Search Results (110)

Background and Objectives: Thailand’s demographic shift toward an aging population increases vulnerability among older adults to the long-term mental health effects of childhood trauma. While childhood adversity is linked to heightened risks of late-life depression and PTSD, the moderating role of resilience remains underexplored in Thai older adults. This study investigated whether resilience moderates the association between childhood trauma and depressive or PTSD symptoms in this population. Materials and Methods: A cross-sectional survey was conducted with 201 older patients (mean age 68.6 years) from the Family Medicine and Geriatric Psychiatry Clinics at Maharaj Nakorn Chiang Mai Hospital. Participants completed validated measures on trauma history, resilience, depression, and PTSD symptoms. A moderation analysis was performed, adjusting for covariates including education, family support, and psychiatric history. Results: The findings revealed that resilience significantly buffered the impact of childhood trauma on depression but did not mitigate PTSD symptoms. Conclusions: These results underscore the protective role of resilience against depression following childhood trauma in older adults, yet also point to its limitations in alleviating trauma-specific responses such as PTSD. This study highlights the need for trauma-informed geriatric mental health strategies and calls for further research on resilience, focusing on cultural context and adaptive mechanisms, including emotion regulation and social connectedness, in older populations. Full article

Background/Objectives: The INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) network introduces an innovative model of psychogeriatric care, combining tertiary mental healthcare with primary care for older adults in low-resource settings in Greece via telemedicine. This study explores viewpoints of healthcare professionals on care delivery within the frames of old-age mental telehealth services in low-resource settings. Methods: All healthcare professionals, including 13 medical and 11 non-medical professionals from diverse healthcare units in urban, rural, and insular areas, participated in a semi-structured survey. Thematic analysis identified key insights. Results: Most participants (N = 19) highlighted the high usability of the INTRINSIC services and their high satisfaction for being members of the network (N = 17) was attributed to the collaborative delivery of integrated, specialized healthcare services in primary healthcare (N = 17). Further identified advantages of the services included the positive impact on timely care delivery (N = 6), cost effectiveness, and alleviation of hospital strain. Healthcare professionals valued the holistic approach of the INTRINSIC services to psychogeriatric care (N = 8) and their role in the improvement of it in communities in low-resource settings (N = 13). However, challenges were also reported, including the low openness and reluctance of service users (N = 7), difficulties in using the INTRINSIC digital platform (N = 5), and increased workload (N = 5). Conclusions: Despite these issues, the INTRINSIC services embody an innovative telehealth model for delivering high-quality, tertiary, mental, and cognitive healthcare services to older adults in underserved areas. Full article

The literature details the healthcare needs of migrant people living with chronic illnesses and the consequent economic, social, and healthcare needs of their caregivers. Similarly, some studies have underscored the social and healthcare needs of 2SLGBTQIA+ (two-spirit, lesbian, gay, bisexual, transgender, queer, and intersex individuals, including diverse sexual and gender identities under the “+” symbol) adults living with chronic illnesses and their caregivers. This narrative review presents the context of migrant 2SLGBTQIA+ unpaid caregivers and how their intersecting identities influence their caregiving roles for family members with chronic illnesses. In this article, caregivers are defined as family members or chosen families who provide unpaid support that may last for three months or longer for people living with chronic illnesses. Most studies and policies overlook 2SLGBTQIA+ migrants who are also unpaid caregivers of individuals living with chronic illnesses, leaving them unsupported through discrimination at the intersection of racism, homophobia, transphobia, ageism, and ableism, forcing them to remain vulnerable to increased emotional and physical strain. There is a presence of pervasive systemic barriers, including a lack of training and education among social and healthcare providers, about the needs of migrant 2SLGBTQIA+ unpaid caregivers. Additional challenges stem from inadequate policies and insufficient targeted resources, particularly for caregivers from marginalized racial and ethnic backgrounds. The findings of this study highlight the necessity for a call to action to address these gaps and improve support systems for these highly marginalized communities. Full article

Eye-tracking studies in virtual reality (VR) deliver insights into behavioral function. The gold standard of evaluating gaze behavior is based on manual scoring, which is labor-intensive. Previously proposed automated eye-tracking algorithms for VR head mount display (HMD) were not validated against manual scoring, or tested in dynamic areas of interest (AOIs). Our study validates the accuracy of an automated scoring algorithm, which determines temporal fixation behavior on static and dynamic AOIs in VR, against subjective human annotation. The interclass-correlation coefficient (ICC) was calculated for the time of first fixation (TOFF) and total fixation duration (TFD), in ten participants, each presented with 36 static and dynamic AOIs. High ICC values (≥0.982; p < 0.0001) were obtained when comparing the algorithm-generated TOFF and TFD to the raters’ annotations. In sum, our algorithm is accurate in determining temporal parameters related to gaze behavior when using HMD-based VR. Thus, the significant time required for human scoring among numerous raters can be rendered obsolete with a reliable automated scoring system. The algorithm proposed here was designed to sub-serve a separate study that uses TOFF and TFD to differentiate apathy from depression in those suffering from Alzheimer’s dementia. Full article

Background: The Dementia Attitude Scale (DAS) is a validated instrument used to capture the affective, behavioural, and cognitive components of attitudes toward people living with dementia (PLwD). This study conducts confirmatory and exploratory factor analyses (CFA and EFA) of the DAS assessed by caregivers of PLwD and BPSD enrolled in the RECage multicentre clinical trial. Methods: The baseline questionnaire was completed by 485 caregivers (29.7% male, 70.3% female), from six European countries, reflecting diverse cultural contexts. CFA tested the two-factor structure of the original model, while EFA thoroughly explored the factor structure. Results: The CFA results showed a poor model fit, with significant deviations from ideal values for RMSEA (0.0861), SRMSR (0.0781), and CFI (0.7117), showcasing an inadequate representation of the data. EFA revealed a three-factor structure, explaining the 45.2% variance for social comfort, 28.8% for social discomfort, and 25.9% for dementia knowledge. The social comfort items reflected positive caregiver attitudes toward PLwD, while social discomfort captured feelings of discomfort and uncertainty about caregiving. Dementia knowledge included items related to understanding dementia’s symptoms and needs. Conclusions: The three-factor model highlights the importance of emotional comfort, knowledge of dementia, and social discomfort as key dimensions in caregiver attitudes. Full article

Background: Guidelines suggest that, in chronic non-cancer pain (CNCP) management, non-opioid modalities should be prioritized, as there are negative consequences related to opioid use. There is a dearth of literature elucidating the risk factors for initiating opioid use amongst veterans with CNCP. Methods: Chart review on 193 patients with a new referral at a local US Department of Veterans Affairs (VA) pain clinic. Patients were required to have CNCP and not be taking opioid medication at the time of referral. The review started on 1 January 2014 and covered the year following. Data were analyzed via stepwise multiple logistic regression using Statistical Analysis System (SAS) software (Version 9.4; SAS institute Inc., Cary, NC, USA). Results: A total of 37 veterans (19%) received a new opioid prescription in the year following initial encounters at the pain clinic for CNCP. A history of substance use was associated with lower odds of receiving an opioid prescription. In contrast, being employed was associated with higher odds of receiving an opioid prescription. Conclusions: Amongst veterans treated for CNCP in a VA pain clinic, a history of substance use and a presence of vocation within the past year prior to presentation are variables associated with the initiation of opioids. Future studies to further elucidate the predictors of opioid prescriptions for CNCP are warranted. Full article

The electroencephalography (EEG)-based approach provides a promising low-cost and non-invasive approach to the early detection of pathological cognitive decline. However, current studies predominantly utilize EEGs from resting state (rsEEG) or task-state (task EEG), posing challenges to classification performances due to the unconstrainted nature of mind wandering during resting state or the inherent inter-participant variability from task execution. To address these limitations, this study proposes a novel feature extraction framework, working memory task-induced EEG response (WM-TIER), which adjusts task EEG features by rsEEG features and leverages the often-overlooked inter-state changes of EEGs. We recorded EEGs from 21 AD individuals, 24 MCI individuals, and 27 healthy controls (HC) during both resting and working memory task conditions. We then compared the classification performance of WM-TIER to the conventional rsEEG or task EEG framework. For each framework, three feature types were examined: relative power, spectral coherence, and filter-bank phase lag index (FB-PLI). Our results indicated that FB-PLI-based WM-TIER features provide (1) better AD/MCI versus HC classification accuracy than rsEEG and task EEG frameworks and (2) high accuracy for three-class classification of AD vs. MCI vs. HC. These findings suggest that the EEG-based rest-to-task state transition can be an effective neural marker for the early detection of pathological cognitive decline. Full article

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen’s kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population. Full article

Background: Aging is a global phenomenon closely associated with changes in cognitive function and mental health. These conditions substantially burden public health systems and adversely affect the quality of life of older adults. This study aimed to examine changes in depressive symptoms and cognitive function over a 12-month follow-up period in a cohort of Brazilian older adults attending primary care. Methods: This observational longitudinal study included a randomized sample of individuals aged ≥60 years residing in São Paulo, Brazil, and registered at a Primary Healthcare Unit (PHU). Data collection involved administering a sociodemographic and health questionnaire along with two validated instruments: the Geriatric Depression Scale-15 (GDS-15) and the Mini-Mental State Examination (MMSE). Linear regression models were used for the analyses. Results: A total of 368 older adults were included, with 63% being men and a mean age of 74.65 years. After one year, depressive symptoms showed a notable increase, with the mean GDS-15 score rising from 5.97 to 7.48 (Cohen-d = 0.542). Likewise, there was a decrease in the mean MMSE score ranging from 19.11 to 18.88 (Cohen-d = 0.216). Adjusted regression analyses revealed that depressive symptoms at baseline (B = 0.696; p = 0.048; R² = 0.19) and cognitive function at baseline (B = 0.444; p < 0.001; R² = 0.26) were predictive of their respective deteriorations over the follow-up period. Conclusions: Depressive symptoms and cognitive decline place a significant burden on public health systems in aging societies. These findings underscore the importance of continuous monitoring and early intervention strategies to mitigate their impact and enhance the quality of life for older adults. Full article

Depressive disorders are highly prevalent among older adults (60+) in Europe. Activating these patients was a core component of the GermanIMPACT study, which evaluated collaborative care in a cluster-randomized primary care setting. The intervention group showed a significant improvement in PHQ-9 remission. The aim of this secondary analysis was to investigate which activities were planned and whether their implementation or non-implementation was associated with depressive symptoms (PHQ-9) after 12 months. Behavioural activation data were collected by the care managers. A categorization for activity type (collected as free text) and activity implementation status was developed. The association of successfully implemented activities, planned-not-implemented activities, and the number of activities per patient with the 12-month PHQ-9 total score was calculated using logistic regressions (adjusted for age, gender, living situation/baseline PHQ-9). A total 2188 activities were planned for 136 patients; 66% were successfully implemented. Mean age was 71 (±7) years (78% female; 52% living alone). Activities focusing on “self-care/spirituality” improved the PHQ-9 outcome (OR 1.540; p = 0.048), while planned-not-implemented activities overall worsened it (OR 1.16; p = 0.007). Patient activation is key to treating depressive symptoms in old age. Particularly ‘self-care/spirituality’ activities could be planned, and organizational activities should be closely supported. Full article

Background: Dementia with Lewy bodies (DLBs) often presents with neuropsychiatric symptoms (NPSs), yet the role of hyperglycemia, a common cause of delirium in older adults, as a contributing factor remains under-recognized. This article aims to explore the relationship between hyperglycemia and NPSs. Methods: We report the case of a 71-year-old male with DLBs and type 2 diabetes mellitus (T2DM) who experienced worsening NPSs closely associated with periods of hyperglycemia. Initial pharmacological and nonpharmacological interventions were insufficient, prompting adjustments to insulin therapy and dietary modifications to stabilize blood glucose levels. Results: Improved glycemic control resulted in a clinically significant reduction in NPSs. Conclusions: This case suggests a potential link between hyperglycemia and NPSs in DLB patients, emphasizing the importance of maintaining glycemic control in managing NPSs. Although the exact mechanisms remain incompletely understood, adopting a holistic framework for brain health could offer a comprehensive approach to cognitive care. Further studies are needed to elucidate the biological pathways involved, validate these findings in larger populations, and develop evidence-based clinical guidelines. Full article

Objectives: Mild cognitive impairment (MCI) is a heterogeneous clinical syndrome and is important for the diagnosis and management of Alzheimer’s disease (AD). With the expansion of biomarker-based diagnostics, the aim of this study is to clarify the current attitudes towards and the use of MCI, and MCI due to AD, in German memory clinics. Methods: An online survey (50 items) was performed in 2022 among specialized clinicians (N = 45) in German memory clinics to assess the use of MCI and biomarkers in current diagnosis and treatment. Attitudinal and frequency items were assessed with a five-point numeric scale (strongly disagree = 1 to completely agree = 5 and never = 1 to always = 5, respectively). Results: All respondents used MCI as a clinical diagnosis. The benefits of diagnosing MCI were labeling deficits as disease symptoms (M = 4.4, SD = 0.7), improving coping with symptoms (M = 4.1, SD = 0.9), and motivating risk reduction activities (M = 4.0, SD = 0.9). Overall, 37 respondents used specialized diagnostic criteria for MCI due to AD, and all had access to biomarker diagnostics. Patients with MCI due to AD received more frequent counseling on memory training (p < 0.001), other non-pharmacological treatments (p < 0.001), and antidementive drug treatment (p < 0.001) than patients with MCI of other etiologies. Acetylcholinesterase inhibitors were prescribed significantly more frequently to patients with MCI due to AD (p < 0.001) compared to other MCI patients. Conclusions: MCI is commonly used as a clinical diagnosis in German memory clinics. AD biomarker assessment is well established and influences patient counseling and treatment recommendations. Full article

In the present study, we investigated the association of genetic predisposition with specific dimensions of dementia pathophysiology for global and domain-specific cognitive decline in older adults. The sample was drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study, comprising 512 cognitively normal individuals over 64 years of age, with a mean follow-up of 2.9 years. Cognitive function was evaluated through a neuropsychological test battery, while genetic predisposition was assessed based on two distinct Polygenic Risk Scores (PRS) for amyloid-beta 42 (Aβ₄₂) and white matter hyperintensities (WMH). The association of each PRS with the cognitive decline rate was examined using generalized estimating equation models. In the whole sample, higher PRSs Aβ₄₂ (β = −0.042) and WMH (β =−0.029) were associated with a higher rate of global cognitive decline per year, an association which remained significant in age, sex, and education subgroups. Moreover, higher PRSs Aβ₄₂ and WMH were related to significant memory decline only in females, older, and highly educated participants. Thus, while the association of both PRSs with global cognitive decline over time was independent of age, sex, or education, the relationship of the specific PRSs with the memory decline rate appeared to vary depending on these factors. Full article

Background: There is a paucity of evidence on the association between genetic propensity for hippocampal atrophy with cognitive outcomes. Therefore, we examined the relationship of the polygenic risk score for hippocampal atrophy (PRShp) with the incidence of amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) as well as the rates of cognitive decline. Methods: Participants were drawn from the population-based HELIAD cohort. Comprehensive neuropsychological assessments were performed at baseline and at follow-up. PRShp was derived from the summary statistics of a large genome-wide association study for hippocampal volume. Cox proportional hazards models as well as generalized estimating equations (GEEs) were used to evaluate the association of PRShp with the combined incidence of aMCI/AD and cognitive changes over time, respectively. All models were adjusted for age, sex, education, and apolipoprotein E (APOE) genotype. Results: Our analysis included 618 older adults, among whom 73 developed aMCI/AD after an average follow-up of 2.96 ± 0.8 years. Each additional SD of PRShp elevated the relative hazard for incident aMCI/AD by 46%. Participants at the top quartile of PRShp had an almost three times higher risk of converting to aMCI/AD compared to the lowest quartile group. Higher PRShp scores were also linked to steeper global cognitive and memory decline. The impact of PRShp was greater among women and younger adults. Conclusions: Our findings support the association of PRShp with aMCI/AD incidence and with global cognitive and memory decline over time. The PRS association was sex- and age-dependent, suggesting that these factors should be considered in genetic modelling for AD. Full article

High-throughput proteomic platforms are crucial to identify novel Alzheimer’s disease (AD) biomarkers and pathways. In this study, we evaluated the reproducibility and reliability of aptamer-based (SomaScan^® 7k) and antibody-based (Olink^® Explore 3k) proteomic platforms in cerebrospinal fluid (CSF) samples from the Ace Alzheimer Center Barcelona real-world cohort. Intra- and inter-platform reproducibility were evaluated through correlations between two independent SomaScan^® assays analyzing the same samples, and between SomaScan^® and Olink^® results. Association analyses were performed between proteomic measures, CSF biological traits, sample demographics, and AD endophenotypes. Our 12-category metric of reproducibility combining correlation analyses identified 2428 highly reproducible SomaScan CSF measures, with over 600 proteins well reproduced on another proteomic platform. The association analyses among AD clinical phenotypes revealed that the significant associations mainly involved reproducible proteins. The validation of reproducibility in these novel proteomics platforms, measured using this scarce biomaterial, is essential for accurate analysis and proper interpretation of innovative results. This classification metric could enhance confidence in multiplexed proteomic platforms and improve the design of future panels. Full article