American Journal of Geriatric Psychiatry最新文献

{"title":"Effects of Wisdom-Enhancement Narrative-Therapy and Empathy-Focused interventions on loneliness over 4 weeks among older adults: A Randomized Controlled Trial","authors":"Da Jiang Ph.D. ,&nbsp;Vivien Foong Yee Tang M.Sc. ,&nbsp;Maninder Kahlon Ph.D. ,&nbsp;Esther Oi-wah Chow Ph.D. ,&nbsp;Dannii Yuen-lan Yeung Ph.D. ,&nbsp;Rhonda Aubrey M.H.I. ,&nbsp;Kee-Lee Chou Ph.D.","doi":"10.1016/j.jagp.2024.07.003","DOIUrl":"10.1016/j.jagp.2024.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>In this three-armed RCT, we tested the effects of a telephone-delivered wisdom enhancement narrative therapy-based intervention (Tele-NT) and a telephone-delivered empathy-focused intervention (Tele-EP) in reducing loneliness against an active control group that received regular call (ACG) at the 4-week follow-up assessment.</div></div><div><h3>Design, Setting, Intervention, and Participants</h3><div>To evaluate the effects of the interventions on loneliness, we randomized 287 older adults based in Hong Kong, ages 65 to 90, into Tele-NT (<em>N</em> = 97), Tele-EP (<em>N</em> = 95), or ACG (<em>N</em> = 95).</div></div><div><h3>Measurement</h3><div>The primary outcome was loneliness, calculated using the De Jong Gierveld Scale and the UCLA Loneliness Scale. Secondary outcomes were sleep quality, depressive symptoms, social network engagement, and perceived social support. Assessments were done before training and 4 weeks after the intervention period.</div></div><div><h3>Results</h3><div>Results from linear mixed models showed significant positive effects of Tele-NT on loneliness measured by the De Jong Gierveld Loneliness Scale compared to ACG. Compared to the ACG, the Tele-NT group significantly reduced loneliness at the 4-week follow-up (mean difference = −0.51, <em>p</em> = 0.019, Cohen's <em>d</em> = 0.60). However, the difference between Tele-EP and the ACG at the 4-week follow-up was not significant (MD = −0.34, <em>p</em> = 0.179, Cohen's <em>d =</em> 0.49). Tele-NT and Tele-EP did not show significant effects on the secondary outcomes, compared to the ACG.</div></div><div><h3>Conclusions</h3><div>In this randomized clinical trial, we found that a 4-week wisdom enhancement narrative therapy program significantly reduced feelings of loneliness. This effective telephone-based, lay-therapist-delivered program is scalable for broader implementation.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 1","pages":"Pages 18-30"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693663","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":"Loss of Insight in Syndromes Associated with Frontotemporal Lobar Degeneration: Clinical and Imaging Features","authors":"Valeria Bracca M.S. ,&nbsp;Enrico Premi M.D. ,&nbsp;Maria Sofia Cotelli M.D. ,&nbsp;Anna Micheli M.D. ,&nbsp;Daniele Altomare Ph.D. ,&nbsp;Valentina Cantoni Ph.D. ,&nbsp;Roberto Gasparotti M.D. ,&nbsp;Barbara Borroni M.D.","doi":"10.1016/j.jagp.2024.12.005","DOIUrl":"10.1016/j.jagp.2024.12.005","url":null,"abstract":"<div><h3>Objectives</h3><div>The present study aims to assess the prevalence, associated clinical symptoms, longitudinal changes, and imaging correlates of Loss of Insight (LOI), which is still unexplored in syndromes associated with Frontotemporal Lobar Degeneration (FTLD).</div></div><div><h3>Design</h3><div>Retrospective longitudinal cohort study, from Oct 2009 to Feb 2023.</div></div><div><h3>Setting</h3><div>Tertiary Frontotemporal Dementia research clinic.</div></div><div><h3>Participants</h3><div>A sample of 712 FTLD patients, 331 of whom had follow-up evaluation.</div></div><div><h3>Measurements</h3><div>LOI was assessed by interview with the primary caregiver. Univariate and multiple logistic regression and linear mixed models were used to estimate predictors and longitudinal changes over time associated with LOI. Voxel-based morphometry and structural covariance analyses of brain structural MRI images were implemented in Statistical Parametric Mapping.</div></div><div><h3>Results</h3><div>LOI was reported in 45% of patients (321/712, 95%CI = 41–49), with progressively increased prevalence from prodromal to severe dementia stages. LOI was more prevalent in the behavioural variant FTD, in the semantic variant of Primary Progressive Aphasia (svPPA) and FTD with Amyotrophic Lateral Sclerosis than in other phenotypes (all p<em>-values</em>&lt;0.001). LOI severity increased over time only in patients with svPPA (β = +0.59, p &lt;0.001) and clustered with other behavioral symptoms (all p<em>-values</em> &lt;0.05). Finally, LOI was significantly associated with greater atrophy in the right medial orbital gyrus (p &lt;0.001 uncorrected). Structural covariance analysis demonstrated loss of negative correlation between right medial orbital gyrus and regions belonging to the Default Mode Network (DMN), such as the left precuneus and the left angular gyrus (p ≤0.05 family-wise error-corrected) in FTLD patients with LOI.</div></div><div><h3>Conclusions</h3><div>A better comprehension of LOI mechanisms could lead to more effective interventions and healthcare policies.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Pages 450-462"},"PeriodicalIF":4.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973371","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":"Ethnic Differences in the Association Between Cognitive Performance and Informant-rated Cognitive Decline","authors":"Emily M. Briceño PhD ,&nbsp;Barbara Mendez Campos MSW, LCSW ,&nbsp;Roshanak Mehdipanah PhD ,&nbsp;Wen Chang MS ,&nbsp;Steven G. Heeringa PhD ,&nbsp;Joshua Martins-Caulfield BS ,&nbsp;Deborah A. Levine MD, MPH ,&nbsp;Nelda Garcia BS ,&nbsp;Xavier F. Gonzales PhD ,&nbsp;Kenneth M. Langa MD, PhD ,&nbsp;Darin B. Zahuranec MD ,&nbsp;Lewis B. Morgenstern MD","doi":"10.1016/j.jagp.2024.12.003","DOIUrl":"10.1016/j.jagp.2024.12.003","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Design, Setting, and Participants</h3><div>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.</div></div><div><h3>Measurement</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 664-677"},"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 M.D. ,&nbsp;Robin J. Casten Ph.D.","doi":"10.1016/j.jagp.2024.12.001","DOIUrl":"10.1016/j.jagp.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Pages 337-341"},"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":"10.1016/j.jagp.2024.11.013","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 3","pages":"Page 335"},"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":"10.1016/j.jagp.2024.11.016","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Page 716"},"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":"10.1016/j.jagp.2024.11.014","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Page 484"},"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 B.S. ,&nbsp;Bo-Hyun Kim Ph.D. ,&nbsp;Eun Hye Lee M.D. ,&nbsp;Daeun Shin M.D. ,&nbsp;Heejin Yoo M.S. ,&nbsp;Sang Won Seo M.D., Ph.D. ,&nbsp;Jun Pyo Kim M.D., Ph.D.","doi":"10.1016/j.jagp.2024.11.015","DOIUrl":"10.1016/j.jagp.2024.11.015","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 678-688"},"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 Ph.D. ,&nbsp;Lindsay W. Victoria Ph.D. ,&nbsp;Zareen Mir M.A. ,&nbsp;Dustin Phan B.A. ,&nbsp;Matthew J. Hoptman Ph.D. ,&nbsp;Patricia Areán Ph.D. ,&nbsp;George S. Alexopoulos M.D. ,&nbsp;Faith M. Gunning Ph.D.","doi":"10.1016/j.jagp.2024.11.017","DOIUrl":"10.1016/j.jagp.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>a priori</em>: 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Article Summary</h3><div>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.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 611-623"},"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 Ph.D. ,&nbsp;Emily Carter B.A. ,&nbsp;Samprit Banerjee Ph.D. ,&nbsp;Clare Culver B.S. ,&nbsp;Nili Solomonov Ph.D. ,&nbsp;Jo Anne Sirey Ph.D.","doi":"10.1016/j.jagp.2024.11.018","DOIUrl":"10.1016/j.jagp.2024.11.018","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.</div></div><div><h3>Participants</h3><div>A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).</div></div><div><h3>Intervention</h3><div>PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.</div></div><div><h3>Measures</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 689-701"},"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}