American Journal of Geriatric Psychiatry最新文献

{"title":"Alexithymia in Parkinson's Disease: A Meta-analysis","authors":"Roberto Fernández-Fernández M.D. ,&nbsp;Javier Ibias Ph.D. ,&nbsp;Cristina del Toro-Pérez M.D., Ph.D. ,&nbsp;Guillermo Lahera M.D., Ph.D. ,&nbsp;Carmen Gasca-Salas M.D., Ph.D.","doi":"10.1016/j.jagp.2024.11.009","DOIUrl":"10.1016/j.jagp.2024.11.009","url":null,"abstract":"<div><div>Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor manifestations, including alexithymia. This condition is defined by difficulty in recognizing, articulating, and expressing one's emotional states. In this study, we conducted a systematic review and meta-analysis to compare the prevalence of alexithymia in PD patients and a healthy population, and to identify associated demographic and clinical factors. We identified 16 observational studies through Pubmed, EMBASE, PsycINFO, and SCOPUS, selecting articles published since 2002. Data were analyzed using a random-effects model. We conducted additional prevalence meta-analyses and correlation meta-analyses. We found that PD patients exhibit higher levels of alexithymia compared to the general population (combined effect size 0.65 [95% CI = 0.49–0.81; <em>P</em> &lt;0.05]), and moderate but significant heterogeneity (I² = 52.42%, Q = 29.42, <em>P</em> &lt;0.05), partially explained by regional differences, levodopa equivalent dosage (positive regression coefficient of 0.0006 [95% CI = 0.0001; 0.0011, <em>P</em> &lt;0.05]); and cognitive scores (negative regression coefficient of -0.14 [95% CI = -0.24; -0.04, <em>P</em>&lt;0.05]), after adjusting for covariates. The additional meta-analysis reported higher prevalence of alexithymia in PD and a pooled correlation coefficient of 0.496 (95% CI = 0.40–0.59, <em>P</em> &lt;0.05) when we analyzed alexithymia and depression scores. To our knowledge, there are no previous meta-analysis applied to alexithymia in PD patients. Even though we could not determine whether alexithymia is a primary characteristic of PD, we found an association of higher levels of alexithymia with depression and higher levodopa equivalent daily dose. Furthermore, there are not enough studies to draw clear conclusions about the influence of cognitive status.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 638-653"},"PeriodicalIF":4.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900707","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":"The Medico-Legal Approach to the Assessment of Testamentary Capacity: A Systematic Review","authors":"Anna Jakubek ,&nbsp;Tristan Montag B.Sc. (Hons) ,&nbsp;Ian M. Hull L.L.B., L.S.M. ,&nbsp;Kenneth Shulman M.D., F.R.C.P.C.","doi":"10.1016/j.jagp.2024.11.002","DOIUrl":"10.1016/j.jagp.2024.11.002","url":null,"abstract":"<div><div>An increase in will challenges on the grounds of lack of capacity and undue influence is anticipated in the face of an imminent transfer of generational wealth by a growing elderly population with a high prevalence of cognitive impairment. Medical experts will be a necessary element of litigation to help the courts make the best legal determinations involving cognitive and psychiatric functions that may affect mental capacity and vulnerability to influence. We conducted the first systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (“PRISMA”) guidelines in order to identify articles that addressed a comprehensive medico-legal approach to the assessment of testamentary capacity. Only 12 articles met the criteria for the systematic review. <em>Banks v Goodfellow</em> (<em>“Banks”</em>) continues to be considered the leading case that defines the criteria for the courts and lawyers in the determination of testamentary capacity. However, quantitative data to support this impression is nowhere to be found. Moreover, unpredictability remains a hallmark of cases involving will challenges. Since calls for increased medico-legal collaboration and updates to the <em>Banks</em> test have not been evaluated, a scoping review of a large number of judicial decisions is required to better understand the current approach to this legal determination. Relevant variables could be used to develop a predictive model that would help lawyers and medical experts in this important societal collaboration.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 5","pages":"Pages 546-555"},"PeriodicalIF":4.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848437","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":"Undue Influence in Financial Decision Making","authors":"Oliver M. Glass M.D.","doi":"10.1016/j.jagp.2024.11.012","DOIUrl":"10.1016/j.jagp.2024.11.012","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 5","pages":"Pages 556-557"},"PeriodicalIF":4.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830930","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":"Ringing in the Ears: A Harbinger Not of Gossip but of Suicidality","authors":"Jane P. Gagliardi M.D., M.H.S.","doi":"10.1016/j.jagp.2024.11.008","DOIUrl":"10.1016/j.jagp.2024.11.008","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Pages 413-415"},"PeriodicalIF":4.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808710","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":"Pandemic Impacts on Paid and Unpaid Dementia Caregivers: Mental Health, Resilience, and Policy Needs","authors":"Seyeon Jang MD ,&nbsp;Jie Chen PhD","doi":"10.1016/j.jagp.2024.11.006","DOIUrl":"10.1016/j.jagp.2024.11.006","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Pages 426-427"},"PeriodicalIF":4.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824890","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":"Do Caregivers Value the New Antiamyloid Treatments for Alzheimer's Disease More Than Home-Based Care?","authors":"Caroline R. Morehouse B.A. ,&nbsp;Saskia Hendriks M.D., Ph.D. ,&nbsp;Nusrat Rabbee Ph.D. ,&nbsp;Scott YH Kim M.D., Ph.D.","doi":"10.1016/j.jagp.2024.11.011","DOIUrl":"10.1016/j.jagp.2024.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>The new antiamyloid medications Lecanemab (Leqembi) and donanemab (Kisunla) are the first disease-modifying treatments for Alzheimer's disease (AD) to receive full FDA approval. However, some commentators question whether the drugs’ benefits outweigh their risks, burdens, and costs to patients. This study assessed the perceived value of these medications by asking caregivers of persons with AD to compare them to a widely used intervention in AD management: home-based care.</div></div><div><h3>Design</h3><div>Online survey (March 27th–April 17th, 2024) of 392 AD caregivers recruited via CloudResearch Prime Panels to match the U.S. public in education, household income, race, and ethnicity. The survey used vignettes describing antiamyloid medication and 25 hours/week of home-based care (estimated to be of similar monetary value). After rating the desirability of medication and home-based care, respondents indicated their preference for which intervention they wanted their loved one's insurance to cover.</div></div><div><h3>Results</h3><div>Respondents expressed a desire for their loved ones to receive both the medication and home-based care. Over half (56.9%) favored home-based care coverage. Those preferring medication coverage were more likely to believe its benefits outweigh its risks and burdens. Preference for medication coverage was also associated with being male, Hispanic, less educated, and correctly answering fewer comprehension questions.</div></div><div><h3>Conclusions</h3><div>Our findings show most caregivers perceive modest clinical value in the novel antiamyloid therapies, and the decision to use these drugs will be preference-sensitive, pointing to the need for thorough informed consent discussions.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Pages 438-449"},"PeriodicalIF":4.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873530","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":"Association Between Multimorbidity and Depression in Older Adults: Evidence From Six Large Longitudinal Cohorts","authors":"Qianqian Du B.M. ,&nbsp;Menghan Yao B.Sc. ,&nbsp;Wei Wang Ph.D. ,&nbsp;Junyu Wang B.M. ,&nbsp;Sheng Li M.S. ,&nbsp;Kai Lu B.M. ,&nbsp;Chen Li B.Sc. ,&nbsp;Yuxin Wei B.M. ,&nbsp;Tao Zhang Ph.D. ,&nbsp;Fei Yin Ph.D. ,&nbsp;Yue Ma Ph.D.","doi":"10.1016/j.jagp.2024.11.010","DOIUrl":"10.1016/j.jagp.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Multimorbidity may increase the risk of depression in older adults, but the global average effect of multimorbidity on depression remains unknown. This research aimed to exclude the regional heterogeneity to quantify the exposure-response association between multimorbidity and depression in older adults worldwide.</div></div><div><h3>Method</h3><div>We collected 23,947 participants aged 65 years or above from six large prospective cohorts from developed and developing countries, including Mexico, South Korea, Europe, America, China, and England. Multimorbidity was defined as an individual experiencing two or more chronic conditions simultaneously at baseline. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) or the EURO-D scale in each wave. We utilized Stratified Cox proportional hazards models to assess the effects of multimorbidity on depression in each cohort. Meta-analysis was then applied to obtain the average effects across cohorts.</div></div><div><h3>Results</h3><div>Multimorbidity was significantly associated with depression in each cohort and the pooled HR for depression excluding the heterogeneity among six cohorts was 1.30 (95% CI: 1.25–1.37, Z = 10.28, p &lt; 0.001). Compared with participants without any chronic condition, those with 1, 2, and ≥3 chronic conditions had HRs for depression of 1.15 (95% CI: 1.09–1.21, Z = 5.10, p &lt; 0.001), 1.37 (95% CI: 1.29–1.45, Z = 10.00, p &lt; 0.001), and 1.57 (95% CI: 1.45–1.70, Z = 10.9, p &lt; 0.001), respectively. The effects of multimorbidity on depression were more pronounced in males (HR: 1.40 in males vs. 1.25 in females) and participants aged between 65 and 74 years (HR: 1.36 in 65–74 years vs. 1.22 in 75 years and older).</div></div><div><h3>Conclusion</h3><div>Older adults with multimorbidity are more likely to suffer depression. Effective strategies should be developed for older adults, including preventing and managing chronic conditions and improving mental health services.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 702-715"},"PeriodicalIF":4.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822968","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":"Response to Dr. Kawada's Letter “Suicidal Behavior in Older Adults With Cognitive Impairment.”","authors":"Laura Kenneally M.S. ,&nbsp;Anna Szücs M.D. ,&nbsp;Hanga Galfalvy Ph.D. ,&nbsp;Katalin Szántó M.D.","doi":"10.1016/j.jagp.2024.11.007","DOIUrl":"10.1016/j.jagp.2024.11.007","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 5","pages":"Pages 585-586"},"PeriodicalIF":4.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824892","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":"Brexpiprazole for the Treatment of Agitation in Alzheimer's Disease Dementia: Clinical Uncertainties and the Path Forward","authors":"Vimal M. Aga M.D., F.A.P.A.","doi":"10.1016/j.jagp.2024.11.003","DOIUrl":"10.1016/j.jagp.2024.11.003","url":null,"abstract":"<div><div>Brexpirazole was approved for the treatment of nonpsychotic agitation in Alzheimer's disease (AD) dementia by the United States Food and Drug Administration (FDA) in May 2023 after three phase 3 clinical trials found brexpiprazole 2 to 3 mg/day to be an effective and well-tolerated treatment for agitation in AD dementia, albeit with small effect sizes. It appeared to especially benefit dementia patients with severe agitation/aggression, but it took between 6 and 12 weeks across the three studies for the medication to separate from placebo. However, much remains unknown about its place in the psychopharmacological armamentarium for the treatment of AD dementia-related agitation, including the optimal duration of a brexpiprazole trial, bridging options during the time it takes for brexpiprazole to become effective, and whether it should be continued in the presence of or upon emergence of psychosis during treatment. This Research in Action article uses a case vignette to synthesize the findings of the brexpiprazole trials and apply them to clinical practice, highlight the current uncertainties associated with its use, and compare it with other psychopharmacological options for the treatment of agitation in AD dementia.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 3","pages":"Pages 322-329"},"PeriodicalIF":4.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796252","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":"Predicting Progression to Dementia Using Auditory Verbal Learning Test in Community-Dwelling Older Adults Based On Machine Learning","authors":"Xin-Yan Xie Ph.D. ,&nbsp;Lin-Ya Huang M.S. ,&nbsp;Dan Liu M.D., Ph.D. ,&nbsp;Gui-Rong Cheng M.D. ,&nbsp;Fei-Fei Hu Ph.D. ,&nbsp;Juan Zhou M.S. ,&nbsp;Jing-Jing Zhang M.S. ,&nbsp;Gang-Bin Han M.S. ,&nbsp;Jing-Wen Geng M.S. ,&nbsp;Xiao-Chang Liu M.S. ,&nbsp;Jun-Yi Wang M.S. ,&nbsp;De-Yang Zeng B.S. ,&nbsp;Jing Liu M.S. ,&nbsp;Qian-Qian Nie M.S. ,&nbsp;Dan Song M.S. ,&nbsp;Shi-Yue Li M.S. ,&nbsp;Cheng Cai M.S. ,&nbsp;Yu-Yang Cui M.S. ,&nbsp;Lang Xu M.D., Ph.D. ,&nbsp;Yang-Ming Ou M.D., Ph.D. ,&nbsp;Yan Zeng M.D., Ph.D.","doi":"10.1016/j.jagp.2024.10.016","DOIUrl":"10.1016/j.jagp.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Primary healthcare institutions find identifying individuals with dementia particularly challenging. This study aimed to develop machine learning models for identifying predictive features of older adults with normal cognition to develop dementia.</div></div><div><h3>Methods</h3><div>We developed four machine learning models: logistic regression, decision tree, random forest, and gradient-boosted trees, predicting dementia of 1,162 older adults with normal cognition at baseline from the Hubei Memory and Aging Cohort Study. All relevant variables collected were included in the models. The Shanghai Aging Study was selected as a replication cohort (n = 1,370) to validate the performance of models including the key features after a wrapper feature selection technique. Both cohorts adopted comparable diagnostic criteria for dementia to most previous cohort studies.</div></div><div><h3>Results</h3><div>The random forest model exhibited slightly better predictive power using a series of auditory verbal learning test, education, and follow-up time, as measured by overall accuracy (93%) and an area under the curve (AUC) (mean [standard error]: 088 [0.07]). When assessed in the external validation cohort, its performance was deemed acceptable with an AUC of 0.81 (0.15). Conversely, the logistic regression model showed better results in the external validation set, attaining an AUC of 0.88 (0.20).</div></div><div><h3>Conclusion</h3><div>Our machine learning framework offers a viable strategy for predicting dementia using only memory tests in primary healthcare settings. This model can track cognitive changes and provide valuable insights for early intervention.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 5","pages":"Pages 487-499"},"PeriodicalIF":4.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792993","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}