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

{"title":"Association of Cardiovascular-Kidney-Metabolic Health With Structural Brain Imaging and the Risk of Specific-Cause Dementia: A Cohort Study.","authors":"Heng Zhang, Xinhui Liu, Diyang Lyu, Tingting Hou, Fuzhong Xue, Yifeng Du","doi":"10.1016/j.jagp.2026.03.205","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.03.205","url":null,"abstract":"<p><strong>Objectives: </strong>CKM syndrome may represent the coexistence of multiple risk factors for dementia; however, its large sample-based effects on the risk of specific-cause dementia and the alterations revealed by brain imaging remain unclear.</p><p><strong>Measurements: </strong>The 239,617 dementia-free participants from the UK Biobank were included in this study. Multivariate Cox regression analyses and stratifications were used to assess longitudinal associations. Linear regression analyses were employed to evaluate CKM-brain structure links. Sensitivity and Mendelian randomization (MR) analyses were performed to confirm the robustness of the results.</p><p><strong>Results: </strong>Over a 13.6-year median follow-up duration, 3,503 participants developed dementia that included 1,526 Alzheimer's disease (AD) and 770 vascular dementia (VaD) cases. Advanced CKM syndrome stages showed a dose-dependent risk of dementia: stage 3 (Hazard Ratio [HR] = 1.74 versus stage 0, χ² = 19.92, df = 1, p <0.001) and stage 4 (HR = 1.92, χ² = 38.52, df = 1, p <0.001). This pattern held for VaD but not AD, although CKM syndrome stage progression elevated the risk of AD by 130%. MR analysis confirmed significant associations. As a component of the CKM syndrome, metabolic disorders (MD) (abdominal obesity and metabolic syndrome) significantly elevated the risk of VaD but not that of AD. Notably, midlife adults, women, non-APOEε4 carriers, and those displaying low physical activity and education exhibited heightened susceptibility to dementia. Further, there was a spatial correlation pattern between CKM syndrome and brain atrophy (imaging biomarker of dementia): early sensorimotor-limbic shrinkage expanded to prefrontal-parietal and posterior cingulate regions, culminating in hippocampal degeneration.</p><p><strong>Conclusions and implications: </strong>CKM syndrome stages may serve as a comprehensive predictor of dementia. Individualized monitoring of CKM factors across the lifespan of a person may mitigate progressive neurodegeneration and the risk of dementia.</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":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625262","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":"Knee Osteoarthritis as a Causal Risk Factor for Parkinson's Disease: Converging Evidence From a National Survey and Genetic Analysis.","authors":"Zhan Peng, Guangye Wang","doi":"10.1016/j.jagp.2026.02.017","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.02.017","url":null,"abstract":"<p><strong>Objective: </strong>Osteoarthritis (OA) and Parkinson's disease (PD) are age-related degenerative conditions with potentially shared pathophysiological pathways. This study aimed to investigate the association and potential causal links between site-specific OA phenotypes and PD risk using a dual-method approach.</p><p><strong>Design: </strong>We employed a dual-method approach combining cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data with bidirectional two-sample Mendelian randomization (MR) analysis using large-scale genome-wide association study data.</p><p><strong>Setting: </strong>The cross-sectional analysis used a nationally representative U.S. population sample. The MR analysis used summary statistics from large international genetic consortia.</p><p><strong>Participants: </strong>The NHANES analysis included 21,414 adults aged ≥40 years (1999-2016). The MR analysis utilized genetic data from hundreds of thousands of European individuals.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements: </strong>In NHANES, OA and PD were based on self-reported physician diagnoses. In MR, genetic variants served as instrumental variables for OA phenotypes and PD. Multiple MR methods (inverse-variance weighted, weighted median, weighted mode, and MR-Egger) were used to assess potential causal links, with comprehensive sensitivity analyses performed.</p><p><strong>Results: </strong>In the fully adjusted NHANES analysis, OA was significantly associated with higher odds of PD (OR=2.99, 95% CI: 1.92-4.65). MR analyses revealed that genetic predisposition to knee OA was associated with an increased PD risk (OR=1.49, 95% CI: 1.11-2.02), with a similar effect for combined hip/knee OA (OR=1.23, 95% CI: 1.03-1.47). In contrast, hip OA showed no significant association with PD. Reverse MR analyses found no evidence supporting causal effects of PD on any OA phenotype.</p><p><strong>Conclusions: </strong>Both observational and genetic evidence consistently suggest that knee OA, but not hip OA, may be a causal risk factor for PD, with no evidence of reverse causality. The phenotype-specific findings suggest joint-specific mechanisms linking OA to neurodegeneration.</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":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597833","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":"Clinical Associations and Possible Risk Factors for Affective Neuropsychiatric Symptoms in Older Adults With and Without Cognitive Impairment.","authors":"Daniel W Fisher, Ronak Mehta, Christopher B Morrow, Kathleen F Kerr, Suman Jayadev, Kimiko Domoto-Reilly, Michael J Schrift, Martin Darvas","doi":"10.1016/j.jagp.2026.02.015","DOIUrl":"10.1016/j.jagp.2026.02.015","url":null,"abstract":"<p><strong>Objective: </strong>Affective neuropsychiatric symptoms (NPS)-depression, anxiety, and apathy-are frequent in older adults. Understanding which clinical characteristics might be associated with which affective NPS may guide future treatment and prevention strategies.</p><p><strong>Design: </strong>The National Alzheimer's Coordinating Center dataset, a large case series of more than 170,000 clinical visits.</p><p><strong>Setting: </strong>Multiple Alzheimer's Disease Research Centers throughout the United States.</p><p><strong>Participants: </strong>Adults 60 years and older with and without cognitive impairment.</p><p><strong>Measurements: </strong>The authors associated the odds of depression, anxiety, and apathy with clinical variables, including common and cardiovascular comorbidities, vital signs, medication classes, APOE status, race and ethnicity, and marital status across three cognitive groups: Cognitively Normal, Mild Cognitive Impairment, and Dementia.</p><p><strong>Results: </strong>Hearing loss and sleep abnormalities were robustly associated with all affective NPS at all cognitive stages. Cardiovascular diseases were not consistently associated with depression but were associated with greater apathy odds in cognitively normal participants. Nearly all odds ratios for all three affective NPS tended to attenuate to 1 as cognition worsened, potentially suggesting that neurodegeneration may drive affective NPS beyond other risk factors. Other associations with angina, osteoarthritis, blood pressure, heart rate, tobacco use, and race were noted.</p><p><strong>Conclusions: </strong>Clinical associations often vary by NPS metric choice. Hearing and sleep deficits may be important therapeutic targets to increase quality of life by reducing affective NPS in older adults. Further research into the specific biological mechanisms whereby neurodegeneration can cause affective NPS presentation may be warranted, separate from other risk factors for affective NPS in 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":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535597","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":"The Incidence of Schizophrenia Across the Lifespan: A Longitudinal Register Study in an Urban Population.","authors":"Simon Hogerzeil, Rob M Kok, Hans W Hoek, Albert M van Hemert","doi":"10.1016/j.jagp.2026.02.001","DOIUrl":"https://doi.org/10.1016/j.jagp.2026.02.001","url":null,"abstract":"<p><strong>Objectives: </strong>The idea that schizophrenia manifests before age 40 has shaped research and clinical practice. We aimed to estimate the incidence rate (IR) and lifetime morbidity risk (LMR) and age of onset of schizophrenia over a much wider age range.</p><p><strong>Methods: </strong>Age- and sex-stratified incidence rates and lifetime morbidity risk for schizophrenia over ages 20-79 years in the city of The Hague in The Netherlands during a 15-year study period were estimated. A register covering all psychiatric services with clinical diagnoses was used, with a cumulative time frame.</p><p><strong>Results: </strong>The pooled incidence of schizophrenia was 47 (95% confidence interval (CI) 45-49) per 100.000 person-years over the age range 20-79 years. The incidence decreased from 67 (95% CI: 63-71) in the early onset age range between 20-39 years, 45 (95% CI: 42-49) in the late onset age range between 40-59 years, and 19 (95% CI: 16-22) in the very-late onset age range of over 60 years. The lifetime morbidity risk (LMR) up to age 79 was 3.7% for males and 2.3% for females. At least 5 out of 6 (84%) of schizophrenia cases were diagnosed after the age of 30 years, and nearly half (46%) after the age of 40 years.</p><p><strong>Conclusions: </strong>Despite higher incidence rates in the youngest cases, particularly for males, onset after age 30 years of age is the norm, not the exception. Case finding should extend across the lifespan.</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":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373785","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":"How Having a Higher Sense of Life Meaning and Purpose Can Lower Risk for Cognitive Impairment.","authors":"Helen Lavretsky","doi":"10.1016/j.jagp.2025.06.012","DOIUrl":"10.1016/j.jagp.2025.06.012","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1032-1034"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621763","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":"Evaluating the Agreement Between ChatGPT-4 and Validated Mental Health Scales in Older Adults: A Cross-Sectional Study.","authors":"Jiali Liu, Juan Gu, MengJie Tong, YaKe Yue, Yufei Qiu, Lijuan Zeng, Yiqing Yu, Fen Yang","doi":"10.1016/j.jagp.2025.04.213","DOIUrl":"10.1016/j.jagp.2025.04.213","url":null,"abstract":"<p><strong>Background: </strong>The chat generative pretrained transformer (ChatGPT), an artificial intelligence-based web application, has demonstrated substantial potential across various knowledge domains, particularly in medicine. This cross-sectional study assessed the validity and possible usefulness of ChatGPT-4 in assessing mental health by comparing several scales.</p><p><strong>Methods: </strong>A cross-sectional study recruited 127 older adults (≥60 years old) from December 2023 to October 2024 in Wuhan. Scenarios contextualized to daily life were adapted using ChatGPT-4 to adapt six scales (PHQ-9, GAD-7, K10, PSS-4, ULS-6, WHO-5). The level of agreement between the ChatGPT-4 adapted scales and the traditional scales was compared using Spearman correlation, Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), and Bland-Altman analysis.</p><p><strong>Results: </strong>The ChatGPT-adapted questionnaires showed moderate to strong correlations with traditionally validated measures of anxiety, depression, psychological distress, perceived stress, loneliness, and well-being. Significant positive correlations were observed for total scores, including PHQ-9 (rho = 0.61), GAD-7 (rho = 0.66), K10 (rho = 0.75), PSS-4 (rho = 0.71), and ULS-6 (rho = 0.73), with slightly weaker correlation for WHO-5 (rho = 0.41). Reliability analyses yielded Cronbach's α values ranging from 0.66 to 0.91 and ICCs ranging from 0.47 to 0.81, confirming strong internal consistency and test-retest reliability.</p><p><strong>Conclusions: </strong>Moderate to high correlations were found between the adapted ChatGPT-4 questionnaire and the traditional scale, indicating that it shows promise as a supplemental mental health assessment tool. However, further research is needed to explore its broader applicability.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1049-1061"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113297","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":"Loneliness, Theory of Mind, and Artificial Intelligence.","authors":"George S Alexopoulos","doi":"10.1016/j.jagp.2025.06.015","DOIUrl":"10.1016/j.jagp.2025.06.015","url":null,"abstract":"<p><p>Philosophy and neurobiology can guide the integration of smart machines in initiatives intended to address the epidemic of loneliness in the aging population. Behaviorism and functionalism assume that AI systems can develop empathy-like functions. Property dualism posits that consciousness is an emergent function that depends on, but supervenes, its underlying neurobiological functions. Emergent functions occur in biology and, theoretically, they may occur in artificial systems. Therefore, advanced AI systems may develop intentionality, and agency, functions beyond those planned by their designers. Therefore, guidelines are needed for protection of humans and especially older adults with cognitive and cultural limitations related to technology. For AI systems to be helpful in mitigating loneliness, they should have capabilities similar to those of theory of mind functions (ToM), that allow an individual to identify emotions, intentions, and wishes of him/herself and of others and recognize to whom they belong. Cognitive and neurobiological studies show that ToM are disrupted in persons experiencing loneliness. AI systems with ToM functions may produce empathy-like responses appropriate for mitigating loneliness. Smart technology can be most effective against loneliness if integrated in the fabric of social and clinical interventions. Acceptance of technology by geriatric clinicians is critical, because they are best equipped to guide the targeted use of smart machines, prevent complications (e.g. countertherapeutic transference towards the machine), and correct the course of interventions. Neurobiology related to ToM functions and to prolonged grief disorder may guide research examining whether digital interventions can change neural functions related to loneliness and psychopathology.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1111-1118"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669298","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":"Can Artificial Intelligence be Used to Design More Ecologically Valid Mental Health Scales for Older People?","authors":"Aartjan Tf Beekman","doi":"10.1016/j.jagp.2025.05.005","DOIUrl":"10.1016/j.jagp.2025.05.005","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1062-1064"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251890","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":"Resilience and Personality in Older Adults Without Dementia: Some Additional Reflections.","authors":"","doi":"10.1016/j.jagp.2025.06.011","DOIUrl":"10.1016/j.jagp.2025.06.011","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1110"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621764","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":"Life Purpose Lowers Risk for Cognitive Impairment in a United States Population-Based Cohort.","authors":"Nicholas C Howard, Ekaterina S Gerasimov, Thomas S Wingo, Aliza P Wingo","doi":"10.1016/j.jagp.2025.05.009","DOIUrl":"10.1016/j.jagp.2025.05.009","url":null,"abstract":"<p><strong>Objective: </strong>We investigated whether sense of purpose in life (PiL) is associated with a lower risk for and delayed onset of developing cognitive impairment in a diverse US population-based cohort.</p><p><strong>Methods: </strong>Participants from the Health and Retirement Study aged 45 or older with normal cognitive performance at baseline and ≥ 2 subsequent objective cognitive assessments were included. Cognitive performance was objectively assessed biennially using the modified Telephone Interview for Cognitive Status (mTICS). Cognitive impairment was defined as having two consecutive visits with mTICS scores below a psychometrically validated threshold consistent with mild cognitive impairment or dementia. PiL was assessed at baseline using a seven-item questionnaire. Cox Proportional Hazards was modelled to examine the association between PiL and cognitive impairment. Restricted Mean Survival Times was calculated to estimate delay in onset age for cognitive impairment.</p><p><strong>Results: </strong>Of 13,765 participants, 1,820 (13%) developed cognitive impairment during follow-up (median of 8 years and up to 15 years). Those with higher PiL had significantly lower risk for developing cognitive impairment compared to those with lower PiL after adjusting for sex, baseline age, educational attainment, average depressive symptom score, and race/ethnicity (HR = 0.72, 95% CI: [0.63-0.82]). This association remained significant after adjusting for APOE E4 in addition to the above covariates in a subset with genotyping data. Furthermore, participants with higher PiL had a later onset age for cognitive impairment compared to participants with lower PiL after accounting for these covariates.</p><p><strong>Conclusion: </strong>Higher PiL was associated with approximately 28% lower risk for developing cognitive impairment and a later onset of cognitive impairment across the studied ethnic/racial groups, even among those with genetic risk for dementia. These findings indicate that fostering a sense of life purpose has the potential to reduce cognitive impairment and dementia risk.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1021-1031"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487780","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}