American Journal of Geriatric Psychiatry最新文献

{"title":"Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment","authors":"","doi":"10.1016/j.jagp.2024.05.006","DOIUrl":"10.1016/j.jagp.2024.05.006","url":null,"abstract":"<div><h3>Objective</h3><div>This is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD).</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS).</div></div><div><h3>Results</h3><div>In the intention-to-treat sample (<em>n</em> = 229), both LLD-CBT (<em>n</em> = 115) and SUI (<em>n</em> = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (<em>d</em> = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; <em>d</em> = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (<em>F</em>(1,201.31) = 4.71; p <em>=</em> .031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype ‘physical neglect’ was associated with a smaller depressive symptom reduction (<em>F</em>(1,207.16) = 5.37; p <em>=</em> .021).</div></div><div><h3>Conclusions</h3><div>Specific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037825","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":"Anticonvulsants in the Treatment of Behavioral and Psychological Symptoms in Dementia: A Systematic Review","authors":"","doi":"10.1016/j.jagp.2024.05.004","DOIUrl":"10.1016/j.jagp.2024.05.004","url":null,"abstract":"<div><h3>Objectives</h3><p>Behavioral and psychological symptoms of dementia (BPSD) are common and impart a significant burden to patients, caregivers, and the health system. However, there are few pharmacological options for treating BPSD. We conducted a systematic review of clinical trials examining the efficacy of anticonvulsants in BPSD.</p></div><div><h3>Methods</h3><p>We searched five electronic databases through January 2023, for randomized controlled trials and systematic reviews evaluating the efficacy of non-benzodiazepine anticonvulsants for the treatment of BPSD. We used the Cochrane risk of bias tool to ascertain the risk of bias in included trials. Because statistical pooling of results using meta-analysis was not feasible, we synthesized findings using the Cochrane Synthesis Without Meta-analysis reporting guidelines.</p></div><div><h3>Results</h3><p>We identified 12 studies, including randomized controlled trials (RCTs) and 1 systematic review. Five RCTs evaluating valproic acid were synthesized by a recent Cochrane review which concluded that this drug is likely ineffective for BPSD. We extracted data from 6 trials involving 248 individuals comparing non-benzodiazepine anticonvulsants to either placebo or risperidone. Four trials (n = 97 participants) evaluated carbamazepine, only one of which demonstrated an improvement in the Brief Psychiatric Rating Scale measuring agitation, hostility, psychosis, and withdrawal/depression (effect size: 1.13; 95% confidence interval [CI]: 0.54–1.73) relative to placebo. Adverse effects were more common in patients receiving carbamazepine (20/27; 74%) relative to placebo (5/24; 21%). There is low quality evidence that oxcarbazepine is likely ineffective and that topiramate may be comparable to risperidone.</p></div><div><h3>Conclusion</h3><p>Anticonvulsants are unlikely to be effective in BPSD, although the quality of existing evidence is low.</p></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1064748124003336/pdfft?md5=5d73276dca97a5b7bae656d747dbebd5&pid=1-s2.0-S1064748124003336-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054868","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 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":"Twelve Dollars","authors":"","doi":"10.1016/j.jagp.2024.05.003","DOIUrl":"10.1016/j.jagp.2024.05.003","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":"141051263","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}