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

{"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}

{"title":"Visual Working Memory in Older Adults With and Without Early-Onset Depression: An Ecological Momentary Assessment Study.","authors":"Clio E Franklin, Boyu Ren, Jack R Kaufman, Olivia Nercessian, Matthew Schurr, Regan E Patrick, Sara L Weisenbach","doi":"10.1016/j.jagp.2026.06.017","DOIUrl":"10.1016/j.jagp.2026.06.017","url":null,"abstract":"<p><strong>Objective: </strong>To use the dot memory task to examine the impact of early-onset depression (ED) on visual working memory (VWM) in later life when compared to those with no history of depression (CON). As an exploratory aim, we examined VWM in remitted versus non-remitted depression when compared to those with no history of depression.</p><p><strong>Design, setting, participants, and measurements: </strong>A total of 79 participants aged 55-79 underwent lab-based neuropsychological testing. They were then provided with a study-supplied smartphone and were prompted to complete ecological momentary assessments over 14 consecutive days, receiving 3 separate notifications a day. Prompts consisted of a brief survey regarding recent activities, affect ratings, and use of emotion regulation strategies, followed by 3-5 brief cognitive tasks. VWM was measured with a dot memory task. Both response time and error distance were calculated.</p><p><strong>Results: </strong>Mean response rate was 70%. The ED group had significantly slower response times at baseline than the CON group (18.9% slower, 95% CI 2.7-37.6%, p = 0.023). Across the study period, the ED group's response time decreased faster relative to CONs (-0.8% per day, 95% CI -1.6 to +0.0%, p = 0.057), an effect driven by the actively depressed (AD) subgroup, whose response time decreased significantly faster (AD versus CON: -1.3% per day, 95% CI -2.3 to -0.4%, p = 0.007).). There was no significant difference in either the level or the rate of change of error distance between CON and ED participants. Within-person variability (standard deviation) in response time did not differ by group or change over time; within-person variability in error distance declined over the study period in CONs but declined significantly less in the ED group (ED × time: 0.02 units/day, 95% CI 0.001-0.039, p = 0.037).</p><p><strong>Conclusion: </strong>Our findings suggest that the VWM domain may be a malleable target for state improvements in cognitive functioning in depressed patients.</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":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional Factors Associated With Depressive Symptoms in Colombian Centenarians.","authors":"Juan-Manuel Anaya, Hernán Felipe Guillen-Burgos, Ivan David Lozada-Martinez, Claudia Inés Birchenall-Jiménez","doi":"10.1016/j.jagp.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.07.009","url":null,"abstract":"<p><strong>Objectives: </strong>To identify multidimensional factors associated with depressive symptoms in Colombian centenarians and to compare the relative contribution of functional, cognitive, psychosocial, and nutritional domains to these symptoms.</p><p><strong>Design, setting, participants: </strong>Cross-sectional analytical study. Community-based centenarian cohort in Colombia, in which a total of 152 adults aged 100 years or older with comprehensive geriatric assessment were included.</p><p><strong>Measurements: </strong>Positive depressive symptoms were defined as a score ≥6 on the 15-item Geriatric Depression Scale. Twelve candidate variables from functional, cognitive, psychosocial, and nutritional domains were examined. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by domain-specific and combined multivariable logistic models. Model performance was assessed by discrimination, calibration, collinearity diagnostics, influence analysis, and sensitivity analyses using multiple imputation.</p><p><strong>Results: </strong>The prevalence of depressive symptoms was 15.8% (n = 24/152). In bivariate analyses, clinically notable differences include higher sarcopenia prevalence, worse cognitive scores, lower life satisfaction, lower quality of life, loneliness, insomnia, anxiety, worse self-perception, and poorer nutritional status (p <0.05). Across modeling strategies, the psychosocial domain showed the strongest discriminative performance. In the final combined model, less overall life satisfaction and loneliness remained associated with depressive symptoms. The final model demonstrated good apparent discrimination (AUC = 0.836).</p><p><strong>Conclusions: </strong>In Colombian centenarians, depressive symptoms were primarily associated with lower life satisfaction and perceived loneliness. Future studies should determine the temporal relationships among psychosocial, cognitive, and functional domains, evaluate causal pathways underlying depressive symptoms, and establish whether these associations are consistent across diverse populations of individuals with extreme longevity.</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":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764218","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":"Older Adults Have the Highest Suicide Rates in the United States: Can Risk Algorithms Help Identify Those at Highest Risk in Emergency Departments?","authors":"Shane J Sacco, Lisa C Barry, Kun Chen, Robert H Aseltine","doi":"10.1016/j.jagp.2026.07.005","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.07.005","url":null,"abstract":"<p><strong>Objective: </strong>Older adults have high suicide rates, with those age ≥75 years conferring the highest risk. While risk algorithms (i.e., statistical models built to predict suicide risk) show promise in identifying suicide risk in healthcare settings, none have examined how they perform among successive age groups of older adults. Using medical records from ≥65-year-old patients, we developed models to predict risk of suicidal behaviors in this population. We focused on patients seen in emergency departments given this setting serves as an important contact point to identify suicide risk, and older adults are treated and readmitted in disproportionately higher rates than younger adults. Performance was compared across age groups (65-74, 75-84, ≥85 years).</p><p><strong>Design: </strong>Retrospective cohort study of electronic health records from 2019 to 2024.</p><p><strong>Setting: </strong>Cosmos, a nationwide database curated by the Epic Corporation.</p><p><strong>Participants: </strong>Adults ≥65 years old seen in US emergency departments during December 2023 (N = 856,132).</p><p><strong>Measurements: </strong>Patient demographics and International Classification of Diseases version 10 (ICD-10) diagnosis codes were extracted from medical records. Demographics and historical ICD-10 codes (2019-2023) were utilized as model predictors. ICD-10 codes indicating nonfatal or fatal suicidal behaviors during 2024 were utilized as model outcomes.</p><p><strong>Results: </strong>Risk algorithm performance decreased in older age groups. The average area under the receiver operating characteristic curve was 0.85 (95% CI: 0.85-0.86), 0.83 (0.81-0.84), and 0.81 (0.80-0.82) for 65-74-, 75-84-, and ≥85-year-old patient groups, respectively.</p><p><strong>Conclusion: </strong>While risk algorithms can help identify patients at suicide risk, they appear to perform worse among the oldest adults. Efforts to improve risk identification should be explored for older adults seen in general healthcare settings such as emergency departments.</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":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650444","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":"Engagement and Outcomes Associated With Message-Based Psychotherapy Among Older and Younger Adults.","authors":"Brenna N Renn, Emily Peake, Lilla Brody, Aarthi Padmanabhan, Patrick J Raue","doi":"10.1016/j.jagp.2026.06.016","DOIUrl":"10.1016/j.jagp.2026.06.016","url":null,"abstract":"<p><strong>Objective: </strong>Older adults are underrepresented in digital mental health research. As Medicare expands reimbursement for such services, understanding benefit is paramount. This study examined longitudinal engagement and clinical outcomes among older adults receiving virtual psychotherapy.</p><p><strong>Design: </strong>Retrospective cohort study of patients who received usual psychotherapy care delivered as asynchronous message-based care and/or live tele-sessions.</p><p><strong>Setting: </strong>Talkspace, a U.S. telemedicine platform.</p><p><strong>Participants: </strong>Talkspace users aged 65+ (n = 510) with elevated depression and/or anxiety symptoms and a randomly selected comparison sample of 510 adults 25-35 with similar depression/anxiety scores.</p><p><strong>Measurements: </strong>Cohorts were compared across engagement with the platform and clinical outcomes (change in PHQ-9 [depressive symptoms] or GAD-7 [anxiety symptoms]) over 15 weeks.</p><p><strong>Results: </strong>Older adults engaged with the digital platform for a shorter duration than younger adults (mean [SD], 16.4 [26.6] versus 24.6 [31.6] weeks; t(989.45) = -4.45, p < 0.001) but did not differ in weekly message frequency, message word count, or video session attendance. Both groups showed significant reductions in depression and anxiety symptoms over 15 weeks. Among participants retained in treatment at week 15, 78.8% of older adults achieved at least the minimally important clinical difference for depression and 64.3% for anxiety, with corresponding rates of 50.0% and 53.7% among younger adults.</p><p><strong>Conclusion: </strong>Adults aged 65 years and older engaged in digital psychotherapy at levels not significantly different from younger adults. Both older and younger groups experienced substantial reductions in depressive and anxiety symptoms and did not significantly differ in these improvements. Findings support feasibility and clinical utility for older adults.</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":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bayesian Reanalysis of a Pilot Randomized Clinical Trial of Low-Dose Lithium in Mild Cognitive Impairment: A Probabilistic Re-Expression of the LATTICE Trial.","authors":"Anderson M P da Silva, Diogo Haddad-Santos, Daniel Vicente de Siqueira Lima, Leonardo Januário Campos Cardoso, Carolina Braga Moura, Poul F Høilund-Carlsen, George Perry, Taro Kishi, Breno José Alencar Pires Barbosa, Renato Anghinah","doi":"10.1016/j.jagp.2026.06.014","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.06.014","url":null,"abstract":"<p><strong>Objective: </strong>The LATTICE pilot randomized clinical trial found no statistically significant effect of low-dose lithium on 6 coprimary outcomes in mild cognitive impairment (MCI). We aimed to re-express these results in Bayesian terms and estimate the probability of benefit, negligible difference, or harm across cognitive, neuroimaging, biomarker, and safety outcomes.</p><p><strong>Methods: </strong>We conducted a Bayesian reanalysis of published aggregate data from LATTICE, a single-site, randomized, double-blind, placebo-controlled 2-year trial of low-dose lithium carbonate versus placebo. The trial randomized 83 older adults with MCI, of whom 80 initiated treatment. Outcomes included verbal and visuospatial delayed recall, Preclinical Alzheimer Cognitive Composite, hippocampal and cortical volume measures, brain-derived neurotrophic factor, and serious adverse events. Posterior means, 95% credible intervals (CrI), and posterior probabilities were estimated using weakly informative priors.</p><p><strong>Results: </strong>Lithium was associated with a posterior mean standardized effect of 0.38 SD for CVLT-II delayed recall (95% CrI, -0.03 to 0.80), corresponding to a 96.5% probability of benefit and an 80.6% probability of exceeding 0.20 SD. The raw between-group difference was 1.47 points (95% CrI, 0.18-2.75). Bayesian re-expression of the intention-to-treat model showed an annualized CVLT-II treatment-by-time effect of 0.69 points per year (95% CrI, 0.02-1.35). BVMT-R remained near null. Hippocampal outcomes were directionally favorable but imprecise. Other cognitive, biomarker, imaging, and safety outcomes showed no robust signal.</p><p><strong>Conclusions: </strong>This Bayesian reanalysis supports an inconclusive interpretation of LATTICE, while identifying a probabilistic signal for verbal delayed recall-not seen in the other outcomes-that warrants testing in adequately powered trials.</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":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612455","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":"Prevalence of Sarcopenia-Related Muscle-Health Phenotypes in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis.","authors":"Juan Luis Sánchez-González, Alba Sánchez-Gil, Óscar Gonzalo, Luis Polo-Ferrero, Javier Martín-Vallejo, Jesus Perez","doi":"10.1016/j.jagp.2026.06.004","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.06.004","url":null,"abstract":"<p><p>Severe mental illness (SMI) is associated with substantial physical morbidity and premature mortality, yet muscle health has received limited attention in this population. This systematic review and meta-analysis aimed to estimate the prevalence of sarcopenia-related muscle-health phenotypes and to synthesize evidence on impaired muscle health in individuals with SMI. A comprehensive search of PubMed, Cochrane Library, Scopus, and Web of Science was conducted up to February 2026. Eligible studies included patients with SMI and reported sarcopenia or related conditions based on consensus criteria or clearly defined operational definitions. Study selection, data extraction, and risk of bias assessment were conducted following standardized procedures. A random-effects meta-analysis of proportions was performed. Ten studies involving 2210 participants were included; all studies were conducted in China, Japan, or Turkey. Most studies included patients with schizophrenia-spectrum disorders, whereas only one study included individuals with bipolar disorder. The exploratory pooled prevalence of sarcopenia-related muscle-health phenotypes was 43.6% (95% confidence interval: 30.3%-58.2%), with very high heterogeneity and a wide prediction interval. Therefore, this estimate should not be interpreted as a clinically precise prevalence of sarcopenia in SMI. Sensitivity analyses excluding clinically distinct studies and a potentially overlapping sample increased the estimate to 58% (95% confidence interval: 48%-67%), although heterogeneity remained substantial. Exploratory subgroup analyses suggested differences according to country, although this finding may reflect confounding by age distribution, phenotype definition, diagnostic framework, clinical setting, and assessment methods. Overall certainty of evidence was rated as very low due to methodological limitations in prevalence studies, inconsistency, and potential small-study effects. Sarcopenia-related muscle-health phenotypes may represent an underrecognized dimension of physical morbidity in individuals with SMI, although the precision and generalizability of the pooled estimate are limited by high heterogeneity and the use of non-equivalent phenotypes. These findings support broadening physical health assessment beyond cardiometabolic outcomes to include muscle-related impairments and physical frailty.</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":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428566","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":"Age Disparities in Mortality and ICU Utilization Following Suicide Attempts: Insights From the National Trauma Data Bank.","authors":"Sarah Alamprese, Nwe Oo Mon, Elisa Szydziak, Samantha J Goldstein, Sara Cardozo-Stolberg, L D George Angus, Taleah Angus, Matthew Kemmerle, Ryan Senese, Vishes Mehta, Venkatesh Sasthakonar","doi":"10.1016/j.jagp.2026.06.005","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.06.005","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify factors associated with in-hospital mortality following suicide attempts and examine the disparities between methods used amongst older and younger cohorts.</p><p><strong>Methods: </strong>A retrospective analysis of data from the National Trauma Data Bank was completed for the year 2022 for younger adults (18-54) and older adults (≥55) that presented to trauma centers following suicide attempts. The primary outcome was in-hospital mortality with secondary outcomes including any in-hospital complications as well as intensive care unit (ICU) and hospital length of stays.</p><p><strong>Results: </strong>Older adults demonstrated higher in-hospital mortality compared to younger adults and differed in suicide methods, injury patterns, and clinical presentation. Older adults (40.7%) had a higher percentage of firearm use compared to younger adults (24.9%). Older adults were more frequently admitted to the intensive care unit compared to younger adults (44.5% vs 36.5%). In multivariable models, factors associated with increased mortality included, male sex, greater injury severity, lower GCS, head injury, and multiple comorbidities. Interaction analysis demonstrated that the effect of age on mortality differed by suicide method, with a greater age-related difference observed for jumping/lying-in-front injuries. In sensitivity analyses restricted to inpatients, the inverse association between ICU admission and mortality was attenuated.</p><p><strong>Conclusion: </strong>Mortality following suicide attempts is influenced by both age and method, with older adults experiencing higher risk. The impact of early deaths on observed associations highlights the importance of incorporating timing of death in trauma-based analyses. These findings highlight age-related disparities and emphasize the need for tailored suicide prevention 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":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458361","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":"Benefit and Uptake: A Mixed Methods Study Exploring Older Adults' Experiences With a Psychoeducational and Exercise Training Maintenance Intervention.","authors":"Mayra L Sánchez González, Mario Cruz-Gonzalez, Daniel A Pineiro, Carolina Nvé Díaz San Francisco, Nubia A Mayorga, Lulu Zhang, Sheri L Markle, Margarita Alegría","doi":"10.1016/j.jagp.2026.05.018","DOIUrl":"10.1016/j.jagp.2026.05.018","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate whether engaging in a combined psychoeducational and exercise-maintenance intervention was associated with the nonrecurrence of psychological distress and mobility difficulties; explore participants' perceived benefits; and identify factors associated with intervention uptake.</p><p><strong>Design: </strong>Convergent mixed-methods. Quantitative data included 48 participants from the maintenance phase (Months 7-12) of the Positive Minds Strong Bodies-Enhanced randomized trial, and 19 semi-structured interviews with participants who accepted or declined the intervention.</p><p><strong>Setting: </strong>Community-based organizations and clinics in four U.S.</p><p><strong>Locations: </strong>Massachusetts, Maryland, New York, and Puerto Rico. Data was collected between November 2020 and October 2024.</p><p><strong>Participants: </strong>Older adults (60+) with mild-to-severe depression or anxiety symptoms and minor-to-moderate mobility difficulties.</p><p><strong>Interventions: </strong>Up to 24 psychoeducation and up to 48 exercise drop-in maintenance group sessions to sustain and enhance the benefits of the acute phase.</p><p><strong>Measurements: </strong>Recurrence of psychological distress and mobility difficulties at 12 months, using the Hopkins Symptom Check List-25 and the Short Physical Performance Battery. We also identified participant-level demographic and clinical characteristics associated with intervention uptake. We compared all measurements by intervention uptake (accepted vs. declined).</p><p><strong>Results: </strong>There were no differences in the recurrence of psychological distress or mobility difficulties by intervention uptake (accepted vs. declined). However, those who accepted described benefits in symptom relief and daily functioning. Several factors influenced uptake decisions: age, race/ethnicity, cognitive function, and participants' appraisal of their individual and environmental needs.</p><p><strong>Conclusions: </strong>Older adults can reap benefits from maintenance interventions. However, their engagement hinges on alignment with personal, social, and environmental contexts.</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":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Striatal Dopaminergic Neurotransmission, Striato-Cortical Functional Connectivity, and Motivation in Community-Dwelling Older Adults.","authors":"Yixiao Song, Peggy M Cawthon, Xuetong Zhai, Theodore J Huppert, Andrea L Rosso, Meryl A Butters, Lana M Chahine, Brian J Lopresti, Sarah K Royse, Caterina Rosano","doi":"10.1016/j.jagp.2026.03.210","DOIUrl":"10.1016/j.jagp.2026.03.210","url":null,"abstract":"<p><strong>Objective: </strong>Motivation, an important determinant of health and well-being in older adults, often declines in older age leading to negative health outcomes. However, the neurobiological basis of age-related changes in motivation is unclear. We hypothesized that higher striatal dopaminergic neurotransmission is positively related to motivation among community-dwelling older adults, and that striato-cortical functional connectivity explains, at least in part, this relationship.</p><p><strong>Methods: </strong>Dopaminergic neurotransmission was indexed by quantifying Vesicular Monoamine Transporter 2 expression in the striatum using (+)-α-[¹¹C]dihydrotetrabenazine (DTBZ) via positron emission tomography imaging. Resting-state co-activation of the striatum with cortical regions indexed the strength of functional connectivity. Motivation level was assessed using latent class analysis applied to responses on an 18-item questionnaire. Multinomial logistic regression models examined the associations of striatal [¹¹C]DTBZ binding with motivation levels, without and with adjustment for striato-cortical functional connectivity. Structural equation models tested the mediating role of functional connectivity.</p><p><strong>Results: </strong>Among 234 older adults (mean age 75.2 years [range: 67.2-91.2]; 59.8% female; 91.5% White), three distinct motivation groups were identified: low (N = 30), moderate (N = 89), and high motivation (N = 115). Striatal [¹¹C]DTBZ binding was significantly and inversely associated with motivation (adjusted odds ratio = 0.53; 95% CI: 0.32-0.88). Striato-insular and striato-dorsal visual functional connectivity was positively associated with both [¹¹C]DTBZ and motivation, but did not modify the main association; mediation analyses indicated no mediating role.</p><p><strong>Conclusion: </strong>Striatal dopaminergic neurotransmission and striato-insular functional connectivity may influence motivational capacity in older adults, perhaps acting through independent pathways.</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":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680250","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}