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

{"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}

{"title":"The Interplay of Neuroticism and Resilience in Mild Cognitive Impairment: Unveiling Hidden Connections.","authors":"Chunlai Liu, Lei Zhou, Weiliang Cao","doi":"10.1016/j.jagp.2025.06.014","DOIUrl":"10.1016/j.jagp.2025.06.014","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1108-1109"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645240","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":"\"Younger\" and \"Older\" Old Adults Who Die by Suicide: A Comparison Study and Cluster Analysis.","authors":"Sabrina Doering, Sophie I Liljedahl, Sara Lindström, Mark Sinyor, Khedidja Hedna, Erik Bergqvist, Nina Palmqvist Öberg, Stefan Wiktorsson, Anne Stefenson, Jana Hartelius, Åsa Westrin, Margda Waern","doi":"10.1016/j.jagp.2025.05.006","DOIUrl":"10.1016/j.jagp.2025.05.006","url":null,"abstract":"<p><strong>Objectives: </strong>To compare sociodemographic, clinical, and suicide-specific characteristics between younger old (aged 65-74) and older old (aged 75+) adults who died by suicide in 2015, and to identify clinically relevant subgroups in the entire study cohort 65+ through cluster analysis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>All health care units across Sweden.</p><p><strong>Participants: </strong>Individuals aged 65+ with at least one physician contact in the year preceding suicide (N = 277; aged 65-74 n = 145, 75+ n = 132).</p><p><strong>Measurements: </strong>Variables retrieved from medical records and the Swedish Cause of Death Register.</p><p><strong>Results: </strong>There were no differences between age groups, except being widowed, which was documented to a higher proportion in those aged 75+ (10% vs 28%, p < 0.001). Nearly half of the total cohort had a prescription for antidepressants at the time of death, but increased suicide risk was noted in only 13%. Two groups emerged via cluster analysis. One large group (n = 197) was characterized by male sex and comparatively low proportions with notations related to mental ill-health. The other group (n = 80) was characterized by high rates of mental illness including suicidal ideation and prescribed psychoactive medication.</p><p><strong>Conclusions: </strong>We identified no clinically meaningful age group differences. Cluster analysis revealed a large, predominantly male group in which one third were prescribed antidepressants. Otherwise, there was little documentation related to mental health, suggesting other suicidal precipitants, underdiagnosis, and/or underestimation of the severity of mental illness in that group. This points to a need for data sources that go beyond medical records to inform targeted prevention efforts.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1035-1045"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251889","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":"Multimorbidity Profiles and Cause-Specific Mortality Among Older Adults with Schizophrenia.","authors":"Alison R Hwong, Yixia Li, Michael A Steinman, Christina Mangurian, Donna M Zulman, Ruth T Morin, Daniel M Blonigen, Amy L Byers","doi":"10.1016/j.jagp.2025.06.002","DOIUrl":"10.1016/j.jagp.2025.06.002","url":null,"abstract":"<p><strong>Objective: </strong>To characterize multimorbidity patterns among mid- to late-life adults with schizophrenia and evaluate the relationship between multimorbidity patterns and cause-specific mortality.</p><p><strong>Methods: </strong>This study utilized a national, longitudinal, cohort of U.S. veterans aged 50 years and older with schizophrenia who were followed 2012-2020 (n = 91,680). Latent class analysis was used to identify multimorbidity profiles of medical and neuropsychiatric diagnoses. Demographic variables and diagnoses were extracted from the Veterans Affairs (VA) National Patient Care Database and Centers for Medicare & Medicaid Services data. Information on cause-specific mortality was drawn from the VA Mortality Data Repository. Fine-Gray models were used to examine associations between multimorbidity classes and incident mortality over the study period, including death due to natural causes, unintentional injury, and suicide.</p><p><strong>Results: </strong>Four multimorbidity classes were identified: Minimal Multimorbidity (52%), high anxiety/post-traumatic stress disorder (PTSD) (19%), psychiatric and substance use disorder (SUD) (19%), and high Medical-Psychiatric (11%). The high Medical-Psychiatric class had the highest risk of overall mortality during the study period (HR 2.03, 95% CI 1.97-2.09 versus Minimal Multimorbidity), with the most common causes of death due to heart disease, cancer, and chronic lower respiratory disease. The psychiatry and SUD class had the highest risk of death due to unintentional injury (HR 2.24, 95% CI 2.00-2.51). The High Anxiety/PTSD group had the highest risk of suicide death (HR 1.37, 95% CI 1.06-1.77).</p><p><strong>Conclusion: </strong>Older veterans with schizophrenia are a heterogeneous group with distinct multimorbidity patterns and associated causes of mortality. Tailored interventions should address the specific clinical and psychosocial needs of these subgroups.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1095-1105"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562657","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":"Electroconvulsive Therapy in the Oldest-Old Patients With Depression: Response and Remission Rates, Prognostic Factors, Adverse Events and Mortality.","authors":"Tor Arnison, Alina Eriksson, Axel Nordenskjöld","doi":"10.1016/j.jagp.2025.06.013","DOIUrl":"10.1016/j.jagp.2025.06.013","url":null,"abstract":"<p><strong>Objectives: </strong>Depression is common in the oldest-old population (aged ≥85 years), a population in which research is lacking and the effects of psychopharmacological treatment may be adverse. Electroconvulsive therapy (ECT) appears to be well tolerated by older patients with depression; however, it is used rarely in clinical practice and research concerning the oldest-old is lacking. The objective of this study was to assess response and remission rates, as well as adverse effects, in oldest-old depressed patients treated with ECT.</p><p><strong>Methods: </strong>This was a nationwide Swedish register study including 522 oldest-old patients treated with ECT for depression. Two propensity score matched control groups were also included: young patients treated with ECT, and oldest-old depressed patients not treated with ECT. Response and remission rates, clinician-reported adverse events, prognostic factors (including comorbid diseases and treatment parameters), adverse events requiring hospitalization, as well as deaths within 1 week from discharge, were assessed.</p><p><strong>Results: </strong>The oldest-old receiving ECT reported higher response (81.2%) and remission (53.3%) rates than younger counterparts (67.4% versus 27.4%, respectively). Severe psychotic depression was the only prognostic factor for response and remission. The oldest-old experienced fewer adverse events, most commonly confusion and cardiovascular complications, compared to controls. Compared with oldest-old patients not receiving ECT, the ECT group had fewer hospitalizations following discharge.</p><p><strong>Conclusion: </strong>ECT is a viable treatment option for oldest-old patients with depression, who show higher response and remission rates than younger patients, as well as fewer hospitalizations than oldest-old patients not treated with ECT.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1065-1076"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610908","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":"Beneath the Tip of the Iceberg: The Late-Life Suicide Cases We Do Not See in the Clinic.","authors":"Anna Szücs","doi":"10.1016/j.jagp.2025.06.005","DOIUrl":"10.1016/j.jagp.2025.06.005","url":null,"abstract":"","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1046-1048"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565618","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":"Efficacy and Safety of Transcranial Direct Current Stimulation for Depression in Older Adults: A Systematic Review and Meta-Analysis of Mixed-Age Studies.","authors":"Isabel A Yoon, Caili Ren, Vanessa M Pazdernik, John Li, Sandeep R Pagali, Simon Kung, Annie M Waniger, Nick Corriveau-Lecavalier, Alvaro Pascual-Leone, Maria I Lapid","doi":"10.1016/j.jagp.2025.06.009","DOIUrl":"10.1016/j.jagp.2025.06.009","url":null,"abstract":"<p><strong>Objectives: </strong>Geriatric depression is a significant public health burden and is challenging to treat. The current study aimed to examine the effectiveness of transcranial direct current stimulation (tDCS) as a nonpharmacologic intervention approach for depression in older adults.</p><p><strong>Methods: </strong>We performed a systematic review of 24 studies across 13 countries including a total of 1,277 participants. Excluding six studies with incomplete data, we performed a metaanalysis of 18 randomized clinical trials (RCTs) involving 912 patients (502 active tDCS, 410 sham control tDCS).</p><p><strong>Results: </strong>Results revealed a large effect size favouring active tDCS for depressive symptoms (SMD = -0.96, 95% CI -1.56 to -0.37), though with high heterogeneity (I² = 89%). Large effect sizes favouring active tDCS were demonstrated in clinician-administered depression measures (Hamilton Depression Rating Scale [HDRS], Montgomery-Åsberg Depression Rating Scale [MADRS], Cornell Scale for Depression in Dementia [CSDD]) as well as in self-report measures (Beck Depression Inventory [BDI], Zung Self-Rating Depression Scale [SDS]). Subgroup analyses showed a nonsignificant effect in studies focused solely on major depressive disorder (MDD) and a large, though preliminary, effect in studies limited to adults aged 65 and older.</p><p><strong>Conclusions: </strong>These findings suggest that tDCS may be a promising nonpharmacological treatment option for depression in older adults, particularly in the context of comorbid conditions. However, further high-quality research specifically targeting this population is needed to validate its efficacy and optimize treatment protocols.</p>","PeriodicalId":520785,"journal":{"name":"The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry","volume":" ","pages":"1077-1094"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645239","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}