首页期刊导航|The American journal of geriatric psychiatry
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The American journal of geriatric psychiatry
American Psychiatry Press
The American journal of geriatric psychiatry

American Psychiatry Press

1064-7481

The American journal of geriatric psychiatry/Journal The American journal of geriatric psychiatry
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    Risk Prediction Models for Depression in Community-Dwelling Older Adults

    Martino Belvederi MurriLuca Cattelani.Federico Chesani.Federico Triolo...
    12页
    查看更多>>摘要：Objective: To develop streamlined Risk Prediction Models (Manto RPMs) for late-life depression. Design: Prospective study. Setting: The Survey of Health, Ageing and Retirement in Europe (SHARE) study. Participants: Participants were community residing adults aged 55 years or older. Measurements: The outcome was presence of depression at a 2-year follow up evaluation. Risk factors were identified after a literature review of longitudinal studies. Separate RPMs were developed in the 29,116 participants who were not depressed at baseline and in the combined sample of39,439 of non-depressed and depressed subjects. Models derived from the combined sample were used to develop a web-based risk calculator. Results: The authors identified 129 predictors of late-life depression after reviewing 227 studies. In non-depressed participants at baseline, the RPMs based on regression and Least Absolute Shrinkage and Selection Operator (LASSO) penalty (34 and 58 predictors, respectively) and the RPM based on Artificial Neural Networks (124 predictors) had a similar performance (AUC: 0.730-0.743). In the combined depressed and non-depressed participants at baseline, the RPM based on neural networks (35 predictors; AUC: 0.807; 95%o CI: 0.80-0.82) and the model based on linear regression and LASSO penalty (32 predictors; AUC: 0.81; 95%o CI: 0.79-0.82) had satisfactory accuracy. Conclusions: The Manto RPMs can identify community-dwelling older individuals at risk for developing depression over 2 years. A web-based calculator based on the streamlined Manto model is freely available at https://manto. unife.it/for use by individuals, clinicians, and policy makers and may be used to target prevention interventions at the individual and the population levels.
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    Risk Prediction in Late Life Depression: A Screening Tool, a Teaching Tool

    David C. Steffens
    3页
    查看更多>>摘要：In this issue of the Journal, Murri et al.1 present results of their study developing Risk Prediction Models (RPMs) for prediction of onset of late-life depression (LLD) within 2 years. Readers will learn much from this article. First, the methodology of RPM development is complex, and the authors of the article explain well the need for such models from both clinical and policy standpoints as well as their approach to the creation of RPMs.
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    Blood mRNA Expression in Alzheimer’s Disease and Dementia With Lewy Bodies

    Paul C. Donaghy.Simon J. Cockell.Carmen Martin-Ruiz.Jonathan Coxhead....
    12页
    查看更多>>摘要：Objectives: The objective of this study was to investigate the expression of genes in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB), both at the mild cognitive impairment (MCI) and dementia stages, to improve our understanding of disease pathophysiology and investigate the potential for diagnostic and prognostic biomarkers based on mRNA expression. Design: Cross-sectional observational study. Setting: University research center. Participants: People with MCI with Lewy bodies (MCI-LB, n=55), MCI-AD (n=19), DLB (n=38), AD (n=24) and a cognitively unimpaired comparison group (n=28). Measurements: Ribonucleic acid sequencing of whole blood. Differentially expressed genes (DEGs) were identified and gene set enrichment analysis was carried out. Results: Compared with the cognitively unimpaired group, there were 22 DEGs in MCI-LB/DLB and 61 DEGs in MCI-AD/AD. DEGS were also identified when comparing the two disease groups. Expression of ANP32A was associated with more rapid cognitive decline in MCI-AD/AD. Gene set enrichment analysis identified downregulation in gene sets including MYC targets and oxidative phosphorylation in MCI-LB/DLB; upregulation of immune and inflammatory responses in MCI-AD/AD; and upregulation of interferon-a and -g responses in MCI-AD/AD compared with MCI-LB/DLB. Conclusion: This study identified multiple DEGs in MCI-LB/DLB and MCI-AD/AD. One of these DEGs, ANP32A, may be a prognostic marker in AD. Genes related to mitochondrial function were downregulated in MCI-LB/DLB. Previously reported upregulation of genes associated with inflammation and immune responses in MCI-AD/AD was confirmed in this cohort. Differences in interferon responses between MCI-AD/AD and MCI-LB/DLB suggest that there are key differences in peripheral immune responses between these diseases. (Am J Geriatr Psychiatry
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    Progressing Towards Blood Based Diagnostic RNA Biomarkers for Dementia With Lewy Bodies

    Anto P. Rajkumar
    3页
    查看更多>>摘要：Prevalence of Dementia with Lewy bodies (DLB) is second only to Alzheimer's disease (AD) among people with neurodegenerative dementia. Accurate distinction between these two most common subtypes of dementia is essential because they differ in their prognosis, neuropsychiatric symptoms, pharmacological management,1 and sensitivity to medication adverse effects. Misdiagnosing DLB as AD, and prescribing an antipsychotic medication for treating persistent visual hallucinations and associated challenging behaviours may lead to life-threatening adverse events. Moreover, DLB leads to earlier institutionalisation and mortality, more severe neuropsychiatric symptoms, higher costs and more carers' burden than AD. Currently, there are only three indicative biomarkers helping to diagnose DLB, 1) reduced dopamine transporter uptake in basal ganglia, visualised by Single-Photon Emission Computed Tomography or Positron Emission Tomography, 2) low uptake 123iodine-Meta-iodoben-zylguanidine myocardial scintigraphy, and 3) polysomnography confirming rapid eye movement sleep without atonia.2 These indicative biomarkers are not routinely used in most clinical settings because of costs, equipment availability or concerns over feasibility. There is an urgent clinical need for discovering reliable blood-based biomarkers that can aid differentiating DLB from AD. Such blood-based diagnostic biomarkers hold promise for rapid clinical adoption and for facilitating early diagnosis and accurate subtyping of dementia.
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    Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults

    Michael E. Miller.Jasmin Divers.Andrea AndersonGena Hargis...
    12页
    查看更多>>摘要：Objectives: Cognitive-behavioral therapy (CBT) and yoga decrease worry and anxiety. There are no long-term data comparing CBT and yoga for worry, anxiety, and sleep in older adults. The impact of preference and selection on these outcomes is unknown. In this secondary data analysis, we compared long-term effects of CBT by telephone and yoga on worry, anxiety, sleep, depressive symptoms, fatigue, physical function, social participation, and pain; and examined preference and selection effects. Design: In this randomized preference trial, participants (N = 500) were randomized to a: 1) randomized controlled trial (RCT) of CBT or yoga (n = 250); or 2) preference trial (selected CBT or yoga; n = 250). Outcomes were measured at baseline and Week 37. Setting: Community. Participants: Community-dwelling older adults (age 60 + years). Interventions: CBT (by telephone) and yoga (in-person group classes). Measurements: Penn State Worry Questionnaire - Abbreviated (worry); ' Insomnia Severity Index (sleep);3 PROMIS Anxiety Short Form v1.0 (anxiety);4’5 Generalized Anxiety Disorder Screener (generalized anxiety);6’7 and PROMIS-29 (depression, fatigue, physical function, social participation, pain).8’9 Results: Six months after intervention completion, CBT and yoga RCT participants reported sustained improvements from baseline in worry, anxiety, sleep, depressive symptoms, fatigue, and social participation (no significant between-group differences). Using data combined from the randomized and preference trials, there were no significant preference or selection effects. Long-term intervention effects were observed at clinically meaningful levels for most of the study outcomes. Conclusions: CBT and yoga both demonstrated maintained improvements from baseline on multiple outcomes six months after intervention completion in a large sample of older adults. Trial Registration: www. clinicaltrials.gov Identifier NCT 02968238.
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    The Humble Worrier - The LongTerm Impact of Using Yoga to Treat Severe Worry and Anxiety in Older Adults

    Carmen Andreescu
    3页
    查看更多>>摘要：Over the last decade, multiple reports have signaled the association of late-life anxiety and its phenotypes with increased morbidity and mortality. A 2014 study of 6,019 participants showed that higher anxiety symptoms were prospectively associated with increased risk of incident stroke independent of all other risk factors, including depression.1 The independent effect of anxiety on increasing the risk of cognitive decline has been documented in several recent studies,2 including longitudinal studies indicating an increased association between amyloid burden, and anxiety symptoms in cognitively normal older adults.3 The effect of anxiety on cognition appears as early as midlife: in the Nurses' Health Study, a 4-year longitudinal study of community-dwelling older women (N = 16,351), higher midlife anxiety was related to worse later-life overall cognitive function, and verbal memory. Overall, anxiety may be an even stronger risk factor for medical comorbidity than depression,4,5 but the persistent perception of anxiety symptoms as a relatively mild group of heterogenous "negative affect" symptoms with no relevant impact beyond decreased quality of life continues to persist in the medical community.
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    Predicting Medication Nonadherence in Older Adults With Difficult-to-Treat Depression in the IRL-GRey Randomized Controlled Trial

    Helene M. AltmannJoseph KazanMarie Anne GebaraDaniel M. Blumberger...
    9页
    查看更多>>摘要：Objective: Nonadherence to antidepressants interferes with optimal treatment of late-life depression. This analysis examines clinical and treatment factors predicting medication nonadherence in difficult-to-treat late-life depression. Methods: Secondary analysis of data from a clinical trial of antidepressant pharmacotherapy for Major Depressive Disorder in 468 adults aged 60+ years. All participants received venlafaxine XRfor 12 weeks. Nonremitters were randomized to augmentation with either aripiprazole or placebo for 12 additional weeks. Medication adherence was assessed 14 times over 24 weeks. The analyses examined sociodemographic, clinical, and treatment factors that may predict antidepressant nonadherence during early (weeks 1-6), late (weeks 7 -12), and augmentation (weeks 13—24) treatment. Results: Poor cognitive function and early response were predictive of early nonadherence. Poor cognitive function and prior nonadherence were predictive of late nonadherence. Living alone was associated with nonadherence both late and during augmentation treatment. Conclusion: Future studies should consider the role of early response and cognitive function to improve antidepressant adherence, particularly among older adults who live alone. (Am J Geriatr Psychiatry 2022; 30:994 -1002)
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    A Multimodal Intervention to Improve Cognition in Communitydwelling Older Adults

    Xinyi ZhuShufei Yin.Lijuan Huo.Zhiwei Zheng....
    12页
    查看更多>>摘要：Objective: To examine the effects of a multimodal intervention composed of cognitive training, physical exercise, and group counseling on cognitive function in community-dwelling older adults. Design: A four-armed, quasi-experimental intervention study. Setting and Participants: Community-dwelling adults aged 60 years and older (n = 153). Intervention: Participants were allocated into multimodal intervention, cognitive training plus Taichi exercise, cognitive training, or control group. The multimodal intervention included 18 sessions of cognitive training, 18 sessions of Taichi, and 6 sessions of group reminiscence over six weeks. Measurements: Cognitive function, depressive symptoms, and psychological well-being were assessed at the baseline, postintervention, and three-month follow-up. The primary outcome was the change in overall cognition measured by the Montreal Cognitive Assessment (MoCA) and a composite cognitive score derived from a battery of neuropsychological tests. Results: For MoCA, there was no significant difference between any of the three intervention groups and controls. For composite cognition, all three intervention groups showed improvements at the three-month follow-up, with a large effect size in the cognitive training plus Taichi group (change difference 0.37, 95% CI 0.18-0.56, Hedge’s g = 0.92), and medium effect sizes in the multimodal intervention group (change difference 0.23, 95% CI 0.0 -0.42, g = 0.58) and cognitive training group (change difference 0.22, 95% CI 0.03-0.42, g = 0.55). Conclusions: Multimodal intervention, cognitive training plus Taichi, and cognitive training could foster cognitive function in community-dwelling older adults. The combination of cognitive training and Taichi showed greater efficacy than the other two interventions.
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    Structural MRI-Based Measures of Accelerated Brain Aging do not Moderate the Acute Antidepressant Response in Late-Life Depression

    Ryan AhmedClaire RyanSeth ChristmanDamian Elson...
    11页
    查看更多>>摘要：Objective: Late-life depression (LLD) is characterized by accelerated biological aging. Accelerated brain aging, estimated from structural magnetic resonance imaging (sMRI) data by a machine learning algorithm, is associated with LLD diagnosis, poorer cognitive performance, and disability. We hypothesized that accelerated brain aging moderates the antidepressant response. Design and Interventions: Following MRI, participants entered an 8-week randomized, controlled trial of escitalopram. Nonremitting participants then entered an open-label 8-week trial of bupropion. Participants: Ninety-five individuals with LLD. Measurements: A machine learning algorithm estimated each participant’s brain age from sMRI data. This was used to calculate the brain-age gap (BAG), or how estimated age differed from chronological age. Secondary sMRI measures of aging pathology included white matter hyperintensity (WMH) volumes and hippocampal volumes. Mixed models examined the relationship between sMRI measures and change in depression severity. Initial analyses tested for a moderating effect of MRI measures on change in depression severity with escitalopram. Subsequent analyses tested for the effect of MRI measures on change in depression severity over time across trials. Results: In the blinded initial phase, BAG was not significantly associated with a differential response to escitalopram over time. BAG was also not associated with a
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    Phenomenology of Atypical Anxiety Disorders in Parkinson’s Disease: A Systematic Review

    Nadeeka N. Dissanayaka.Elana J. ForbesKatePerepezkoAlbert F.G. Leentjens....
    25页
    查看更多>>摘要：Objective: Anxiety is a prominent concern in Parkinson’s disease (PD) that negatively impacts quality of life, increases functional disability, and complicates clinical management. Atypical presentations of anxiety are under-recognized and inadequately treated in patients with PD, compromising global PD care. Methods: This systematic review focuses on the prevalence, symptomol-ogy and clinical correlates of atypical presentations of PD-related anxiety following PRISMA guidelines. Results: Of the 60 studies meeting inclusion criteria, 14 focused on 'Anxiety Not Otherwise Specified (NOS)’ or equivalent, 31 reported on fluctuating anxiety symptoms, and 22 reported on 'Fear of Falling (FOF)'. Anxiety NOS accounted for a weighted mean prevalence of 14.9%, fluctuating anxiety for 34.19%, and FOF for 51.5%. These latter two exceeded the average reported overall prevalence rate of 31% for anxiety disorders in PD. We identified a diverse array of anxiety symptoms related to motor and nonmotor symptoms of PD, to complications of PD medication (such as “on” and “off” fluctuations, or both), and, to a lesser extent, to cognitive symptoms. Conclusion: Atypical anxiety is common, clinically relevant, and heterogeneous in nature. A better understanding of the phenomenology, clinical course, and pathophysiology of varied forms of atypical anxiety in PD is needed to improve recognition, advance therapeutic development and ultimately optimize quality of life in PD. (Am J Geriatr Psychiatry 2022; 30:1026-1050)
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