A total of 34 RCTs were included. At postintervention, face-to-face group CBT probably reduced anxiety (SMD -1.12, 95% CI -1.85 to -0.38, moderate certainty), whereas face-to-face individual CBT may improve depression (SMD -1.18, 95% CI -1.71 to -0.65, very low certainty) and quality of life (SMD -1.36, 95% CI -2.56 to -0.16, moderate certainty). At follow-up, face-to-face individual CBT probably reduced anxiety (SMD -0.81, 95% CI -1.16 to -0.46, moderate certainty), whereas remote individual CBT probably improved depression (SMD -1.09, 95% CI -1.63 to -0.56, moderate certainty) and quality of life (SMD -0.50, 95% CI -0.81 to -0.19, moderate certainty).</p><p><strong>Conclusion: </strong>Moderate certainty evidence suggests that face-to-face group CBT probably reduces short-term anxiety, face-to-face individual CBT probably improves quality of life and sustains a reduction in anxiety, and remote individual CBT probably improves long-term depression and quality of life. These findings may help clinicians consider CBT delivery formats according to specific therapeutic goals and the expected duration of benefit in PD care.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Escitalopram on Neuropsychiatric Symptoms in Alzheimer Disease: A Secondary Analysis From the S-CitAD Study.","authors":"Emily D Clark, Jamie Perin, Devangere P Devanand, Prasad R Padala, David M Shade, Constantine G Lyketsos, Anton P Porsteinsson","doi":"10.1016/j.jagp.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.011","url":null,"abstract":"<p><strong>Objective: </strong>Using Neuropsychiatric Inventory (NPI) data from the Escitalopram for agitation in Alzheimer disease (S-CitAD) study, the authors explored the potential impact of escitalopram on neuropsychiatric symptom domains and caregiver distress scores outside of agitation.</p><p><strong>Methods: </strong>Caregiver-rated scores were compared from baseline to week 12 in 173 participants receiving escitalopram (5-15 mg/day) or placebo examining the presence or absence of individual neuropsychiatric symptoms, emergence of new symptoms, and median NPI domain severity scores between groups at week 12. Caregiver distress scores were additionally examined by NPI domain at baseline and at week 12 for between group changes.</p><p><strong>Results: </strong>Statistical significance was seen in the depression/dysphoria domain median scores favoring the escitalopram group at week 12. Caregiver distress scores in the domains of apathy/indifference and irritability/lability favored escitalopram at week 12; however, the median NPI domain scores in these domains weren't statistically different from placebo. In evaluating the emergence of new symptoms over the 12-week period, no participants (0%) in the escitalopram group reported new hallucinations versus 5 participants (7%) in the placebo group.</p><p><strong>Conclusion: </strong>Escitalopram may have an impact on the severity of symptoms of depression/dysphoria in AD. No new symptoms of hallucinations in the escitalopram group throughout the 12 week trial suggest a possible direction for future research into selective serotonin reuptake inhibitors (SSRIs) and the treatment and/or delaying of psychotic symptoms in AD. As this was an exploratory analysis involving multiple comparisons, findings may be spurious.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Reviewing the Consistency of Clinical Outcomes in the Treatment of Anxiety Disorders in the Elderly.","authors":"Bela Janare Putra, Kus Hendar","doi":"10.1016/j.jagp.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.005","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Specific Exercise Interventions on Post-Stroke Depression, Anxiety and Cognitive Function in Older Adults: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Yu-Cheng Wang, Yi-Ran Huang, Xiao-Xuan Meng, Qinge Zhang, Yuan Feng, Zhaohui Su, Teris Cheung, Gabor S Ungvari, Todd Jackson, Gang Wang, Yu-Tao Xiang","doi":"10.1016/j.jagp.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.012","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke depression, anxiety, and cognitive impairment are prevalent in older adults and may impede recovery. We evaluated the comparative efficacy of exercise interventions for these outcomes using network meta-analysis.</p><p><strong>Methods: </strong>We systematically searched five international and two Chinese databases from inception to July 2025 for randomized controlled trials enrolling older adults with stroke receiving exercise-based interventions. Primary outcomes were depression, anxiety, and cognitive function. Treatment effects were estimated as standardized mean differences (SMDs) with 95% credible intervals (CrIs), and interventions were ranked using surface under the cumulative ranking curve (SUCRA). Risk of bias and confidence in estimates were assessed with RoB 2 and CINeMA.</p><p><strong>Results: </strong>Fifty-two trials involving 4,170 participants were included; 11 were at low risk of bias. For depression, dual-task training (DTT), mind-body exercise (MBE), and balance/coordination training (BCT) ranked highest and showed statistically credible benefits versus usual care. For anxiety, MBE, resistance/strength training (RST), and DTT ranked highest, with statistically credible benefits observed for RST and DTT, whereas EFR was associated with worse anxiety outcomes. For cognitive function, MBE, general aerobic exercise (GA), and moderate-intensity continuous training (MICT) ranked highest, whereas BCT was the only intervention showing a statistically credible benefit versus usual care. Meta-regression suggested that longer time since stroke was associated with smaller benefits for anxiety and cognitive outcomes.</p><p><strong>Conclusions: </strong>Exercise interventions may yield outcome-specific benefits after stroke in older adults. These findings support individualized, phase-sensitive exercise prescription in post-stroke rehabilitation.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Reviewing the Consistency of Clinical Outcomes in the Treatment of Anxiety Disorders in the Elderly\".","authors":"Carly J Johnco, Sophie J Dickson, Ashleigh Seaton","doi":"10.1016/j.jagp.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.08.002","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive and Physical Effects of Virtual Rehabilitation in Mild Cognitive Impairment and Subjective Cognitive Decline: A Systematic Review and Meta-Analysis.","authors":"Ana Isabel Corregidor-Sánchez, Rui Pimenta Esteves, Martins João Paulo, Raquel Cervigón, Tiago Coelho, António Marques","doi":"10.1016/j.jagp.2026.07.003","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.07.003","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the effects of immersive and nonimmersive clinical virtual reality (CVR) on cognitive and physical outcomes in older adults with mild cognitive impairment (MCI) or subjective cognitive decline (SCD), and to examine the influence of intervention duration.</p><p><strong>Data sources: </strong>Seven databases were searched for randomized controlled trials up to February 2026.</p><p><strong>Review methods: </strong>The review followed PRISMA guidelines. Standardized mean differences (Hedges' g) were calculated using random-effects models.</p><p><strong>Results: </strong>Twenty-one randomized controlled trials involving 1,110 participants were included. CVR produced a significant large effect on global cognitive function (SMD = 0.89; 95% CI, 0.45-1.32; p = 0.001) and memory (SMD = 0.90; 95% CI, 0.50-1.31; p = 0.001). Effects on processing speed and sustained attention were large but not statistically significant (SMD = 0.84; 95% CI, -0.01-1.69; p = 0.052). Executive function showed a significant moderate effect (SMD = 0.54; 95% CI, 0.06-1.02; p = 0.003). Verbal learning and verbal fluency showed moderate, non-significant effects. No significant overall effect was found for physical function (SMD = 0.36; 95% CI, 0.00-0.71; p = 0.050). Nonimmersive CVR showed a larger effect on global cognition than immersive CVR, although the subgroup difference was not significant. Programs lasting at least 900 minutes showed a large effect on global cognition, with no significant difference compared with shorter programs.</p><p><strong>Conclusion: </strong>CVR may improve global cognition and memory in older adults with MCI or SCD and may complement conventional cognitive rehabilitation.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementia Rehabilitation Needs and Risk Prediction in Chinese Middle-Aged and Older Adults: Insights From GBD-WHO and CHARLS.","authors":"Yaqiong Fang, Kejia Cao","doi":"10.1016/j.jagp.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.07.016","url":null,"abstract":"<p><strong>Objective: </strong>Dementia poses a growing public health challenge in China, driving increasing demand for rehabilitation. Quantifying population-level rehabilitation needs and developing individual-level risk stratification tools are essential for targeted policy formulation and efficient resource allocation.</p><p><strong>Methods: </strong>This two-part study integrated population- and individual-level analyses. Using the GBD-WHO Rehabilitation Database (1990-2019), we estimated and forecasted dementia rehabilitation needs among Chinese adults aged 45 years and older. Using the China Health and Retirement Longitudinal Study cohort (n = 10,146), we developed and validated machine learning (ML) models to stratify individual dementia risk and conducted variable importance analysis to identify key predictors.</p><p><strong>Results: </strong>From 1990 to 2019, the number of prevalent dementia cases requiring rehabilitation in China increased 3.6-fold, reaching 15.19 million; while years lived with disability rose 3.7-fold, reaching 3.33 million. The age-standardized prevalence rate increased from 2,447.48 to 2,942.26 per 100,000 [AAPC: 0.63 (95% CI: 0.61-0.66)], and the age-standardized YLDs rate rose from 538.77 to 654.25 per 100,000 [AAPC: 0.67 (95% CI: 0.64-0.69)]. This upward trajectory is projected to continue through 2030. Among the developed ML models, Distributed Random Forest (DRF; test AUC = 0.728) and the gradient boosting machine (GBM; test AUC = 0.712) demonstrated the best overall predictive performance. Key predictors identified included older age, lower educational attainment, pain, self-rated health expectations, and several blood biomarkers.</p><p><strong>Conclusion: </strong>Dementia rehabilitation needs in China are both substantial and rapidly increasing. The developed ML stratification model provides a practical tool for population-level risk assessment, highlighting the urgent need to integrate population-level forecasting with individual-level stratification in national dementia rehabilitation strategies.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Longitudinal Relationships Between Cognitive Impairment and Depression in Older Adults: A Cross-Lagged Panel Network Analysis.","authors":"Hui-Hui Zhou, Yu Sun, Yang-Zi-Ye Guo, Feng Guo, Shuang Li, Ya Wang, Xuan Zhou, Fu-Qin Mu, Yi Qiao, Min Liu, Yan Liu","doi":"10.1016/j.jagp.2026.07.017","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.07.017","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the prospective associations and network characteristics between cognitive impairment and depression among individuals aged 60 years or older.</p><p><strong>Design: </strong>A longitudinal study employing a cross-lagged panel network (CLPN) analysis.</p><p><strong>Setting: </strong>Community-based setting in China.</p><p><strong>Participants: </strong>A total of 6,297 older adults participated, recruited via cluster sampling.</p><p><strong>Measurements: </strong>Cognitive function was assessed using the Ascertain Dementia eight-item questionnaire (AD-8). Depressive symptoms were measured using the Patient Health Questionnaire-nine (PHQ-9). A CLPN analysis was employed to establish the symptom network spanning time-point T1 to T2. Centrality metrics-including out-strength, in-strength, betweenness, and closeness-were quantified.</p><p><strong>Results: </strong>The results show that cognitive impairment (particularly AD-8 item 5: time disorientation and item 1: impaired judgment) was identified as the strongest prospective predictor of depressive symptoms, whereas the reverse influence of depressive symptoms on cognition was comparatively weak. Impaired judgment showed high out-predictability, suggesting its potential as a candidate target for early intervention; conversely, the high in-predictability of fatigue indicates it may be a sensitive marker of upstream network changes.</p><p><strong>Conclusions: </strong>This study provides evidence that cognitive impairment prospectively predicts depression in an asymmetric manner and offers a conceptual cascade model. These findings support further research into a public health shift toward staged interventions, from early screening to targeted strategies, to alleviate the population burden of this comorbidity.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}