American Journal of Geriatric Psychiatry最新文献

{"title":"Association of Family Support With Lower Modifiable Risk Factors for Dementia Among Cognitively Impaired Older Adults","authors":"","doi":"10.1016/j.jagp.2024.05.005","DOIUrl":"10.1016/j.jagp.2024.05.005","url":null,"abstract":"<div><h3>Objectives</h3><p>Cognitive impairment poses considerable challenges among older adults, with the role of family support becoming increasingly crucial. This study examines the association of children's residential proximity and spousal presence with key modifiable risk factors for dementia in cognitively impaired older adults.</p></div><div><h3>Methods</h3><p>We analyzed 14,600 individuals (35,165 observations) aged 50 and older with cognitive impairment from the Health and Retirement Study (1995–2018). Family support was categorized by spousal presence and children's residential proximity. Modifiable risk factors, including smoking, depressive symptoms, and social isolation, were assessed. Associations between family support and the modifiable risk factors were determined using mixed-effects logistic regressions.</p></div><div><h3>Results</h3><p>A significant proportion of older adults with cognitive impairment lacked access to family support, with either no spouse (46.9%) or all children living over 10 miles away (25.3%). Those with less available family support, characterized by distant-residing children and the absence of a spouse, had a significantly higher percentage of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the percentage of the risk factors by the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest percentage of the risk factors. These findings were robust to various sensitivity analyses.</p></div><div><h3>Conclusions</h3><p>Family support from spouses and nearby children serves as a protective factor against modifiable dementia risk factors in cognitively impaired older adults. Policies that strengthen family and social support may benefit this population.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141039993","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":"Information for Subscribers","authors":"","doi":"10.1016/S1064-7481(24)00307-5","DOIUrl":"https://doi.org/10.1016/S1064-7481(24)00307-5","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140914361","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":"How to Live Forever: Thoughts Upon Receiving a “Lifetime” Award","authors":"David A. Brent M.D.","doi":"10.1016/j.jagp.2024.05.002","DOIUrl":"10.1016/j.jagp.2024.05.002","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141034964","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":"Specific Association of Worry With Amyloid-β But Not Tau in Cognitively Unimpaired Older Adults","authors":"","doi":"10.1016/j.jagp.2024.04.016","DOIUrl":"10.1016/j.jagp.2024.04.016","url":null,"abstract":"<div><h3>Objective</h3><p>Anxiety disorders and subsyndromal anxiety symptoms are highly prevalent in late life. Recent studies support that anxiety may be a neuropsychiatric symptom during preclinical Alzheimer's disease (AD) and that higher anxiety is associated with more rapid cognitive decline and progression to cognitive impairment. However, the associations of specific anxiety symptoms with AD pathologies and with co-occurring subjective and objective cognitive changes have not yet been established.</p></div><div><h3>Methods</h3><p>Baseline data from the A4 and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration studies were analyzed. Older adult participants (<em>n</em> = 4,486) underwent assessments of anxiety (State-Trait Anxiety Inventory–6 item version [STAI]), and cerebral amyloid-beta (Aβ; ¹⁸F-florbetapir) PET and a subset underwent tau (¹⁸F-flortaucipir) PET. Linear regressions estimated associations of Aβ in a cortical composite and tau in the amygdala, entorhinal, and inferior temporal regions with STAI-Total and individual STAI item scores. Models adjusted for age, sex, education, marital status, depression, Apolipoprotein ε4 genotype, and subjective and objective cognition (Cognitive Function Index-participant; Preclinical Alzheimer Cognitive Composite).</p></div><div><h3>Results</h3><p>Greater Aβ deposition was significantly associated with higher STAI-Worry, adjusting for all covariates, but not with other STAI items or STAI-Total scores. In mediation analyses, the association of Aβ with STAI-Worry was partially mediated by subjective cognition with a stronger direct effect. No associations were found for regional tau deposition with STAI-Total or STAI-Worry score.</p></div><div><h3>Conclusion</h3><p>Greater worry was associated with Aβ but not tau deposition, independent of subjective and objective cognition in cognitively unimpaired (CU) older adults. These findings implicate worry as an early, specific behavioral marker and a possible therapeutic target in preclinical AD.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141049656","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 Useful Map With Some Blind Spots Still: Neurofilament Light Protein Differentiating Behavioral Variant Frontotemporal Dementia From Psychiatric Disorders","authors":"Dhamidhu Eratne B.H.B., M.B.Ch.B., F.R.A.N.Z.C.P. ,&nbsp;Alexander F Santillo M.D., Ph.D.","doi":"10.1016/j.jagp.2024.04.013","DOIUrl":"10.1016/j.jagp.2024.04.013","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924060","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":"Tai Chi-Induced Exosomal LRP1 is Associated With Memory Function and Hippocampus Plasticity in aMCI Patients","authors":"","doi":"10.1016/j.jagp.2024.04.012","DOIUrl":"10.1016/j.jagp.2024.04.012","url":null,"abstract":"<div><h3>Objectives</h3><p>The study was designed to identify the potential peripheral processes of circulating exosome in response to Tai Chi (TC) exercise and the possibility of its loaded cargos in mediating the effects of TC training on cognitive function among older adults with amnestic mild cognitive impairment (aMCI).</p></div><div><h3>Design, setting, and participants</h3><p>This was a multicenter randomized controlled trial. One hundred community-dwelling old adults with aMCI were randomly assigned (1:1) to experimental (n = 50) and control groups (n = 50).</p></div><div><h3>Intervention</h3><p>The experimental group participated in TC exercise 5 times/week, with each session lasting 60 minutes for 12 weeks. Both experimental and control groups received health education every 4 weeks.</p></div><div><h3>Measurements</h3><p>The primary outcome was global cognitive function. Neurocognitive assessments, MRI examination, and large-scale proteomics analysis of peripheric exosome were conducted at baseline and after 12-week training. Outcome assessors and statisticians were blinded to group allocation.</p></div><div><h3>Results</h3><p>A total of 96 participants (96%) completed all outcome measurements. TC training improved global cognitive function (adjusted mean difference [MD] = 1.9, 95%CI 0.93–2.87, p &lt;0.001) and memory (adjusted MD = 6.42, 95%CI 2.09–10.74, p = 0.004), increased right hippocampus volume (adjusted MD = 88.52, 95%CI 13.63–163.4, p = 0.021), and enhanced rest state functional connectivity (rsFC) between hippocampus and cuneus, which mediated the group effect on global cognitive function (bootstrapping CIs: [0.0208, 1.2826], [0.0689, 1.2211]) and verbal delay recall (bootstrapping CI: [0.0002, 0.6277]). Simultaneously, 24 differentially expressed exosomal proteins were detected in tandem mass tag-labelling proteomic analysis. Of which, the candidate protein low-density lipoprotein receptor-related protein 1 (LRP1) was further confirmed by parallel reaction monitoring and ELISA. Moreover, the up-regulated LRP1 was both positively associated with verbal delay recall and rsFC (left hippocampus-right cuneus).</p></div><div><h3>Conclusion</h3><p>TC promotes LRP1 release via exosome, which was associated with enhanced memory function and hippocampus plasticity in aMCI patients. Our findings provided an insight into potential therapeutic neurobiological targets focusing on peripheric exosome in respond to TC exercise.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929775","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":"Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review","authors":"","doi":"10.1016/j.jagp.2024.04.008","DOIUrl":"10.1016/j.jagp.2024.04.008","url":null,"abstract":"<div><h3>Objective</h3><p>Online interventions hold promise in supporting the well-being of family caregivers and enhancing the quality of care they provide for individuals with long-term or chronic conditions. However, dropout rates from support programs among specific groups of caregivers, such as caregivers of people with dementia, pose a challenge. Focused reviews are needed to provide more accurate insights and estimates in this specific research area.</p></div><div><h3>Methods</h3><p>A meta-analysis of dropout rates from available online interventions for family caregivers of people with dementia was conducted to assess treatment acceptability. A systematic search yielded 18 studies involving 1,215 caregivers.</p></div><div><h3>Results</h3><p>The overall pooled dropout rate was 18.4%, with notable heterogeneity indicating varied intervention adherence. Interventions incorporating human contact, interactive features, and personalization strategies for specific types and stages of dementia predicted significantly lower dropout rates. Methodological assessment revealed variability in study quality.</p></div><div><h3>Conclusion</h3><p>Findings support the effectiveness of social support, personalization strategies, and co-design in enhancing intervention adherence among dementia family caregivers. Further research is needed to explore factors influencing dropout rates and conduct robust trials to refine the implementation of future interventions<em>.</em></p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1064748124003191/pdfft?md5=a232985a2d8c98e20197850ca716f328&pid=1-s2.0-S1064748124003191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Regular Opioid Use With Incident Dementia and Neuroimaging Markers of Brain Health in Chronic Pain Patients: Analysis of UK Biobank","authors":"","doi":"10.1016/j.jagp.2024.04.010","DOIUrl":"10.1016/j.jagp.2024.04.010","url":null,"abstract":"<div><h3>Objectives</h3><p>We aimed to investigate the association of regular opioid use, compared with non-opioid analgesics, with incident dementia and neuroimaging outcomes among chronic pain patients.</p></div><div><h3>Design</h3><p>The primary design is a prospective cohort study. To triangulate evidence, we also conducted a nested case-control study analyzing opioid prescriptions and a cross-sectional study analyzing neuroimaging outcomes.</p></div><div><h3>Setting and Participants</h3><p>Dementia-free UK Biobank participants with chronic pain and regular analgesic use.</p></div><div><h3>Measurements</h3><p>Chronic pain status and regular analgesic use were captured using self-reported questionnaires and verbal interviews. Opioid prescription data were obtained from primary care records. Dementia cases were ascertained using primary care, hospital, and death registry records. Propensity score-matched Cox proportional hazards analysis, conditional logistic regression, and linear regression were applied to the data in the prospective cohort, nested case-control, and cross-sectional studies, respectively.</p></div><div><h3>Results</h3><p>Prospective analyses revealed that regular opioid use, compared with non-opioid analgesics, was associated with an increased dementia risk over the 15-year follow-up (Hazard ratio [HR], 1.18 [95% confidence interval (CI): 1.08–1.30]; Absolute rate difference [ARD], 0.44 [95% CI: 0.19–0.71] per 1000 person-years; Wald χ² = 3.65; df = 1; p &lt;0.001). The nested case-control study suggested that a higher number of opioid prescriptions was associated with an increased risk of dementia (1 to 5 prescriptions: OR = 1.21, 95% CI: 1.07–1.37, Wald χ² = 3.02, df = 1, p = 0.003; 6 to 20: OR = 1.27, 95% CI: 1.08–1.50, Wald χ² = 2.93, df = 1, p = 0.003; more than 20: OR = 1.43, 95% CI: 1.23–1.67, Wald χ² = 4.57, df = 1, p &lt; 0.001). Finally, neuroimaging analyses revealed that regular opioid use was associated with lower total grey matter and hippocampal volumes, and higher white matter hyperintensities volumes.</p></div><div><h3>Conclusion</h3><p>Regular opioid use in chronic pain patients was associated with an increased risk of dementia and poorer brain health when compared to non-opioid analgesic use. These findings imply a need for re-evaluation of opioid prescription practices for chronic pain patients and, if further evidence supports causality, provide insights into strategies to mitigate the burden of dementia.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1064748124003208/pdfft?md5=ef4f6b08749aae77b7dc6d65267968ce&pid=1-s2.0-S1064748124003208-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Simultaneous Aerobic Exercise and Video Game Training on Executive Functions and Brain Connectivity in Older Adults","authors":"","doi":"10.1016/j.jagp.2024.04.009","DOIUrl":"10.1016/j.jagp.2024.04.009","url":null,"abstract":"<div><h3>Objective</h3><p>The study was designed to examine the effects of simultaneous combination of aerobic exercise and video game training on executive functions (EFs) and brain functional connectivity in older adults.</p></div><div><h3>Design</h3><p>A four-armed, quasi-experimental study.</p></div><div><h3>Setting and participants</h3><p>Community-dwelling adults aged 55 years and older.</p></div><div><h3>Methods</h3><p>A total of 97 older adults were divided into one of four groups: aerobic exercise (AE), video game (VG), combined intervention (CI), and passive control (PC). Participants in intervention groups received 32 sessions of training over a 4-month period at a frequency of twice a week. EFs was evaluated using a composite score derived from a battery of neuropsychological tests. The Montreal Cognitive Assessment (MoCA) was employed to evaluate overall cognitive function, while the 6-Minute Walking Test (6MWT) was utilized to gauge physical function. Additionally, the functional connectivity (FC) of the frontal-parietal networks (FPN) was examined as a neural indicator of cognitive processing and connectivity changes.</p></div><div><h3>Results</h3><p>In terms of EFs, both VG and CI groups demonstrated improvement following the intervention. This improvement was particularly pronounced in the CI group, with a large effect size (Hedge's g = 0.83), while the VG group showed a medium effect size (Hedge's g = 0.56). A significant increase in MoCA scores was also observed in both the VG and CI groups, whereas a significant increase in 6MWT scores was observed in the AE and CI groups. Although there were no group-level changes observed in FC of the FPN, we found that changes in FC was behaviorally relevant as increased FC was associated with greater improvement in EFs.</p></div><div><h3>Conclusion</h3><p>The study offers preliminary evidence that both video game training and combined intervention could enhance EFs in older adults. Simultaneous combined intervention may hold greater potential for facilitating EFs gains. The initial evidence for correlated changes in brain connectivity and EFs provides new insights into understanding the neural basis underlying the training gains.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755536","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":"Risk of Sleep Problems in Middle-Aged and Older Adults Experiencing Bodily Pains: Serial Multiple Mediation Estimates of Emotional Distress and Activity Limitations","authors":"","doi":"10.1016/j.jagp.2024.04.011","DOIUrl":"10.1016/j.jagp.2024.04.011","url":null,"abstract":"<div><h3>Objectives</h3><p>Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association.</p></div><div><h3>Methods</h3><p>We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016–2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress.</p></div><div><h3>Results</h3><p>Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: <em>β</em> = 0.049–0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: <em>β</em> = 0.264, Bootstrap 95% confidence interval [CI] = 0.165–0.362; direct effect: (<em>β =</em> 0.107, Bootstrap 95% CI = 0.005–0.210; total indirect effect: <em>β =</em> 0.156, Bootstrap 95% CI = 0.005–0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: <em>β =</em> 0.404, Bootstrap 95% CI = 0.318–0.490; direct effect: <em>β =</em> 0.292, Bootstrap 95% CI = 0.201–0.384; and total indirect effect: <em>β =</em> 0.112, Bootstrap 95% CI = 0.069–0.156) yielding ∼28%.</p></div><div><h3>Conclusion</h3><p>Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793401","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}