American Journal of Geriatric Psychiatry最新文献

{"title":"Ethnic Differences in the Association Between Cognitive Performance and Informant-rated Cognitive Decline.","authors":"Emily M Briceño, Barbara Mendez Campos, Roshanak Mehdipanah, Wen Chang, Steven G Heeringa, Joshua Martins-Caulfield, Deborah A Levine, Nelda Garcia, Xavier F Gonzales, Kenneth M Langa, Darin B Zahuranec, Lewis B Morgenstern","doi":"10.1016/j.jagp.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.12.003","url":null,"abstract":"<p><strong>Objectives: </strong>It is unknown whether cognitive test scores are equivalently associated with informant-rated cognitive decline across culturally and linguistically diverse older adults. We examined the association between cognitive domain scores on the Harmonized Cognitive Assessment Protocol (HCAP) and informant-rated cognitive decline in a harmonized population-based sample of older adults.</p><p><strong>Design, setting, and participants: </strong>We combined data from the HCAP sub-study of the Health and Retirement Study (HRS; 2016) and the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C; 2018-2020) study. We included Hispanic/Latino-a-e-x (H/L; n = 566) and non-H/L white (NHW; n = 2,145) older adults.</p><p><strong>Measurement: </strong>Both studies included the HCAP cognitive assessment with domain scores for memory, attention/executive function (EF), language, visuospatial, orientation, and general cognitive performance (GCP). Informants rated cognitive decline with the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE).</p><p><strong>Results: </strong>Cognitive domain scores were more strongly associated with IQCODE scores for NHW than H/L participants for four of six domains (GCP, EF, visuospatial, and orientation) after adjusting for demographics (age, sex/gender, education) and study membership. Informants generally rated greater cognitive decline in NHW than H/L respondents for a given cognitive domain score, and the magnitude of this difference was greater for lower cognitive test scores.</p><p><strong>Conclusions: </strong>We found generally weaker associations between cognitive performance and informant-rated cognitive decline in H/L compared to NHW older adults. These findings suggest cognitive measurement differences across culturally and linguistically diverse older adult populations, which may result in underestimation of cognitive impairment in H/L populations.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980449","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":"Discordant Medication Beliefs in Black Individuals With Mild Cognitive Impairment and Diabetes.","authors":"Barry W Rovner, Robin J Casten","doi":"10.1016/j.jagp.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.12.001","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of discordant medication beliefs on diabetes self-management and glycemic control in older Black individuals with diabetes and Mild Cognitive Impairment (MCI).</p><p><strong>Methods: </strong>Cross-sectional analysis of baseline data from two clinical trials testing behavioral interventions to improve glycemic control in older Black primary care patients with diabetes and MCI.</p><p><strong>Results: </strong>The mean number of discordant medication beliefs was 6 (SD = 3; range 0 to 16). Sixty-seven of 246 (27%) participants held ≥ 9 discordant beliefs (i.e., one SD above the mean), and these participants had worse diabetes self-management and glycemic control than participants with fewer beliefs.</p><p><strong>Conclusions: </strong>Discordant medication beliefs, low adherence to diabetes self-management, poor glycemic control, and impaired cognition may exist in a causal relationship. Modifying discordant medication beliefs may eliminate the first step of this pathogenic sequence and reduce risk of cognitive decline in a high-risk population of older Black individuals with diabetes.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878684","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":"Rx.","authors":"J Barrie Shepherd","doi":"10.1016/j.jagp.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.013","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900709","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":"All creatures great and small.","authors":"J Barrie Shepherd","doi":"10.1016/j.jagp.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.016","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878664","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":"All in a day's work.","authors":"J Barrie Shepherd","doi":"10.1016/j.jagp.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.014","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878680","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 Metabolic Resilience in Alzheimer's Disease: A Predictor of Cognitive Decline and Conversion to Dementia.","authors":"Hyunwoo Lee, Bo-Hyun Kim, Eun Hye Lee, Daeun Shin, Heejin Yoo, Sang Won Seo, Jun Pyo Kim","doi":"10.1016/j.jagp.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.015","url":null,"abstract":"<p><strong>Objective: </strong>Brain atrophy measured by structural imaging has been used to quantify resilience against neurodegeneration in Alzheimer's disease. Considering glucose hypometabolism is another marker of neurodegeneration, we quantified metabolic resilience (MR) based on Fluorodeoxyglucose positron emission tomography (FDG PET) and investigated its clinical implications.</p><p><strong>Methods: </strong>We quantified the MR and other resilience metrics, including brain resilience (BR) and cognitive resilience (CR), using partial least squares path modeling from the ADNI database. A linear mixed-effects model and a Cox proportional hazards model were used to identify the impact of each resilience on longitudinal cognitive function and conversion to dementia, respectively.</p><p><strong>Results: </strong>A total of 848 participants were included in this study. All resilience metrics (CR, BR, and MR) were associated with slower cognitive decline. Results from the ANOVA test, AIC and BIC values showed that the additional inclusion of MR improved the performances of the linear mixed effect models. In survival analysis, all resilience variables were negatively associated with the risk of conversion to dementia. In line with the results of the linear mixed effects models, the additional inclusion of MR into the models with different resilience variables increased the C-index.</p><p><strong>Conclusion: </strong>Relative preservation of brain glucose metabolism is a valuable predictor of future cognitive decline and conversion to dementia, adding value to existing resilience metrics. While the utility of FDG PET in clinical settings is limited by cost and accessibility, it might have potential usefulness as a prognostic marker, especially in a context of resilience.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873529","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 Activation Associated With Response to Psychotherapies for Late-Life Depression: A Task-Based fMRI Study.","authors":"Nili Solomonov, Lindsay W Victoria, Zareen Mir, Dustin Phan, Matthew J Hoptman, Patricia Areán, George S Alexopoulos, Faith M Gunning","doi":"10.1016/j.jagp.2024.11.017","DOIUrl":"10.1016/j.jagp.2024.11.017","url":null,"abstract":"<p><strong>Background: </strong>The course of late-life depression is associated with functioning of multiple brain networks. Understanding the brain mechanisms associated with response to psychotherapy can inform treatment development and a personalized treatment approach. This study examined how activation of key regions of the salience network, default mode network and reward systems is associated with response to psychotherapies for late-life depression.</p><p><strong>Methods: </strong>Thirty-three older adults with major depressive disorder were randomized to 9 weeks of Engage or Problem-Solving Therapy for late-life depression. Participants completed a Probabilistic Reversal Learning task in the MRI at baseline and Week 6. We focused on focal activation in regions of interest selected a priori: the subgenual cingulate cortex (sgACC; DMN); the dorsal anterior cingulate cortex (dACC; salience network and reward system); and the nucleus accumbens (NAcc; reward system). We applied mixed-effects regression models to examine whether brain activation was associated with psychotherapy response.</p><p><strong>Results: </strong>We found that at baseline, low activation of the dACC and the sgACC was associated with lower depression severity over 6 weeks of psychotherapy. In addition, we observed significant time*activation interactions, such that after 6 weeks of psychotherapy, lower dACC activation and higher NAcc and sgACC activation were each associated with lower depression severity. Further, we found that baseline slower response to negative feedback and faster response to positive feedback was associated with lower depression severity over 6 weeks of psychotherapy.</p><p><strong>Conclusions: </strong>Our findings suggest that activation of reward, salience, and DMN regions may serve as markers of response during psychotherapy for late-life depression. Engagement of these networks may be linked to treatment outcome. Personalized psychotherapies can target individuals' brain profiles to improve outcomes for older adults with major depression.</p><p><strong>Article summary: </strong>This study examined whether activation of regions of the reward, salience and default mode networks is associated with response to psychotherapies for late-life depression. We found that baseline low activation of the dACC and the sgACC was associated with lower depression severity during psychotherapy. We also found that at week 6, lower dACC activation and higher NAcc and sgACC activation were linked with lower depression severity. These regions may represent promising brain mechanisms for future personalized interventions.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873572","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":"Reducing Depression and Suicidal Ideation Among Elder Abuse Victims Using PROTECT.","authors":"Isabel Rollandi, Emily Carter, Samprit Banerjee, Clare Culver, Nili Solomonov, Jo Anne Sirey","doi":"10.1016/j.jagp.2024.11.018","DOIUrl":"10.1016/j.jagp.2024.11.018","url":null,"abstract":"<p><strong>Objective: </strong>Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation.</p><p><strong>Design: </strong>Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.</p><p><strong>Participants: </strong>A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).</p><p><strong>Intervention: </strong>PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.</p><p><strong>Measures: </strong>Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment.</p><p><strong>Results: </strong>There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SI at baseline and 5.7% at end of treatment.</p><p><strong>Conclusions: </strong>Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856021","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":"Alexithymia in Parkinson's Disease: A Meta-analysis.","authors":"Roberto Fernández-Fernández, Javier Ibias, Cristina Del Toro-Pérez, Guillermo Lahera, Carmen Gasca-Salas","doi":"10.1016/j.jagp.2024.11.009","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.009","url":null,"abstract":"<p><p>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; P <0.05]), and moderate but significant heterogeneity (I² = 52.42%, Q = 29.42, P <0.05), partially explained by regional differences, levodopa equivalent dosage (positive regression coefficient of 0.0006 [95% CI = 0.0001; 0.0011, P <0.05]); and cognitive scores (negative regression coefficient of -0.14 [95% CI = -0.24; -0.04, P<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, P <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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"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, Tristan Montag, Ian M Hull, Kenneth Shulman","doi":"10.1016/j.jagp.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.11.002","url":null,"abstract":"<p><p>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. Banks v Goodfellow (\"Banks\") 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 Banks 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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"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}