American Journal of Geriatric Psychiatry最新文献

{"title":"96. USING MACHINE LEARNING MODELS TO DETECT EARLY ALZHEIMER’S DISEASE THROUGH SPEECH ANALYSIS","authors":"Julia Kimball ,&nbsp;Ashley Abi Chaker ,&nbsp;Alp Canbulat ,&nbsp;Ipsit Vahia","doi":"10.1016/j.jagp.2025.04.098","DOIUrl":"10.1016/j.jagp.2025.04.098","url":null,"abstract":"<div><h3>Introduction</h3><div>There is an urgent need for novel approaches that may facilitate early detection of Alzheimer's disease and thus, create targets for effective intervention and management. Current diagnostic methods often rely on expensive and/or time-consuming procedures such as brain imaging and cognitive assessments. A novel approach proposes leveraging AI/ML models to detect AD early through the analysis of spontaneous speech and language use. This method holds the potential to advance the process of AD diagnosis by offering a non-invasive, cost-effective, and easily accessible screening tool that may identify subtle variations in linguistic (and by extension, neurocognitive) function that may not yet be identified by standard screening tools. Here, we explore the range of deep learning models that have been applied to language and cognition. We also compare their analytic approaches and available results, with a view to identifying which approach may translate most readily to clinical care.</div></div><div><h3>Methods</h3><div>We used a multi-faceted approach that included a literature review, brainstorming sessions with an interdisciplinary team and field experts, and targeted internet searches for relevant web-based resources. The focus of our search was to compile studies that explored the development and application of AI algorithms to identify subtle changes in speech patterns, linguistic features, and acoustic properties associated with the early stages of AD. We considered, but did not apply a traditional biomedical search algorithm, since the literature in this space is often found outside of the biomedical literature, and because this is an exploratory project. We noted that by analyzing extensive datasets of speech samples from both healthy individuals and those with AD, all the identified studies sought to establish robust predictive models for early detection. We further examined whether confounding variables present in current linguistic AD models, such as those arising from language barriers, are also present in trained deep learning models.</div></div><div><h3>Results</h3><div>Our investigation demonstrated the consistent application across the literature, of a multimodal system, encompassing both neural networks and traditional analysis models, which were fine-tuned for the early detection of Alzheimer's disease. Among these, the ADReSS dataset emerged as the most effective, with the ensemble method achieving the highest accuracy in predicting Alzheimer’s disease based on speech patterns. However, we noted a crucial limitation: the model’s training relied solely on English speech data. This restriction introduces bias and hinders generalizability. Languages exhibit distinct phonetic structures, accents, and rhythms, potentially causing a model trained exclusively on English to misinterpret speech from other languages. Furthermore, while deep neural networks excel at discerning complex patterns, their internal wo","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S71"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614265","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":"8. TO GIVE OR NOT TO GIVE (LORAZEPAM): A CASE REPORT OF CATATONIA MASQUERADING AS DELIRIUM IN A GERIATRIC PATIENT","authors":"Lauren Behlke ,&nbsp;Tatiana Winkelman ,&nbsp;Ipsit Vahia ,&nbsp;Alexis Freedberg","doi":"10.1016/j.jagp.2025.04.011","DOIUrl":"10.1016/j.jagp.2025.04.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Catatonia is a complex clinical syndrome defined by a variety of motor and behavioral symptoms. Given the heterogeneity and non-specificity of its symptoms, catatonia is often confused with other psychiatric conditions, such as delirium and apathy. Few guidelines exist in the literature for differential treatment approaches for older adults who may manifest with unclear diagnoses. Here we describe a single-case example of catatonia, the process of diagnostic clarification and treatment, and a review of the relevant literature with the aim of demonstrating the importance of accurate catatonia diagnosis and treatment in the geriatric population.</div></div><div><h3>Methods</h3><div>We present a case of a 73-year-old woman with a past psychiatric history of Major Depressive Disorder, Alcohol Use Disorder in sustained remission, history of Wernicke Encephalopathy 3 years prior, and a history of ischemic stroke who presented with new onset disorientation in the setting of decreasing oral intake and ongoing auditory hallucinations. The initial working diagnosis was delirium, but further examinations and lorazepam trial revealed a diagnosis of catatonia. We review the literature on catatonia in geriatric patients, with an emphasis on differentiating catatonia from delirium in complex patients who are at risk for both.</div></div><div><h3>Results</h3><div>Catatonia is common in older adults in acute psychiatry inpatient and consult-liaison settings, with an estimated prevalence of 5.5-39.6%. The most common catatonic symptoms seen in this population include immobility/stupor, staring, and mutism. Accurate diagnosis and treatment are vital, as catatonia can have serious medical consequences in older adults, such as skin breakdown, urinary tract infections, dehydration, DVTs, or even death. Treatment recommendations in older adults are consistent with those in younger adults, with a benzodiazepine trial as first line and ECT indicated as second line. However, presenting clinical features are often complex, may evolve, and can be confused with delirium. In our case, the patient presented as withdrawn, with psychomotor slowing and paucity of speech suggestive of hypoactive delirium and was initially maintained on neuroleptics. While awaiting lab results, she developed mutism, rigidity, and stereotypies, which is aligned with the reports in the literature of common catatonic symptoms seen in the geriatric population. This patient responded well to a lorazepam trial, consistent with current treatment recommendations for catatonia in older adults, and neuroleptics were discontinued. An important consideration remains whether her history of alcohol use disorder in sustained remission increased her risk for catatonia. There is a notable paucity of literature on the contribution of alcohol use history to the development of catatonia in older adults.</div></div><div><h3>Conclusions</h3><div>Our case demonstrates that catatonia can pre","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S6"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613898","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":"50. WHY NOT GERIATRICS? TRAINEE INTEREST IN AND BELIEFS ABOUT WORKING WITH OLDER ADULTS","authors":"Emily Kulpa ,&nbsp;Sierra D. Thomas ,&nbsp;Emma Williams ,&nbsp;Tasha Woodall ,&nbsp;Arushi Kapoor ,&nbsp;Carissa Lau-Julien","doi":"10.1016/j.jagp.2025.04.052","DOIUrl":"10.1016/j.jagp.2025.04.052","url":null,"abstract":"<div><h3>Introduction</h3><div>The global population of older adults is rapidly increasing, yet there is a persistent shortage of healthcare professionals trained to address their unique and growing care needs. A contributing factor to this gap is the relative lack of popularity of geriatrics as a specialty among trainees. This study explores the attitudes of resident physicians and pharmacy students towards pursuing careers in geriatrics through two qualitative analyses.</div></div><div><h3>Methods</h3><div>Eight resident physicians specializing in family medicine, internal medicine, and psychiatry participated in focus groups at a single training site in North Carolina. Discussions were moderated by a research associate, without affiliation to a specific medical field, using five open-ended questions, recorded, transcribed, and analyzed for recurring themes.</div><div>Additionally, two virtual focus groups were conducted with second- and third-year pharmacy students from a public school of pharmacy in North Carolina. A moderator guided discussions through 13 questions addressing career aspirations, factors influencing interest or disinterest in geriatrics, and general attitudes toward older adults. Transcripts were systematically coded and analyzed to identify common themes.</div></div><div><h3>Results</h3><div>Among the resident physician focus groups, the key factors fostering interest in geriatrics included: (1) the opportunity to build deep connections with patients, (2) personal fulfillment from focusing on quality of life and dignity at end-of-life care, and (3) the diverse practice settings available.</div><div>Conversely, barriers included: (1) inadequate resources and support for the geriatric population, (2) emotional and cognitive challenges related to complex care needs, (3) perceived undervaluation of geriatrics within medicine and (4) lower financial compensation.</div><div>For the pharmacy students, factors encouraging interest comprised: (1) job security, (2) alignment with preferred clinical activities, (3) exposure to higher clinical acuity, (4) meaningful relationships with older adults, and (5) positive prior experiences with older adults.</div><div>Deterrents included: (1) heightened professional liability, (2) negative past experiences, (3) insufficient geriatric exposure, and (4) communication challenges with older adults.</div></div><div><h3>Conclusions</h3><div>Both resident physicians and pharmacy students highlighted the significance of forming meaningful relationships with patients as a primary motivator for interest in geriatrics. These findings provide a foundation for addressing barriers and enhancing factors that can attract more trainees to the field, thereby mitigating the ongoing shortage of geriatric healthcare professionals.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S37"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613910","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":"51. DEMOGRAPHIC AND CLINICAL PREDICTORS OF PARTICIPANT ENGAGEMENT IN SUSTAIN","authors":"Emily Kulpa ,&nbsp;Isabelle Duerr ,&nbsp;Rachel Chiu ,&nbsp;Kristin Montague ,&nbsp;Ashleigh Fenton ,&nbsp;Arushi Kapoor ,&nbsp;Joel E. Streim ,&nbsp;Mary Beth Connolly Gibbons","doi":"10.1016/j.jagp.2025.04.053","DOIUrl":"10.1016/j.jagp.2025.04.053","url":null,"abstract":"<div><h3>Introduction</h3><div>This study utilized data from the well-established Supporting Seniors Receiving Treatment And Intervention (SUSTAIN) program. SUSTAIN is sponsored by the Commonwealth of Pennsylvania Department of Aging, and is delivered by the University of Pennsylvania as a free clinical service. Through this partnership, SUSTAIN provides geriatric mental health care management and other behavioral health services by telephone to enrollees in the Pennsylvania Department of Aging’s Pharmaceutical Assistance Contract for the Elderly (PACE) and PACE Needs Enhancement Tier (PACENET). PACE and PACENET, respectively, provide prescription drug coverage for low- and moderately low-income elderly (age 65+) residents of Pennsylvania. Weekly random samples of PACE and PACENET cardholders that have been newly prescribed an antidepressant, anxiolytic, or antipsychotic medication are offered participation in SUSTAIN. SUSTAIN has demonstrated benefits for patients in reducing psychiatric symptom burden and improving quality of life when they engage in services. To support broader implementation of this effective intervention it is important to explore patient engagement in services. This analysis aimed to examine demographic and clinical predictors of patient engagement.</div><div>Current literature suggests that geriatric patients who are younger, white, female, and live in an urban area are more likely to engage in mental health services. We examined participant data to determine if the participants who engage in SUSTAIN follow these demographic trends. Clinically, previous studies have demonstrated that geriatric patients with higher symptom burden or previous positive experience with mental health treatment engage more frequently with mental health services. However, these predictors may be less applicable to the older adult population as psychiatric symptoms may be attributed to other medical illnesses and engagement may be influenced by stigma against participating in behavioral health services. We sought to explore if the clinical factors of prior health service utilization and patient identified resource needs were predictors of engagement in treatment.</div></div><div><h3>Methods</h3><div>This study analyzed a sample of 1071 SUSTAIN participants who were enrolled in the program as indicated by completing a baseline measure between the years of 2018 and 2024. Their level of engagement was denoted by the number of telephone contacts with a behavioral health clinician (nurses and/or licensed clinical social workers) for a care management session. To evaluate demographic predictors of program engagement, participants’ age, gender, race, ethnicity, and geographic area were correlated with the number of care management sessions attended.</div><div>To evaluate clinical predictors of program engagement, two sections of the comprehensive baseline assessment were reviewed: service utilization and a needs assessment. To evaluate medical service ut","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S37-S38"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613911","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":"32. OREXIN 1 RECEPTOR ANTAGONISM EXACERBATES SLEEP DEFICITS AND REDUCES ANXIETY IN A TAU TRANSGENIC MOUSE MODEL OF ALZHEIMER'S DISEASE","authors":"Yasmin Potts ,&nbsp;Stuart McDougall ,&nbsp;Heather Daykin ,&nbsp;Maarten Van Den Bossche ,&nbsp;Daniel Hoyer ,&nbsp;Laura Jacobson","doi":"10.1016/j.jagp.2025.04.034","DOIUrl":"10.1016/j.jagp.2025.04.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Alzheimer's disease (AD) affects more than 55 million people globally and current pharmacological treatments for symptoms remain limited. Neurons producing orexin peptides located in the lateral hypothalamus project widely throughout the brain, and represent a novel target in AD. Orexins bind to orexin 1 and orexin 2 receptors (OX1Rs and OX2Rs). Dual orexin receptor antagonists (DORAs) are an effective treatment for insomnia in AD as they improve REM sleep and memory consolidation. They also reduce phosphor-tau variants and amyloid-beta in human CSF. OX1Rs are involved in stress responses and motivated behaviours. OX1R antagonists remain underexplored and offer a novel potential treatment modality for psychiatric disorders and, unlike DORAs, are not hypnotic.</div></div><div><h3>Methods</h3><div>We pharmacologically antagonised OX1Rs in an AD mouse model with the aim of reducing psychiatric-like behaviours without somnolence. Male and female PS19 mice (an AD mouse model with overexpression of P301S mutant human tau), and wild type littermates, were dosed daily p.o. with the OX1R antagonist 1-SORA-51 (60mg/kg/d) or vehicle. Vigilance states were recorded using polysomnography recordings and anxiety-like behaviours were assessed using a range of behavioural tests.</div></div><div><h3>Results</h3><div>Male and female transgenic mice showed significant REM sleep deficits, with males also exhibiting decreased non-REM sleep and increased wakefulness. Male transgenic mice demonstrated hyperlocomotion in the open field test. Unexpectedly, the OX1R antagonist 1-SORA-51 exacerbated REM sleep deficits in male tau transgenic mice and, contrastingly, rescued anxiety-like behaviours in the open field assay.</div></div><div><h3>Conclusions</h3><div>OX1R antagonism in AD may be effective in ameliorating anxiety symptoms during the daytime, while discordantly worsening REM sleep deficits at night.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S22-S23"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613891","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":"4. CANADIAN GUIDELINES FOR THE ASSESSMENT AND TREATMENT OF ANXIETY IN OLDER ADULTS","authors":"Andrea Iaboni ,&nbsp;Alastair Flint ,&nbsp;Zahra Goodarzi ,&nbsp;Amy Gough ,&nbsp;Heli Juola ,&nbsp;Sarah Neil-Sztramko ,&nbsp;Kristin Reynolds ,&nbsp;Shanna Trenaman ,&nbsp;Michael Van Ameringen ,&nbsp;Erica Weir ,&nbsp;Carly Whitmore ,&nbsp;Anthony Yeung ,&nbsp;Sebastien Grenier","doi":"10.1016/j.jagp.2025.04.007","DOIUrl":"10.1016/j.jagp.2025.04.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Anxiety is not a normal part of aging, and misconceptions about anxiety in older adults lead to it being underrecognized and undertreated. Anxiety has a negative impact on quality of life, increases disability and caregiver burden, and is a risk factor for depression and dementia. To address the need for up-to-date, comprehensive clinical guidelines aimed at the assessment, treatment, and prevention of anxiety in older adults, the Canadian Coalition for Seniors Mental Health (CCSMH) has led a guideline project which has engaged with older adults and caregivers, healthcare providers, and community organizations across Canada to produce guidelines and tools that establish best practices for the care of older people with anxiety.</div></div><div><h3>Methods</h3><div>The guideline development followed a rigorous process set out by the Guidelines International Network (GIN)-McMaster Guideline Development checklist, including systematic reviews and meta-analyses across priority areas, with certainty of evidence evaluated using the GRADE methodology, and Evidence to Decision Frameworks used to consolidate evidence on the interventions to establish the recommendations.</div></div><div><h3>Results</h3><div>The guideline contains a total of 32 recommendations across case-finding, assessment, and treatment. This presentation will provide an overview of the guidelines, with a focus on the treatment recommendations including non-pharmacological (CBT, Mindfulness, Exercise) and pharmacological interventions (antidepressants, buspirone, benzodiazepines, antipsychotics and gabapentinoids). The presentation will also include sharing of knowledge translation tools and other resources to support care.</div></div><div><h3>Conclusions</h3><div>Anxiety in older adults is a treatable mental health condition and there are many evidence-based interventions that are helpful. These guidelines are an important step in setting out best practices in the assessment and treatment of anxiety in older adults.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S3-S4"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613893","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":"90. WHERE HAVE WE LOST THEM? THE UNHEARD NARRATIVES OF GERIATRIC MENTAL HEALTH","authors":"Azma Parhin ,&nbsp;Walter Wills ,&nbsp;Gloria Monasmith ,&nbsp;Preetham Grandhi ,&nbsp;Shirley Alleyne","doi":"10.1016/j.jagp.2025.04.092","DOIUrl":"10.1016/j.jagp.2025.04.092","url":null,"abstract":"<div><h3>Introduction</h3><div>The general course of mental illness is one of worsening with age, with geriatric patients often experiencing more severe illness, with higher comorbidity. Despite a general increase in mental health care (MHC) utilization among US adults, older adults were less likely to access mental health services compared to younger groups, with over half of those with diagnosable conditions not seeking professional help. Moreover, the continued MHC needs of aging individuals remain poorly defined. Identifying barriers to accessing MHC, while considering resource constraints is crucial for delivering high-quality geriatric MHC.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of the electronic health records of new adult patients receiving MH services at a large community-based hospital between February 1, 2022, and July 31, 2022. The primary outcome was the number of MH follow-up visits (psychotherapy visits, psychotropic medication management visits, or both) in the subsequent three months following their initial encounter. Poisson regression was used to model the relationship between the outcome and variables.</div></div><div><h3>Results</h3><div>Across the sample (N = 403), 49 (12.16%) cases were aged 65 years or older (geriatric). Being in the geriatric patient group was negatively associated with the number of FU visits over the subsequent three months (IRR = 0.672, 95% CI [0.486, 0.930], p = 0.017). Also, geriatric patients were more likely to receive both psychotherapy and pharmacotherapy concurrently (p = 0.04, z = 1.6) than adults ages 18 to 64 years, and were noted to experience a more severe median comorbidity burden (p &lt; .001).</div></div><div><h3>Conclusions</h3><div>Regardless of having a higher burden of comorbid MH illnesses typically requiring more frequent MH services, geriatric patients in this study had fewer FU appointments. Further investigation is needed to identify the roadblocks that impede MHC utilization among the aging population, with the ultimate goal of informing policy development to increase access to MH services by this population.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S67"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614424","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":"69. LOST IN THE SILENCE: A CASE OF AUDITORY CHARLES BONNET SYNDROME AND COGNITIVE DECLINE","authors":"Amanda Actor ,&nbsp;Patricia Serrano Andrews ,&nbsp;Jason Greenhagen ,&nbsp;Warren Taylor","doi":"10.1016/j.jagp.2025.04.071","DOIUrl":"10.1016/j.jagp.2025.04.071","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Charles Bonnet syndrome (CBS) is an isolated visual pseudohallucinatory phenomena in the setting of visual impairment with preserved insight and lack of other psychiatric diagnoses. This rare condition was identified originally in 1938 by de Morsier [1], later expanded to include atypical cases of CBS in which auditory hallucinations develop following hearing impairment rather than the more common visual hallucinations [2,3]. While some reports have hinted at connections between CBS and the development of dementia, few cases of auditory CBS have been published in the setting of cognitive impairment [4,5].&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Ms. S is a 75 year old female with no prior psychiatric history who suffered progressive hearing loss requiring hearing aids in her late 60s. At age 70, she began to experience auditory phenomena where she would hear music and conversations from next door that were not present. These auditory hallucinations were accompanied by the development of paranoid and persecutory delusions. By her early 70s, Ms. S had multiple inpatient psychiatric hospitalizations and had been trialed on many psychotropic agents with only modest improvement. These hallucinations would often initially remit while in the hospital, only to return at home. After three years of persistent auditory symptoms, Ms. S began to exhibit motor symptoms including gait instability, fine tremor, and stooped posture. Shortly after, she began exhibiting word finding difficulties and further cognitive decline including difficulty completing instrumental activities of daily living.&lt;/div&gt;&lt;div&gt;Brain Magnetic Resonance Imaging (MRI) was notable for moderate global atrophy and mild chronic cerebrovascular disease burden, but etiology of Ms. S’s cognitive impairment remained inconclusive. Dopamine transporter (DaT) Scan, alpha-synuclein dermal punch biopsy, Fludeoxyglucose-18 (FDG) Positron Emission Tomography (PET) scan and neuropsychiatric testing were unable to further identify a specific neurological diagnosis.&lt;/div&gt;&lt;div&gt;During her last inpatient psychiatric admission, Ms. S was started on a low dose of oral olanzapine in addition to a rivastigmine transdermal patch which was found to eliminate delusional content though intermittent auditory phenomenon remained. At discharge, Ms. S reported she was no longer bothered by the voices and music, and understood that they were likely related to her hearing loss.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Auditory CBS may affect up to 2.5% of elderly individuals with hearing loss [6]. Isolated case reports have shown a possible connection between auditory CBS and cognitive impairment, though research in this area is lacking [3]. While there are no controlled trials in CBS, case studies have indicated reassurance as a main treatment modality, though this is notably more challenging in the setting of memory impairment [3]. Olanzapine, pregabalin, clonazepam, and acetylcholinesterase inhibi","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S50-S51"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614432","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":"15. DESIGN OF THE PHASE 2/3, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER STUDIES INVESTIGATING THE EFFICACY AND SAFETY OF ACP-204, A NOVEL 5-HT2A INVERSE AGONIST, IN ALZHEIMER’S DISEASE PSYCHOSIS","authors":"Samantha Friend ,&nbsp;Bryan Dirks ,&nbsp;Becky Howell ,&nbsp;Xiaoshu Feng ,&nbsp;Peter Zhang ,&nbsp;Sanjeev Pathak","doi":"10.1016/j.jagp.2025.04.018","DOIUrl":"10.1016/j.jagp.2025.04.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately 30% of patients with Alzheimer’s disease experience hallucinations and/or delusions related to Alzheimer’s disease psychosis (ADP). Patients are often managed with off-label antipsychotics, which are associated with considerable safety concerns. ACP-204 is a 5-HT2A selective inverse agonist and antagonist (and, less so, 5-HT2C). It was developed with an improved pharmacological profile compared with first-in-class pimavanserin. Here we describe the study design for 3 independent phase 2 and 3 studies of ACP-204.</div></div><div><h3>Methods</h3><div>The master protocol ACP-204-006 (NCT06159673) includes 3 similar, independent, operationally seamless, double-blind, placebo-controlled, multicenter studies investigating the efficacy and safety of ACP-204 in ADP. Eligibility criteria include individuals 55-95 years of age with Alzheimer’s disease and psychosis. Part 1 (phase 2) will evaluate efficacy and dose response of ACP-204 60 mg and 30 mg vs placebo in participants with ADP. Part 2A and Part 2B (phase 3) will either confirm both doses, or pursue only a single dose from Part 1. Participants in each of the 3 independent studies will be randomized 1:1:1 to receive ACP-204 60 mg, 30 mg, or 0 mg (placebo) for 6 weeks in a double-blind treatment period. Part 1 will enroll ∼318 total participants (∼106 per arm), and Parts 2A and 2B separately will each enroll ∼378 total participants (∼126 per arm), providing ≥80% (Part 1) or ≥85% (Part 2A and 2B) power to detect a significant effect of ACP-204 over placebo at alpha level 0.05 using a two-sided test. Participants who complete Part 1, 2A, or 2B may be eligible to roll over into the long-term open-label extension (OLE) study, ACP-204-008 (NCT06194799). Each of the 3 studies will include a ≤42-day screening period, 6-week double-blind treatment period, 30-day safety follow-up period for participants not rolling over into OLE, and a mortality follow-up for participants with early study termination (Figure 1). The primary, secondary, and select other endpoints are shown in Figure 1.</div></div><div><h3>Results</h3><div>This ongoing study has an estimated completion date of February 2028.</div></div><div><h3>Conclusions</h3><div>ACP-204-006 will be the first clinical study to evaluate the efficacy and safety of ACP-204 in patients with ADP, a population with considerable unmet needs.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S11-S12"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614462","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":"43. BEYOND ENTERTAINMENT: MEDIA PATTERNS AND ASSOCIATIONS WITH DEPRESSION IN OLDER ADULTS","authors":"Justine Ku ,&nbsp;Alexander Parker ,&nbsp;Jacklyn Vargas ,&nbsp;Emily Troyer ,&nbsp;Jordan Kohn","doi":"10.1016/j.jagp.2025.04.045","DOIUrl":"10.1016/j.jagp.2025.04.045","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;As individuals age, leisure time often increases, leading to greater engagement in less physically demanding activities like various forms of media, including television, books, and computer use (Matthews et al., 2008). While media use has been a significant area of research among younger populations, it remains underexplored in studies involving older adults. In particular, the connections between media usage and mental health—specifically, depression— in this demographic are even less understood. For example, do individuals with depression tend to favor certain types of media over others? It is essential to examine actual data and patterns of media usage in older adults, especially given that depression significantly increases mortality rates in elderly populations aged 65 and older compared to non-depressed counterparts (Schulz et. al., 2000). Although pharmacological treatments for depression are available, older adults often face increased sensitivity to side effects, potential interactions with other medications, and issues related to drug metabolism. Polypharmacy and the cumulative effects of medication usage over decades also warrant caution amongst older populations. As such, examining how behavioral preferences and variations in media consumption impact mental health among aging populations is important for developing more holistic guidelines to inform health delivery and policy. This research therefore aims to improve the quality of life for old age individuals by investigating behavioral patterns and associations with depression, particularly by addressing gaps in understanding media preferences among older adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This analysis utilized 2020 Public Survey data and 2021 Consumption and Activities Mail Survey (CAMS) from the Health and Retirement Study (HRS), sponsored by the National Institute on Aging (NIA U01AG009740) and conducted by the Univ. of Michigan. Data missingness ranged 0-2.4% and were multiply imputed (m=20) under the missing at random mechanism using random forest classification and regression (analytical sample N=3,710, &gt; 55 years old). Respondents were categorized as having significant depressive symptoms (N=532; 14.7%) based on previously-validated CESD-8 score ≥4 cutoff. Media activities (MAs) included TV/movies, newspapers/magazines, books, music, communication (telephone, letters, e-mail, facebook, skype), and computer use. Covariates included age, gender, race, ethnicity, marital status, employment status, educational attainment, and degree of functional impairment (e.g., ADLs, IADLs). Negative binomial (NB) and binary logistic regression models were used to determine relationships between MAs, CESD score and depression category. Descriptive statistics, univariate comparisons, and regression model estimates and confidence intervals were obtained by pooling results across imputed datasets according to Rubin’s rules.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S31-S32"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613994","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}