American Journal of Geriatric Psychiatry最新文献

{"title":"Improving Adherence to Psychotherapy and Clinical Outcome in Patients With Late-Life Depression Through Gamified mHealth Technology","authors":"Yuqing Qiu M.S. ,&nbsp;Emily Carter B.A. ,&nbsp;Natalie Benda Ph.D. ,&nbsp;Jo Anne Sirey Ph.D. ,&nbsp;Soohyun Kim Ph.D. ,&nbsp;Younghoon Kim Ph.D. ,&nbsp;Zilong Yu M.S. ,&nbsp;Dimitris Kiosses Ph.D. ,&nbsp;Patricia Marino Ph.D. ,&nbsp;Faith Gunning Ph.D. ,&nbsp;George Alexopoulos M.D. ,&nbsp;Samprit Banerjee Ph.D.","doi":"10.1016/j.jagp.2025.09.004","DOIUrl":"10.1016/j.jagp.2025.09.004","url":null,"abstract":"<div><h3>Objectives</h3><div>We assessed the impact of implementing gamification via mHealth in psychotherapies treating late-life depression on promoting adherence to between-session homework and improving depressive symptoms. We also assessed the relationship between adherence and depressive symptoms.</div></div><div><h3>Design &amp; Setting</h3><div>We compared a gamified phase (Phase II) and a nongamified phase (Phase I) of three reward exposure-based psychotherapies treating late-life depression at the Weill Cornell ALACRITY Research Center. Each phase recruited its own cohort of participants.</div></div><div><h3>Participants</h3><div>Middle-aged to older adults (Mean [SD] age 69.4 [8.04]) with major depression (<em>N</em> = 102).</div></div><div><h3>Measurements</h3><div>Adherence was indicated using daily self-reported homework completion, and depressive symptoms were measured four times over the 12-week study using the Montgomery Åsberg Depression Rating Scale (MADRS).</div></div><div><h3>Results</h3><div>Participants who received gamified psychotherapy had higher odds (aOR = 8.20 [95% CI: 2.68–25.04]; p &lt;0.001) of completing daily homework and greater reduction in MADRS (9.58 vs. 4.73, Δ=4.85 [95% CI: 2.23–7.47], p &lt;0.001) compared to those who received a nongamified version. In the gamified version, a 20% increase in homework completion rate was associated with a 2.97-point reduction (95% CI: 1.31–4.63; p &lt;0.001) in MADRS at the following assessment.</div></div><div><h3>Conclusions</h3><div>Using gamification in mHealth psychotherapies treating late-life depression was associated with higher homework adherence and reduced depressive symptoms. Higher adherence in gamified psychotherapies was associated with a greater reduction in depressive symptoms. This suggests that gamification could enhance the effectiveness of mHealth psychotherapies and promote the wider adoption among older adults, helping to address the growing demand for mental health care among this population.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 568-579"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310675","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":"Telepsychotherapy Improves Health-Related Quality of Life in Parkinson’s Disease","authors":"Christopher Liong Ph.D. ,&nbsp;Alejandro Interian Ph.D. ,&nbsp;Roseanne D. Dobkin Ph.D.","doi":"10.1016/j.jagp.2025.11.010","DOIUrl":"10.1016/j.jagp.2025.11.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Parkinson's disease (PD) is associated with significant impairments in health-related quality of life (HRQoL). Little is known about the impact of psychotherapy on HRQoL in PD. This study aimed to assess the effects of virtual cognitive-behavioral therapy on HRQoL among veterans with PD, and to identify possible mediators for change.</div></div><div><h3>Methods</h3><div>Veterans with both PD and primary depressive disorders (n = 90) were recruited nationwide and randomized to PD-informed cognitive-behavioral therapy (CBT) or treatment as usual (TAU). The 10-session telehealth CBT intervention focused on behavioral activation, cognitive restructuring, and stress management, with strategies for problem-solving PD-related challenges highlighted throughout. The TAU group received routine VA care with clinical monitoring by study staff. HRQoL was measured with the SF-36, which included summary scores for physical and mental quality of life, along with eight health domain subscales. Depression (HAM-D), behavioral activation (BADS), and automatic negative thoughts (ATQ) were assessed as mediators of CBT and HRQoL in parallel and parallel-serial mediation models.n.</div></div><div><h3>Results</h3><div>There were significant group-by-time effects for physical (p = 0.007) and mental quality of life (p = 0.04) such that the CBT group improved in both by end-of-treatment, while the control group did not. Depression mediated the relationship between CBT and physical quality of life in both parallel (B = 1.90, 95% CI [0.06, 3.94]) and parallel-serial (B = 1.35, 95% CI [0.01, 3.13]) models.</div></div><div><h3>Conclusions</h3><div>Cognitive-behavioral therapy holistically improves both the physical and mental challenges that Parkinson's disease places on everyday life. The routine assessment and management of depression in PD is a key component of evidence-based interdisciplinary care.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 422-433"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829788","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":"Commentary on “Association Between the Ratio of Triglycerides to HDL-C and Cognitive Impairment: A Longitudinal Population-Based Analysis and Mendelian Randomization Study”","authors":"Shangavi Vellingiri Pharm.D","doi":"10.1016/j.jagp.2025.12.016","DOIUrl":"10.1016/j.jagp.2025.12.016","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 658-659"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146169290","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":"Comment on Costilla et al. (2025) “Improvements in Depressive Symptoms, Perceived Social Support, and Quality of Life Through an Educational Program in Community-Dwelling Older Adults With Frailty Phenotype: A Randomized Controlled Trial of the FRAGSALUD Project”","authors":"Qiwei Wu Ph.D. ,&nbsp;Qian Cai M.Sc. ,&nbsp;Jing Shao Ph.D.","doi":"10.1016/j.jagp.2026.01.003","DOIUrl":"10.1016/j.jagp.2026.01.003","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 654-655"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138122","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":"Catch It. Check It. Change It: A PRISM-Informed Micro-Practice to Counter Ageism and Other “Isms” in Clinical and Scientific Work—And Beyond","authors":"Kiran Rabheru M.D., C.C.F.P., F.R.C.P.","doi":"10.1016/j.jagp.2026.01.021","DOIUrl":"10.1016/j.jagp.2026.01.021","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 645-648"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215540","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":"A Systematic Review and Meta-analysis of Diagnostic Remission, Treatment Response, Attrition and Relapse Following Cognitive Behavior Therapy (CBT), Other Psychological Therapies and Pharmacological Treatments for Anxiety Disorders in Older Adults","authors":"Carly J. Johnco Ph.D. ,&nbsp;Sophie J. Dickson MRes ,&nbsp;Ashleigh Seaton B.Psych(Hons)","doi":"10.1016/j.jagp.2025.05.010","DOIUrl":"10.1016/j.jagp.2025.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review and meta-analysis examined rates of diagnostic remission, treatment response, attrition and relapse following psychological and pharmacological treatments for anxiety disorders in older adults (≥60 years). A key limitation of existing meta-analyses is their conflation of diagnostic and treatment response definitions, obscuring true treatment effects and rendering outcomes limited for guiding treatment decisions.</div></div><div><h3>Methods</h3><div>22 randomized controlled trials were included (N = 2,321).</div></div><div><h3>Results</h3><div>Meta-analytically weighted remission following Cognitive Behavioral Therapy (CBT) was 54% (95% CI = 35%–73%). Remission was significantly higher following CBT than inactive control (OR = 7.14; 59% versus 18%), with similar patterns compared to active control (44%–48% versus 19%–50%). Remission was significantly higher following pharmacotherapy (36%) than placebo (19%), OR = 2.50. Definitions of treatment response varied widely (eight across 12 CBT trials; seven across 10 pharmacological trials). Overall treatment response rate for CBT was 53%. Treatment response was significantly higher for CBT than inactive control (OR = 3.17; 45% versus 19%), but not active control (OR = 2.26; 61% versus 44%). Response was significantly higher following pharmacotherapy (62%) than placebo (35%), OR = 3.25. Pooled CBT attrition rate was 19% (95% CI = 14%–26%), with no difference between CBT and inactive control (OR = 1.17; 19% versus 16%) or active control (OR = 1.25; 22% versus 19%), and no difference between pharmacotherapy and placebo (OR = 1.02; 20% versus 17%). Average relapse rate after CBT was 33% (95% CI = 18%-49%), while no pharmacotherapy trials reported relapse.</div></div><div><h3>Conclusion</h3><div>Overall, results suggest potential superiority of CBT as a first-line treatment for late-life anxiety, and provide a benchmark for clinical implementation and efforts to optimize treatment for late-life anxiety disorders.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 500-521"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532877","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":"Still-Life","authors":"Mark Steven Aster B.A.","doi":"10.1016/j.jagp.2025.12.011","DOIUrl":"10.1016/j.jagp.2025.12.011","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Page 693"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992966","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 Independent Effect of Depression on Financial Decision-Making in Older Adults","authors":"Kevin J. Manning Ph.D. ,&nbsp;R. Scott Mackin Ph.D. ,&nbsp;Rong Wu Ph.D. ,&nbsp;Milap Nowrangi M.D. ,&nbsp;David C. Steffens M.D., M.H.S. ,&nbsp;Patricia A. Boyle Ph.D.","doi":"10.1016/j.jagp.2025.11.002","DOIUrl":"10.1016/j.jagp.2025.11.002","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the association between clinically significant depressive symptoms in late life or late-life depression (LLD) and financial and healthcare-related decision-making in older adults.</div></div><div><h3>Methods</h3><div>821 older adults from the Rush Memory and Aging Program underwent a cross-sectional evaluation of depressive symptoms, cognitive functioning, and a performance-based measured of financial and healthcare decision-making. Participant data on financial and health literacy were also obtained. Rush clinicians assigned a diagnosis of mild cognitive impairment (MCI) or normal cognition (NC) based upon review of the clinical data, and participants were assigned to one of three groups based on the presence of clinically significant depression and antidepressant medication use: active depressive symptoms, remitted depressive symptoms, or no-depression. Patients with dementia were excluded from the current analyses.</div></div><div><h3>Results</h3><div>Depression status was not associated with the total decision-making score. However, active depression, MCI status, financial literacy, and demographics were statistically significant independent predictors of financial decision-making. MCI status, but not depression status, was a significant predictor of healthcare decision-making.</div></div><div><h3>Conclusions</h3><div>Older depressed adults may be at risk for impaired financial decision-making. Evaluation of financial decision-making should be considered in research and clinical management of depression in older adults and could lead to the early identification of seniors at risk for financial exploitation.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 437-446"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746614","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":"Brain White Matter Microstructure in Middle and Older Aged Adults With Bipolar Disorder: A 2-Site Study","authors":"Anjali Sankar Ph.D. ,&nbsp;Lejla Colic Ph.D. ,&nbsp;Rebecca B. Marks M.D. ,&nbsp;Niroop Rajashekar M.D. ,&nbsp;Brian Pittman M.S. ,&nbsp;R. Todd Constable Ph.D. ,&nbsp;Martha Sajatovic M.D. ,&nbsp;Lisa T. Eyler Ph.D. ,&nbsp;Hilary P. Blumberg M.D.","doi":"10.1016/j.jagp.2025.09.013","DOIUrl":"10.1016/j.jagp.2025.09.013","url":null,"abstract":"<div><h3>Objective</h3><div>Adolescents and adults with bipolar disorder (BD) show white matter (WM) microstructural alterations in tracts important for emotion regulation and cognition, including the anterior corpus callosum, cingulum, and uncinate fasciculus. Less is known about WM microstructure in middle age and older adults with BD (MOABD), although they often have substantial mood symptoms, cognitive impairments, and suicide and dementia risk. The present study investigated WM microstructure in MOABD and its relationship with age.</div></div><div><h3>Design, Setting, Participants, and Measurements</h3><div>In a 2-site diffusion tensor imaging study of adults ages 40–79 years (primary sample: <em>n</em> = 88 MOABD, 93 age-comparable non-psychiatric adults (NP); confirmatory sample: <em>n</em> = 29 MOABD, 47 NP). WM fractional anisotropy (FA) in the corpus callosum, cingulum, and uncinate fasciculus were compared between groups. Furthermore, diagnosis by age interaction analysis was performed.</div></div><div><h3>Results</h3><div>Across both sites, relative to NP, MOABD showed significantly lower FA throughout corpus callosum and in left cingulum (p &lt; 0.05, multiple comparisons-corrected). Lower FA in the bilateral uncinate was observed, significant at the primary site and with a similar effect size at the confirmatory site. Diagnosis by age interactions were not significant.</div></div><div><h3>Conclusions</h3><div>The results support abnormalities in inter- and intra-hemispheric WM tracts connecting regions that subserve emotion regulation and cognition in MOABD, consistent with findings in younger cohorts with BD. Findings in the posterior corpus callosum suggest a greater extent of alterations in MOABD that may contribute to their phenotype, while findings in other regions align with prior research suggesting early WM neurodevelopmental alterations that persist into older adulthood.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 580-590"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314430","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":"Clozapine in Older Adults: Benefits and Challenges","authors":"Rachel Moster M.D. ,&nbsp;Sabina Bera M.D., M.S. ,&nbsp;Poonam Awatramani M.D. ,&nbsp;George S. Alexopoulos M.D.","doi":"10.1016/j.jagp.2025.08.002","DOIUrl":"10.1016/j.jagp.2025.08.002","url":null,"abstract":"<div><div>Schizophrenia worsens quality of life, causes family disruption, and shortens longevity. Clozapine can be efficacious in schizophrenia refractory to other antipsychotic agents. Many older patients have been on clozapine for decades and may need to continue its use into late life to prevent emergence of psychotic symptoms. However, older adults are more prone to clozapine adverse effects than younger patients. Pneumonia and paralytic ileus are the most common serious adverse effects in older adults with significant mortality. Agranulocytosis and myocarditis usually occur early in treatment and are infrequent in older adults who have been on clozapine for years. Overall, adverse effects of clozapine should be managed by decreasing polypharmacy of both psychotropic and nonpsychotropic agents, by making lifestyle changes, and by reducing the dosage of clozapine under vigilant surveillance. Relapse of psychosis remains a possibility even when clozapine dose reduction is conducted with appropriate clinical monitoring. Shared decision making with patients and their families is important, especially when a clozapine dose reduction is considered. Support measures will be needed in case psychotic symptoms emerge. There are significant gaps in the literature on the management of side effects of clozapine in late life. The recommendations offered here are based on available studies and on clinical experience and will need to be amended as new empirical information becomes available.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 4","pages":"Pages 602-610"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322735","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}