American Journal of Geriatric Psychiatry最新文献

{"title":"36. ANOTHER DUALISM: COGNITIVE VERSUS PERSONALITY PREDICTORS OF RUMINATION IN LATER LIFE DEPRESSION","authors":"Allison Gregg , Joseph Kim , Jack Kaufman , Jeremy Maciarz , Vincent Koppelmans , Scott Langenecker , Regan Patrick , Sara Weisenbach","doi":"10.1016/j.jagp.2025.04.038","DOIUrl":"10.1016/j.jagp.2025.04.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Rumination, a predisposing and perpetuating feature of depression, has been linked to personality and cognitive variables. However, little is known about their comparative influence on rumination. This study examined personality and cognition as predictors of rumination in early-onset, later life depression (LLD), for those with and without a history of depression. Exploratory analysis investigated this relationship in the subset of patients in a current depressive episode (state depression).</div></div><div><h3>Methods</h3><div>Participants were 76 adults aged 55-79 divided into two groups: “ever depressed” (N=35) including those with current or remitted depression, and “never depressed” (N=41) including those with no history of depression. A subset of the “ever depressed” group in a current depressive episode (N=18) were considered in the exploratory state depression analysis. Personality predictors were the five domains assessed by the NEO Personality Inventory – Revised (NEO-PI-R), openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Cognitive predictors were selected based on theory and existing support in the literature for their association with rumination, and included measures of executive function (Trail Making Test B, D-KEFS Color-Word Interference Condition 3, Wisconsin Card Sorting Test Perseverative Responses), attention (WAIS-IV Digit Span Forward), and global cognitive ability (Mini Mental Status Exam).</div><div>The omnibus analysis was conducted using hierarchical linear regression modelling for predictors of rumination, with variable blocks composed of 1) demographic factors (age, sex, education), 2) depression history (ever/never depressed), 3) all cognitive and personality variables, and 4) interaction terms (depression history x variable) for WCST Perseverative Errors and NEO-PI Neuroticism, the only variables with significant interaction effects in Block 3. Exploratory analysis considered whether results were influenced by depression severity for those in a current depressive episode, with hierarchical regression variable blocks of 1) demographic factors (age, sex, education), 2) MADRS score, and 3) WCST Perseverative Responses and NEO-PI Neuroticism Factor Score, along with their interaction terms based on depression severity (MADRS total score x variable).</div></div><div><h3>Results</h3><div>Depression history was a significant predictor of rumination in the primary analysis and remained significant following inclusion of all cognitive and personality variables. Neuroticism (β=.39, p LESS THAN .001) and WCST Perseverative Responses (β=0.18, p LESS THAN .05) significantly predicted rumination, though their interaction terms with depression history were nonsignificant. After inclusion of the interaction terms, MMSE emerged as a significant predictor of rumination (β=.17, p LESS THAN .05), despite initial nonsignificance.</div><div>For the exploratory analys","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S26"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"39. APATHY IS ASSOCIATED WITH GAIT VELOCITY IN A SOUTH INDIAN COMMUNITY DWELLING COHORT","authors":"Matthew Engel ,&nbsp;Emmeline Ayers ,&nbsp;Joe Verghese ,&nbsp;Mirnova Ceïde","doi":"10.1016/j.jagp.2025.04.041","DOIUrl":"10.1016/j.jagp.2025.04.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Apathy is frequently seen in neuropsychiatric diseases, including Parkinson disease and Alzheimer dementia, and may also be an independent risk factor for the development of motoric-cognitive risk syndrome (MCR). Existing literature on apathy has focused on community-dwelling cohorts from highly developed nations, such that the generalizability of work identifying a link between apathy and motoric-cognitive outcomes has not been fully demonstrated.</div></div><div><h3>Methods</h3><div>N=742 older adults were recruited from urban and rural areas in Kozhikode district, Kerala, India to participate in this cross-sectional study to examine the relationship between apathy, MCR, cognitive impairment, and other demographic characteristics. Apathy was assessed using the Apathy Evaluation Scale, and depression was measured with the Geriatric Depression Scale. MCR was defined as cognitive complaints and slow gait, with gait speed assessed as 1 SD below age- and sex-adjusted norms. Statistical analyses, including bivariate and regression models, were conducted to evaluate associations between apathy, gait velocity, and MCR using SPSS software.</div></div><div><h3>Results</h3><div>Compared with subjects in the lowest apathy tertile, those in the highest tertile were older (69.9 vs 67.5 years, p LESS THAN 0.0001), less physically active (0.9 vs 1.5 active days per week, p LESS THAN 0.05), in worse subjective general health (p LESS THAN 0.05) and had slower gait (74.9 vs 81.4 cm/s, p LESS THAN 0.005). High-apathy subjects also had lower ACE scores (79.3 vs 84.3, p LESS THAN 0.0001) and higher GDS scores (9.6 vs 5.6, p LESS THAN 0.0001), but not higher levels of dysphoria (p=0.1519). Before adjustment, apathy was found to negatively correlate with gait velocity (β = -0.112, p≤0.005), and this relationship was principally moderated by ACE score. Although subjects with MCR had higher levels of apathy compared to those without MCR (34.6 vs 31.4, p LESS THAN 0.01), prevalent MCR and apathy tertile were not significantly associated in logistic regression models.</div></div><div><h3>Conclusions</h3><div>Among community-dwelling older adults in Kerala, apathy is inversely associated with gait velocity but not prevalent MCR, and the former relationship is moderated by degree of cognitive impairment, as determined by ACE score. These findings suggest that apathy may exist on a continuum with gait slowing, MCR, and clinically significant dementia, but future longitudinal studies will be needed to determine a temporal relationship.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S28"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"63. BEST PRACTICES IN FAMILY CAREGIVER SUPPORT OF THE MEDICALLY COMPLEX OLDER ADULT","authors":"Ethan Lau","doi":"10.1016/j.jagp.2025.04.065","DOIUrl":"10.1016/j.jagp.2025.04.065","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Medically complex older adults in geriatric psychiatry often find themselves requiring additional layers of social support to access optimal care, including transportation to various medical appointments, housing support, and coordination of care between multiple specialties. Of particular importance is the need for psychosocial support in the form of close family, friends, and peers, especially since these key pillars of support tend to diminish with age. Preserving the wellbeing of these caregivers and mitigation of caregiver burden are among some of the major priorities in supporting these patients throughout their psychiatric care [1]. The purpose of this poster is to promote best practices in caregiver support and to raise awareness regarding the need for more research in this area.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This case focuses on Mr. M, a 69 yo male with a psychiatric history of schizophrenia and major depressive disorder with multiple medical comorbidities including malignant tumor of bladder currently undergoing chemotherapy. Patient’s clinical documents in our electronic medical records system were reviewed. A literature survey was performed on the topics of caregiver burden and strategies to alleviate this burden. Mr. M has had multiple suicide attempts in the past and four recorded psychiatric hospitalizations and has baseline aggression and perseverative speech concerning for neurocognitive dysfunction. Mr. M receives multiple layers of support that assist him in continuing to receive both psychiatric and medical care, including subsidies for independent living, case management, and his sister, Ms. S, who acts as his primary caregiver and attends all appointments with him. Mr. M has had multiple risks of eviction in the context of psychiatric decompensation as a result of medication nonadherence. However, Ms. S, as his primary caregiver, has assisted Mr. M in not only adherence to medication but also by advocating for him at home and at medical appointments. While Ms. S has cited the emotional and psychological constraints of long-term caregiving, acknowledgement of caregiver burden and provision of psychosocial support has helped in reducing caregiver distress.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The review of recent literature supports family caregiving as an important factor in promoting health in older adults while also providing best practice guidelines in how to mitigate caregiver burden and continue promoting patient health throughout the course of their psychiatric illness. These strategies are broadly categorized in three main groups: first, psychosocial interventions such as addressing information needs and providing communication and stress management skills; second, meditative interventions such as mindfulness-based cognitive therapy, acceptance and commitment therapy; third, physical activity interventions which promote psychological well-being [2]. Notably, evidence shows a reduct","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S46-S47"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2. GOING FURTHER TOGETHER: INTERDISCIPLINARY, COLLABORATIVE UNIVERSITY OF SOUTH CAROLINA BRAIN HEALTH NETWORK TO EMPOWER PATIENT-CENTERED APPROACHES TO INNOVATIVE DEMENTIA CARE","authors":"Shilpa Srinivasan ,&nbsp;Brad Cole MBA FACMPE ,&nbsp;James McMahon APRN ,&nbsp;Takia Woods BA, CCHW ,&nbsp;Amberly Osteen BS, CST ,&nbsp;Alice Bruce MD ,&nbsp;Leonardo Bonilha MD, PhD ,&nbsp;Julius Fridriksson PhD","doi":"10.1016/j.jagp.2025.04.005","DOIUrl":"10.1016/j.jagp.2025.04.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Approximately 6.9 million older Americans are living ith Alzheimer’s dementia (AD) and other dementias, ith prevalence increasing with age, affecting 5.0% of people ages 65-74 years, 13.2% of people ages 75-84 years, and 33.4% of people above age 85. While the diagnosis of Mild Cognitive Impairment (MCI) or dementia can facilitate access to treatment and interventions, delays in timely diagnosis, as well as coordination of care across caregivers and community resources serve as barriers, especially in primary care settings, where the majority of older adults receive their medical care. Such barriers include volume of primary care provider (PCP) visits with brief durations for each, lack of sufficient access to collateral informants, and variable confidence and expertise of PCPs to screen, diagnose and subsequently manage patients with cognitive disorders. With the advent of biomarkers for detection, disease-modifying therapies for the treatment of MCI and AD, and the growing focus on prevention and health promotion in midlife, responding to innovative approaches in diagnostics and therapeutics is a critical yet imminent challenge for PCPs and dementia specialists.&lt;/div&gt;&lt;div&gt;In response to these challenges and needs, the University of South Carolina (USC) Brain Health Network (BHN) was developed as a permanent, State-funded initiative with the main mission of ensuring statewide access to advanced, collaborative cognitive care, and to provide community support throughout South Carolina. Responding to needs assessment and focus groups of caregivers statewide, the BHN represents a collaborative, interdisciplinary partnership with health system providers (Primary Care, Geriatric Psychiatry, Neurology, etc.) to set up a seamless and integrated process to support front-line providers (PCPs) and aim to ensure persons with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers receive support and obtain a clear understanding of their health care system and care navigation in their community.&lt;/div&gt;&lt;div&gt;This poster describes the development and operational processes of the BHN, highlighting the interdisciplinary aspects of dementia care, as well as the interprofessional role of community health workers (CHW), through relationships with organizations and formal partnerships with the Alzheimer's Association and the Area Agency on Aging/Council of Government, including Area Agency on Aging departments statewide, to facilitate patient engagement and caregiver support state-wide to promote health and enhance care navigation across the continuum of dementia care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The BHN partners with health systems to achieve 3 main goals: (1) provide greater access and coordinated care for patients and caregivers, (2) provide further support and education for individuals diagnosed (and their caregivers), and (3) provide access to innovations in treatment and diagnostics, especially in under-serve","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S1-S3"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"17. SAINT FOR TREATMENT-RESISTANT DEPRESSION: REAL WORLD FINDINGS","authors":"Amy Grooms ,&nbsp;Margaret May-Martin ,&nbsp;Lou Ann Eads ,&nbsp;George James ,&nbsp;Laura Dunn","doi":"10.1016/j.jagp.2025.04.020","DOIUrl":"10.1016/j.jagp.2025.04.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Among older adults with major depressive disorder who receive pharmacologic treatment, it has been estimated that at least one-third do not respond to at least two adequate trials of antidepressants—i.e., the definition of treatment-resistant depression currently used by the FDA when considering indications for new therapies. Although electroconvulsive therapy (ECT) is a highly effective intervention for severe depression or depression with psychotic features, its use in older adults can be limited due to concerns for adverse side effects, including anterograde and retrograde amnesia, and increased risks in individuals with cardiovascular or neurologic comorbidities.&lt;/div&gt;&lt;div&gt;Repetitive transcranial magnetic stimulation (rTMS), particularly in the form of intermittent theta-burst stimulation (iTBS), has emerged as a promising non-invasive alternative for treatment of depression. The novel Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which recently received FDA clearance, consists of ten daily high-dose sessions of iTBS targeting the left dorsolateral prefrontal cortex (DLPFC), which enables treatment time to be condensed into five days, rather than the typical four to six week course of conventional rTMS. The protocol also utilizes functional connectivity (fcMRI)-guided, personalized, algorithmic targeting of the region of the left DLPFC that is identified as being the most anticorrelated with the subgenual anterior cingulate cortex.&lt;/div&gt;&lt;div&gt;In the initial clinical trials, the SAINT protocol demonstrated impressive results, with over 80% of patients achieving remission in the open-label trial, and 50-80% meeting remission criteria at some point during the four week follow-up period in the randomized sham-controlled trial. However, studies evaluating the efficacy of SAINT in the geriatric population remain absent. Furthermore, real-world patient populations need to be treated to better gauge the effectiveness of this treatment outside of clinical trials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The University of Arkansas for Medical Sciences (UAMS), through its Interventional Psychiatry Program, was the first site in the United States to offer SAINT to patients in a clinical setting. We received patient referrals from all over the United States, as well as, locally, with the majority being self-referrals. After a comprehensive psychiatric evaluation, patients were offered SAINT TMS if they met criteria for treatment resistant MDD without psychotic features and had no contraindications for the MRI or procedure. A resting-state fMRI was obtained for each patient in the Brain Research Institute housed within the psychiatry department at UAMS. The fMRI data was then uploaded to Magnus Medical to develop a personalized treatment target within the left DLPFC for each patient.&lt;/div&gt;&lt;div&gt;Each patient received ten sessions a day for 5 consecutive days. Each session lasted 10min and there was a min","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S13-S14"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"6. LATENT ASPECTS OF LATE-LIFE DEPRESSION: EXPLORING THE ROLE OF CHILDHOOD TRAUMA AND PERSONALITY","authors":"Jack Kaufman ,&nbsp;Sara Weisnebach","doi":"10.1016/j.jagp.2025.04.009","DOIUrl":"10.1016/j.jagp.2025.04.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The presence of childhood trauma in the geriatric population is as high, if not higher than those in middle age or young adulthood, where many estimates range from 15-45%. This is likely especially true among those with history of depression (LLD). Still, geriatricians, psychiatrists, and psychologists often remain focused on the acute aspects of worsening mood and possible depression tied to typical aging (e.g., functional limitations, declining physical health, and interpersonal losses, etc.) neglecting two important aspects of a person’s depressive past and current presentation: childhood trauma and baseline personality characteristics. We sought to investigate if, and to what extent, neuroticism – the personality variable most implicated in psychopathology – and childhood trauma relate to a person’s history of depression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;99 adults aged 55-79 (M age = 65, SD = 6.5) were administered the Structured Clinical Interview for DSM-5 (SCID-5) and categorized as 61 never-depressed (N-DEP) and 38 with at least one depressive episode (DEP) with a first onset before the age of 35 (including active and remitted). All participants were administered the NEO Personality Inventory (NEO-PI) and the Childhood Trauma Questionnaire (CTQ). There were two primary outcomes: to describe the prevalence and make-up of childhood trauma in a sample of older adults and to investigate its relationship with personality variables to an individual’s history of depression. Exploratory analyses were conducted to see if the type of childhood trauma uniquely predicted depressive episodes. Linear mixed models, including hierarchical regression were used to for this analysis and were adjusted for age, sex, and education.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In our sample with a majority of never-depressed participants, 54% scored over 35, the typical threshold for clinical significance on the CTQ, with the sexual abuse subscale receiving the lowest amount of suprathreshold scores (22%) and emotional neglect being the highest amount (55%). Further, when comparing between N-DEP and DEP groups, we found nearly three and a half times as much emotional abuse and nearly three times as much physical abuse in the DEP group. Neuroticism facet scores (entered in the second block) were predictive of depression history (p LESS THAN .001), but childhood trauma scores (entered in the third block) were not. Finally, of the five subscales, only emotional abuse was a significant contributor to the model (block three, replacing overall CTQ scores; p = 01) when entered in their own model steps.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The majority of the sample reporting scores considered clinically meaningful confirmed our hypothesis that these experiences are likely more common than previously suspected. Further, our results highlight the importance of giving trait-based variables – principally, the facet of personality labeled neu","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S5"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"14. VALUES AND PRIORITIES OF OLDER ADULTS: CREATING COLLABORATIVE GOALS IN PSYCHIATRIC CARE","authors":"Ryan Pate ,&nbsp;Christine Gould ,&nbsp;Ira Yenko ,&nbsp;Maryam Makowski ,&nbsp;Oceanna Li ,&nbsp;Vanessa Silva ,&nbsp;Feng Vankee Lin ,&nbsp;Dolores Gallagher-Thompson ,&nbsp;Erin Cassidy-Eagle","doi":"10.1016/j.jagp.2025.04.017","DOIUrl":"10.1016/j.jagp.2025.04.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The number of older adults seeking psychiatric care is increasing exponentially and the pressure is on to create interventions that can increase the access of support for older adults and reach as many patients as possible. Positive psychological interventions that focus on the psychological wellbeing of older adults present an opportunity to address a range of factors that can impact the lives of older adults. Group interventions foster social connections while reducing cost and limited access to clinicians; the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of patient values and priorities, including the What Matters Most tool, in older adults was performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their personal values and goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three goals matter the most above all.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Older adults (N=19) were enrolled in the psychological wellness group, including 9 males and 10 females. Nine of the participants reported that they lived alone. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than several aspects of physical functionality. The following representative direct patient quotes encapsulate this sentiment well with one subject’s list “1. Connecting deeply with people. 2. Having confidence I can handle whatever comes my way. 3. I’d like to remove the fear that currently has a grip on me so that I am comfortable getting out and about without anxiety.” “[Be] able to take care of myself, have a clear mind ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S10-S11"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"45. DEVELOPING NATIONAL LEADERS IN GERIATRIC PSYCHIATRY WORKFORCE; A SURVEY OF GERIATRIC PSYCHIATRY. FELLOWSHIP GRADUATES WHO WERE TRAINED IN UNDERSERVED AREAS OF NEW YORK STATE.","authors":"Sadeq Kawsar ,&nbsp;Katharine Brewster ,&nbsp;Mark Nathanson ,&nbsp;Margaret Hamilton ,&nbsp;Mahfuzur Rahman","doi":"10.1016/j.jagp.2025.04.047","DOIUrl":"10.1016/j.jagp.2025.04.047","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a national shortage of psychiatrists in the field of geriatric psychiatry, particularly in underserved areas. The main goals of the New York Statewide / Columbia University Geriatric Psychiatry Fellowship are to 1) develop geriatric psychiatrists who are national leaders; (2) disseminate expertise in geriatric psychiatry to underserved urban and rural areas; and (3) foster the development of a geriatric mental health workforce in NY State.</div><div>The program provides educational experiences in a variety of academic and federally designated medically underserved urban and rural settings, from its academic base at the Columbia University Irving Medical Center to hospital centers in underserved areas such as Greater Binghamton Health Center and Rockland Psychiatric Center. All fellows, in both the NYC and Binghamton tracks, rotate at a wide range of clinical sites in NYC, Upstate NY, and Rockland County and have been entitled to many resources. However, while the NYC track consistently fills its fellowship slots, our Upstate NY track is often underfilled. We hypothesize that the diversity of training opportunities in the program and availability of many academic and clinical resources are a main draw to the fellowship Columbia Geriatric Psychiatry Fellowship, but we do not know whether completion of the fellowship has helped contribute to a geriatric mental health workforce and developed leaders in the field of geriatric psychiatry in NY State. The survey also asks about graduates’ experiences in the fellowship and suggestions to improve recruitment into rural fellowship programs nationwide.</div></div><div><h3>Methods</h3><div>We have identified over 30 email addresses of graduates of the Columbia Geriatric Psychiatry Fellowship since 2001 and we aim to send out a 12-question confidential survey to the fellowship graduates asking about their experience in the fellowship, how it has influenced their career trajectory, as well as their current work settings and patient population.</div></div><div><h3>Results</h3><div>We have developed the 12-question survey, and we aim to send it out to fellowship graduates after receiving IRB approval. We will send the survey out in December 2024, collect all data by January 2025, and publish the results in March 2025 for the AAGP annual meeting.</div></div><div><h3>Conclusions</h3><div>We will hypothesize if the fellowship’s unique collaboration between an urban academic medical center and rural state-run hospitals, working with underserved population in NY State, utilization of resources and teach geriatric psychiatry to a wide range of learners has helped facilitate leadership opportunities in geriatric psychiatry in the United States.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S33-S34"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"28. BREXPIPRAZOLE FOR AGITATION ASSOCIATED WITH DEMENTIA DUE TO ALZHEIMER’S DISEASE: NUMBER NEEDED TO TREAT, NUMBER NEEDED TO HARM, AND LIKELIHOOD TO BE HELPED OR HARMED","authors":"Leslie Citrome ,&nbsp;Sanjeda R. Chumki ,&nbsp;Pedro Such ,&nbsp;David Wang ,&nbsp;Anton M. Palma ,&nbsp;Zhen Zhang ,&nbsp;Alireza Atri ,&nbsp;Alireza Atri","doi":"10.1016/j.jagp.2025.04.030","DOIUrl":"10.1016/j.jagp.2025.04.030","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Agitation is a prevalent, highly distressing and burdensome neuropsychiatric symptom of Alzheimer’s disease. In this vulnerable patient population, it is especially critical to maximize benefits, minimize risks, and understand expected treatment outcomes. This analysis delineates the clinical benefit and risk profile of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease, using number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Data are pooled from two fixed-dose pivotal clinical trials of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease (NCT01862640 [Trial 283], NCT03548584 [Trial 213]), and analyzed for brexpiprazole 2 or 3 mg/day (FDA-approved recommended-to-maximum dose) versus placebo. In both trials, the Cohen-Mansfield Agitation Inventory (CMAI) was the primary efficacy measure. For this post hoc analysis, the main efficacy outcome was agitation response rate, defined as ≥20-point reduction in CMAI Total score from baseline to Week 12. Previous analyses indicate that a 20-point within-person CMAI reduction reflects a clinically meaningful benefit in this population. The main safety outcome was incidence of discontinuation due to treatment-emergent adverse events (TEAEs). Other efficacy and safety outcomes were also analyzed. For the identified outcomes, NNT, NNH and LHH were calculated. NNT and NNH indicate how many patients would need to be treated with brexpiprazole versus placebo in order for one additional patient to experience a benefit (NNT) or a harm (NNH). LHH is the ratio of NNH to NNT. Lower NNT values, and higher NNH and LHH values, are more supportive of brexpiprazole versus placebo.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Response rates (≥20-point CMAI Total reduction) were 50.1% (182/363) for brexpiprazole, and 37.7% (93/247) for placebo, yielding a NNT of 9 (95% confidence internal [CI]: 5, 22). The incidence of discontinuation due to TEAEs was 4.9% (18/366) for brexpiprazole, and 4.8% (12/251) for placebo, yielding a NNH of 730 (95% CI: not significant). Together, these specific outcomes result in a LHH of 81.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Brexpiprazole is 81 times more likely to result in treatment response (as defined by a ≥20-point reduction in CMAI Total score) than discontinuation because of a TEAE. This analysis provides meaningful clinical interpretation of benefits and risks of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease. These data expand the evidence-base for brexpiprazole, and underscore the favorable efficacy and safety profile that supports the use of brexpiprazole in this patient population.&lt;/div&gt;&lt;div&gt;This abstract was submitted at the late-breaker deadline to allow sufficient time to discuss the methodology, and ultimately ensure that clinically relev","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S20"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"37. EXAMINING PSYCHOTROPIC MEDICATION, SOCIAL FACTORS, NORMAL PRESSURE HYDROCEPHALUS AND MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH ALZHEIMER DEMENTIA: A RETROSPECTIVE COHORT ANALYSIS.","authors":"Oluranti Omolara Babalola ,&nbsp;Adebobola Imeh-Nathaniel (PhD) ,&nbsp;Addison Niles (MD) ,&nbsp;Richard L. Goodwin (PhD) ,&nbsp;Laurie Theriot Roley (MD) ,&nbsp;Ohmar Win (MD) ,&nbsp;Thomas I. Nathaniel (PhD)","doi":"10.1016/j.jagp.2025.04.039","DOIUrl":"10.1016/j.jagp.2025.04.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite tauhe significant burden of Alzheimer's Dementia (AD) with Normal Pressure Hydrocephalus (NPH) and Mild Cognitive Impairment (MCI), placed on the aging population, their loved ones, and healthcare systems, these conditions remain under-researched. The overlap of NPH and MCI symptoms in persons with AD presents challenges for diagnosis, however, timely and effective management of these comorbidities can help prevent the progression to severe dementia. This study aims to examine the relationship between sociodemographic factors and psychotropic medication use in AD patients diagnosed with NPH and MCI, using the Social Determinants of Health (SDH) model.</div></div><div><h3>Methods</h3><div>The study analyzed 33,735 patients diagnosed with MCI (n=33,064) or NPH (n=671) between February 2016 and August 2021 at Prisma Health-Upstate South Carolina. Multivariable logistic regression identified key factors associated with NPH and MCI, including age, race, and medication use.</div></div><div><h3>Results</h3><div>NPH patients were older (69.38 ± 16.42 vs. 63.19 ± 21.78 years) and predominantly White (92.1% vs. 80.7%). Tobacco use (OR = 1.175, 95% CI, 1.004-1.375) and buspirone use (OR = 1.415, 95% CI, 1.116-1.794) were positively associated with NPH while being Black (OR = 0.388, 95% CI, 0.277-0.542) and risperidone use (OR = 0.217, 95% CI, 0.103-0.459) were associated with MCI. Sex-stratified analyses revealed that men with NPH were more likely to use SSRIs, while women were more likely to use memantine and buspirone.</div></div><div><h3>Conclusions</h3><div>The SDH framework highlighted disparities in diagnosis, revealing that White patients with AD are more likely to be diagnosed with NPH, potentially due to better access to healthcare. These findings emphasize the need for targeted interventions that address social factors, improve access to psychotropic medications, and reduce healthcare disparities to enhance outcomes for AD patients with NPH and MCI.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S27"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}