for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Elsevier   (Total: 3181 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3181 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 443, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 319, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 423, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 384, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 482, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 265, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 210, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Similar Journals
Journal Cover
American Journal of Geriatric Psychiatry
Journal Prestige (SJR): 1.524
Citation Impact (citeScore): 3
Number of Followers: 14  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1064-7481 - ISSN (Online) 1545-7214
Published by Elsevier Homepage  [3181 journals]
  • Perspectives: Measuring the Impact of Articles Published in The American
           Journal of Geriatric Psychiatry, July 1, 2017, to June 30, 2018
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Charles F. Reynolds, Stephan Arndt, Dan G. Blazer, Jordan Karp, Helen Lavretsky, Gwenn Smith, David Steffens, Ipsit Vahia
       
  • Corrigendum to ‘Does Cognition Predict Treatment Response and Remission
           in Psychotherapy for Late-Life Depression'’ [The American Journal of
           Geriatric Psychiatry 23 (2015) 215–219]
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Sherry A. Beaudreau, Tiffany Rideaux, Ruth O'Hara, Patricia Arean
       
  • Katharine Hepburn: Markings and Remembrances
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Charles F. Reynolds
       
  • Medication-Assisted Treatment for Opioid Use Disorder in Older Adults: An
           Emerging Role for the Geriatric Psychiatrist
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Pallavi Joshi, Nikita K. Shah, Harshal D. Kirane
       
  • Aging and Postintensive Care Syndrome– Family: A Critical Need for
           Geriatric Psychiatry
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Patricia Serrano, You Na P. Kheir, Sophia Wang, Sikandar Khan, Leslie Scheunemann, Babar KhanPostintensive care syndrome–family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment compared with older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared with other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared with other geriatric populations. Third, evidence for models of care centered on patients with multimorbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multimorbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.
       
  • Evaluation of Technology-Based Interventions for Informal Caregivers of
           Patients With Dementia—A Meta-Analysis of Randomized Controlled Trials
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Friederike Deeken, Anna Rezo, Matthias Hinz, Robert Discher, Michael A. RappObjectiveThe aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD).MethodsPubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated.ResultsMeta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects.ConclusionTechnology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with “traditional services,” e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed.
       
  • Ten-Year Prevalence of Cognitive Impairment Diagnoses and Associated
           Medical and Psychiatric Conditions in a National Cohort of Older Female
           Veterans
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Sandy J. Lwi, Deborah E. Barnes, Feng Xia, Carrie Peltz, Tina Hoang, Kristine YaffeABSTRACTObjectiveVeterans are at risk for dementia because of elevated general risk factors and exposure to military risk factors; however, few studies have focused on female veterans despite their growing numbers. We sought to characterize the 10-year prevalence of cognitive impairment (i.e., mild cognitive impairment and dementia) and associated conditions in older female veterans.MethodsData were extracted from Veterans Health Administration medical records of 168,111 female veterans aged 65 and older. Cognitive impairment (CI) diagnoses were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes or dementia medication prescriptions. Medical comorbidities and psychiatric conditions were determined using ICD-9 codes occurring within 2years of CI diagnosis or the last recorded medical encounter for veterans without CI.ResultsTen-year prevalence was 1.8% (3,075) for mild cognitive impairment (MCI) diagnoses and 8.1% (13,653) for dementia diagnoses. Prevalence increased with age (MCI age 65: 1.4%; age 85+: 2.7%; dementia age 65: 2.5%; age 85+: 17.7%); 37.3% had dementia subtype diagnoses, with Alzheimer's disease being the most prevalent (72.7%). 47.7% of veterans with CI had at least one medical comorbidity, whereas 22.5% had at least one psychiatric condition.ConclusionFew studies have characterized the prevalence of cognitive impairment in female veterans despite the expected increases in CI and impending demographic shifts in the military. The high prevalence of medical and psychiatric conditions in female veterans with CI highlights their healthcare burden and emphasizes the need for further investigations into the prevention, treatment, and care of cognitive impairment in this understudied population.
       
  • Feeling Relieved After the Death of a Family Member With Dementia:
           Associations With Postbereavement Adjustment
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Sarah T. Stahl, Richard SchulzObjectiveAfter an extended period of caregiving, the death of a family member with dementia can provide a sense of relief to individuals because caregiving has ended and their loved one is no longer suffering. Little is known about predeath factors associated with feeling relieved after the death of a family member with dementia. This study examined 1) predeath factors associated with caregiver (CG) relief; and 2) whether CG relief is associated with postbereavement adjustment, namely complicated grief and depression symptoms.MethodsParticipants were bereaved CGs aged 28–90 years old drawn from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) (N = 223) and Family Caregiver Transition Support (FaCTS) (N = 89) studies. In each sample, demographics were assessed at baseline, and CG relief was assessed at the first follow-up assessment after death. Each study administered a similar bereavement battery to CGs following the death of their care recipients (CRs).ResultsCGs of late-stage dementia patients (FaCTS) reported more relief compared with CGs of early- to midstage dementia patients (REACH). CGs were more likely to experience relief if they were prepared for their CR's death and if they perceived their CR's death to be a relief to the CR. A multivariate regression model showed that greater CG relief was associated with less complicated grief postbereavement. CG relief was not significantly associated with depression symptoms.ConclusionWe show prospectively that the caregiving experience impacts feelings of relief, and that feeling relieved facilitates postbereavement adjustment by lessening symptoms of complicated grief.
       
  • Apathy in Dementia: Time to StandUp
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Sergio Starkstein, Bradley Hayhow
       
  • Why Do They Just Sit' Apathy as a Core Symptom of Alzheimer Disease
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Carolyn W. Zhu, Hillel T. Grossman, Mary SanoABSTRACTObjectiveApathy is common in Alzheimer disease (AD) and has a far-reaching impact on patients’ clinical course and management needs. However, it is unclear if apathy is an integral component of AD or a manifestation of depression in cognitive decline. This study aims to examine interrelationships between apathy, depression, and function.MethodsThis was a cross-sectional study of well-characterized AD patients in the National Alzheimer's Coordinating Center Uniform Data Set with a Clinical Dementia Rating (CDR) between 0.5 and 2. Participants’ function was measured using the Functional Assessment Questionnaire. Apathy and depression were measured using clinician judgment and informant-reported Neuropsychiatric Inventory–Questionnaire. Dementia severity was categorized by CDR.ResultsSample included 7,679 participants (55.7% men) with a mean (standard deviation) age of 74.9 (9.7) years; 3,197 (41.6%) had apathy based on clinician judgment. Among those with apathy, approximately half had no depression. Presence of apathy was associated with 21%, 10%, and 3% worsening in function compared with those without apathy in CDR 0.5, 1, and 2 groups, respectively. Depression was not independently associated with functional status. Results revealed no interaction between apathy and depression.ConclusionApathy, but not depression, was significantly associated with worse function, with the strongest effects in mild dementia. Results emphasize the need for separate assessments of apathy and depression in the evaluation and treatment of patients with dementia. Understanding their independent effects on function will help identify patients who may benefit from more targeted management strategies.
       
  • Pride and Prejudice in the Treatment of Depression and Anxiety in Acutely
           Ill Older Adults
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Eric J. Lenze, Michael S. Avidan
       
  • Reliably Assessing Language Function in Dementia in the 21st Century
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Mohit Verma
       
  • The Assessment of Language and Communication in Dementia: A Synthesis of
           Evidence
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Luisa Krein, Yun-Hee Jeon, Amanda Miller Amberber, Judith FethneyObjectiveWithout the current option of a dementia cure, there is an existing need to focus on rehabilitation intervention. This includes interventions that address language and communication impairment (LCI), found to be present early in most types of dementia. Assessment of LCI can occur in many contexts (e.g., speech pathology, neuropsychology, occupational therapy) and is a vital initial step in providing adequate support to people living with dementia and their families. However, no previous research has compared the psychometric properties and utility of currently available and suitable tools for this purpose.MethodsEighteen tools with the potential to assess language and communication in dementia were identified through a two-stage process, and a synthesis of evidence is provided.ResultsThree tools satisfied all selection criteria: the Arizona Battery for Communication Disorders of Dementia, the Sydney Language Battery, and the Addenbrooke's Cognitive Examination III. Main limitations of the 18 tools reviewed concern a lack of standardization, normative data, and criterion validity, as well as poor evidence of reliability of tools originally developed for non-neurodegenerative LCI (e.g., aphasia in the context of cerebrovascular accidents). Furthermore, no tool considers the perspectives of people with dementia regarding the impact of LCI on their daily lives.ConclusionFurther research is needed to improve reliability and validity of currently available tools for the linguistic assessment of people living with dementia. Importantly, a tool to assess early identification of language and communication difficulties and associated needs among people with dementia is warranted to facilitate timely management and support.
       
  • Commentary on “Caregiver-Care Recipient Relationship Closeness is
           Associated With Neuropsychiatric Symptoms in Dementia”
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Martha Sajatovic
       
  • Caregiver-Care Recipient Relationship Closeness is Associated With
           Neuropsychiatric Symptoms in Dementia
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Elizabeth K. Vernon, Bryce Cooley, William Rozum, Gail B. Rattinger, Stephanie Behrens, Joshua Matyi, Elizabeth Fauth, Constantine G. Lyketsos, JoAnn T. TschanzABSTRACTObjectiveCloser caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs.MethodsDue to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002–2012).ResultsIn unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed −0.32 points per year for the psychosis cluster, −0.11 points per year for agitation/aggression, and −0.67 overall for the affective cluster.ConclusionHigher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.
       
  • Opioid Use Disorder and Its Treatment Among Older Adults: An Invited
           Commentary
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Patience Moyo
       
  • Author's Note
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Nancy R. Davison
       
  • In This Issue
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s):
       
  • Information for Subscribers
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s):
       
  • The Ladies Who Know
    • Abstract: Publication date: April 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 4Author(s): Nancy R. Davison
       
  • Transition of Care
    • Abstract: Publication date: Available online 22 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Diane Portman In the course of my work as a Palliative Care physician I confront the profound toll of care transitions on family and patient wellbeing daily.Facing the decline and behaviors of a loved one with cognitive impairment is challenging. Home care may not be possible and many families must select a dedicated facility to provide needed care. Specialized residences that commit to provide the best of memory care often appeal to caregivers based on amenities and environment. While the right atmosphere is important, day to day quality of care should drive facility selection. However, discerning the nuances of the actual care is not always possible in advance and can engender distress. Superficial factors alternately spur and confound choices. We guide families by giving them pertinent questions to ask about essential dimensions of care. My poem, Transition of Care, reflects the facades that memory care facilities may present to reassure that loved ones are cared for and safe.
       
  • Improving Patient Reported Outcomes and Preventing Depression and Anxiety
           in Older Adults with Knee Osteoarthritis: Results of a Sequenced Multiple
           Assignment Randomized Trial (SMART) Study
    • Abstract: Publication date: Available online 21 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Jordan F. Karp, Jun Zhang, Abdus S. Wahed, Stewart Anderson, Mary Amanda Dew, Kelley Fitzgerald, Debra K. Weiner, Steve Albert, Ari Gildengers, Meryl Butters, Charles F. Reynolds ObjectiveOlder adults with knee osteoarthritis (OA) and comorbid subsyndromal depressive symptoms are at elevated risk for incidental major depression or anxiety disorders. Using an indicated prevention paradigm, the authors conducted a sequenced multiple assignment randomized trial (SMART) to: 1) evaluate the effect of cognitive behavioral therapy (CBT) and physical therapy (PT), together with the temporal ordering of these interventions, on patient–reported global impression of change (P-GIC), mood, anxiety, and pain, and 2) compare the strategies’ impact on incidence of common psychiatric disorders over 12-months.MethodThis intervention development trial compared four adaptive strategies delivered in two stages (each up to 8 weeks), contrasted with Enhanced Usual Care (EUC). The strategies were CBT followed by an increased dose of CBT (CBT-CBT), CBT followed by PT (CBT-PT), PT followed by an increased dose of PT (PT-PT), and PT followed by CBT (PT-CBT). Participants (n=99) were ≥ 60 years old and met clinical criteria for knee OA and subthreshold depression. Response was defined as at least “much better” on the P-GIC. Participants were assessed quarterly for 12 months for incidence of psychiatric disorders.ResultsStage 1 response was higher for PT (47.5%) compared to CBT (20.5%). Non-responders receiving an additional dose of the same intervention experienced a response rate of 73%, higher than for switching to a different intervention. All strategies were superior to EUC (5%). Although not powered to detect effects on disorders, neither intervention strategy nor response status affected twelve-month incidence of depression and anxiety disorders.ConclusionsAs response rates were similar for PT-PT and CBT-CBT, it may be dose and not type of these interventions that is necessary for clinical benefit. For non-responders, this finding may guide providers to stay the clinical course for up to 12 weeks before switching. These results support future trials of SMART designs in late-life depression prevention.
       
  • THREE A.M. A RESIDENT'S PRAYER
    • Abstract: Publication date: Available online 21 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): David L. Coulter
       
  • The potential of actigraphy to assess agitation in dementia
    • Abstract: Publication date: Available online 20 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Paul B. Rosenberg, Sarah K. Wanigatunga, Adam P. Spira
       
  • Mild Behavioral Impairment: a new domain of late-life psychiatric symptoms
    • Abstract: Publication date: Available online 20 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): David L. Sultzer
       
  • Commentary on Weintraub and Mamikonyon paper: AMGP 19-47_R1
    • Abstract: Publication date: Available online 20 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Joseph H. Friedman
       
  • Imagining a role for psychedelics in dementia care
    • Abstract: Publication date: Available online 18 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Daniel R. George, Ryan Hanson
       
  • Integration and extension of specialty mental healthcare services to
           community practice in Parkinson's disease
    • Abstract: Publication date: Available online 13 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Gregory M. Pontone, Nadeeka Dissanayaka, Roseanne D. Dobkin, Lynda Mari, Laura Marsh, Beth A. Vernaleo, Daniel Weintraub, Zoltan Mari Parkinson's disease (PD) is a progressive neurodegenerative disease with a higher prevalence of neuropsychiatric symptoms compared to the general population. Symptoms such as anxiety, depression, psychosis, impulse control disorders, and cognitive impairment cause a greater worsening of quality of life than even the motor symptoms that define PD. Despite the ubiquity and impact of neuropsychiatric symptoms, specialty mental healthcare is not routinely available, accessible, or integrated in most neurology practices. Currently, training in PD-specific mental healthcare is not standard in most programs, and the need for subspecialty-trained, mental healthcare providers will only increase over time, as the prevalence of PD will more than double by 2060. Many barriers limit extension of mental healthcare into existing models of integrated or multidisciplinary care and the community at large. Foundations and professional societies have played an important role in raising awareness of mental healthcare needs in PD; however, their initiatives to promote integrated or multidisciplinary care have traditionally focused on disciplines outside of mental health such as physical, occupational, and speech therapy. This article examines these issues and suggests strategies to better address mental healthcare needs for PD patients in the future.
       
  • Training the Next Generation of Geriatric Focused Clinical Neuroscientists
    • Abstract: Publication date: Available online 13 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Kevin J. Manning, Faith M. Gunning, Howard J. Aizenstein, David C. Steffens It remains challenging to integrate clinical neuroscience into clinical practice. Hindrances at the training level (e.g., lack of qualified faculty and curriculum) contribute to this impasse. To help address this, we present a model of training in clinical neuroscience. We expand upon a growing literature on incorporating neuroscience into psychiatry training by emphasizing two points. That is, (1) we propose a training model designed for the geriatric-minded clinician that (2) extends across several phases of education and career development. Considering the relevance of dementia to our population of interest, and the potential impact expertise in clinical neuroscience can have in elders with cognitive impairment, we provide relevant curriculum examples at various training stages. Clinical research, both as a practitioner and consumer, figures prominently into our training model. We discuss two mentoring programs, T32 fellowships and Research Career Institute in the Mental Health of Aging (CIMA) as ways to engage geriatric psychiatrists early in their training and transition them successfully to post-residency clinical investigator positions. While there is increasing opportunity for geriatric psychiatrists and other clinicians to become leaders in the field of neuroscience, this remains a work in progress; ours and others’ training programs continue to evolve based on input from trainers and trainees alike, as well as from the increasing literature on this important topic.
       
  • Early Clinical Exposure to Geriatric Psychiatry and Medical Students’
           Interest in Caring for Older Adults: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 12 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Klara Pokrzywko, Susana Gabriela Torres-Platas, Petal Abdool, Marouane Nassim, Trent Semeniuk, Yara Moussa, Ghizlane Moussaoui, Chloe Leon, Wayne Baici, Michael Wilkins-Ho, Paul Blackburn, Jess Friedland, NP Vasavan Nair, Karl Looper, Marilyn Segal, Tricia Woo, Marie-Andrée Bruneau, Tarek Rajji, Soham Rej IntroductionIn the next 25 years, the population aged 65+ will nearly double in many countries, with few new doctors wishing to care for older adults. We hypothesize that early clinical exposure to elderly patients’ care could increase students’ interest in caring for older adults during their future career.MethodsWe conducted a pragmatic medical education randomized controlled trial at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University in Montreal, Canada. 3rd year Medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomized to the equivalent of 2-4 weeks’ full-time exposure to clinical geriatric psychiatry (n=84).ResultsBeing randomized to geriatric psychiatry exposure (n=44/84) was associated with increased “comfort in working with geriatric patients and their families” at 16-week follow-up (59.1% vs. 37.5%, χ2 (1) =3.9, p=0.05). However, there was no significant association found between geriatric psychiatry exposure and change “in interest in caring for older adults”, or change in “interest in becoming a geriatric psychiatrist”.ConclusionThe results of this pragmatic education RCT suggest that exposing 3rd year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults or become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families.However, more research is necessary to identify potential interventions that could inspire and increase medical students’ interest in caring for older adults as part of their future careers.
       
  • The neuropsychiatry of Parkinson disease: a perfect storm
    • Abstract: Publication date: Available online 9 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Daniel Weintraub, Eugenia Mamikonyan Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and inter-individual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, though psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and under-treated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well tolerated treatment strategies.
       
  • Deterioration of Brain Neural Tracts in Elderly Women with Sarcopenia
    • Abstract: Publication date: Available online 8 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): So Young Kwak, Sang Gyu Kwak, Tae Sang Yoon, Eun Jung Kong, Min Cheol Chang ObjectivesSarcopenia is known to be associated with increased stiffness in brain arteries, which causes deterioration in brain structure and function. In this study, we evaluated the deterioration of neural tracts using diffusion tensor tractography (DTT) in elderly women with sarcopenia, and investigated whether deterioration of neural tracts is consistent with clinical findings.MethodsTwenty elderly women with sarcopenia were recruited. Muscle mass was measured by dual energy X-ray absorptiometry. Hand-grip power and gait speed were also assessed. Memory function was evaluated using the Seoul Neuropsychological Screening Battery. Additionally, using DTT-Studio software, we evaluated eight neural tracts: the corticospinal tract (CST), corticoreticular pathway, fornix, cingulum, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. We measured the DTT parameters (fractional anisotropy [FA] and fiber volume [FV]) for each neural tract.ResultsThe FA and FV values were decreased in all the evaluated neural tracts, compared to those of the 20 normal comparison subjects. The FVs of the CST were significantly correlated with the hand-grip power of elderly women with sarcopenia. The FVs of the fornix and cingulum in elderly women with sarcopenia were significantly correlated with their memory function.ConclusionsWe found that the neural tracts in elderly women with sarcopenia were extensively deteriorated, and their hand-grip power and memory function were associated with related neural tracts. The DTT seems to be a useful tool for evaluating structural changes in the brains of people with sarcopenia.
       
  • Lamotrigine Therapy and Biomarkers of Cerebral Energy Metabolism in Older
           Age Bipolar Depression
    • Abstract: Publication date: Available online 6 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): E. Mellen, D.G. Harper, C. Ravichandran, J.E. Jensen, M.M. Silveri, B.P. Forester ObjectiveThis study compared brain energy metabolism, as measured by cerebral concentrations of glutamate (Glu), glutamine (Gln), and N-acetyl aspartate (NAA), in older age Bipolar Depression (OABD) to that of psychiatrically healthy comparison subjects using proton (1H) magnetic resonance spectroscopy (MRS) imaging at 4-Tesla. Metabolite levels were assessed in OABD subjects before and after 8 weeks of lamotrigine therapy with the goal of determining relationships between cerebral energy metabolism, depression symptom severity and changes in depression symptom response.Participants: Individuals (n=21, mean age 62.0±5.9 years) with bipolar disorder current episode depressed and a healthy comparison group (n=14, mean age 67.5±8.8 years).InterventionParticipants with bipolar disorder, current episode depressed, were treated in open label fashion with lamotrigine monotherapy for 8 weeks.MeasurementsAll subjects were scanned with 1H MRS at 4T at baseline and again after 8 weeks to assess levels of cerebral metabolites in the anterior cingulate cortex (ACC) and parieto-occipital cortex (POC). Metabolite levels were examined as ratios relative to creatine (Cr). Response to 8 weeks of lamotrigine treatment in the bipolar disorder, current episode depressed group, was assessed as a continuous measure on the Montgomery-Asberg Depression Rating Scale (MADRS).ResultsNAA/Cr ratio in OABD was significantly lower by 14% (95% CI [1%, 26%]) than in comparison subjects at baseline.  However, there were no associations between NAA/Cr, Glu/Cr, or Gln/Cr and either depression severity or lamotrigine treatment.ConclusionsGroup differences in NAA suggest evidence for a deficit in cerebral energy metabolism in OABD.
       
  • Thanatopsis
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): David L. Coulter
       
  • INFORMATION FOR SUBSCRIBERS
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s):
       
  • Immigration: A Modifier of Dementia Risk in Old Age'
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Steven M. Albert
       
  • Technology, Communication, Mood, and Aging: An Emerging Picture
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Ipsit V. Vahia
       
  • Statistical Commentary: “Multivariable Versus Multivariate”
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Stephan Arndt
       
  • Late-Life Depression and Lewy Body Disease
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Hiroshige Fujishiro
       
  • Aggressive Behaviors in Alzheimer Disease and Mild Cognitive Impairment:
           Systematic Review and Meta-Analysis
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Rongqin Yu, Anya Topiwala, Robin Jacoby, Seena FazelABSTRACTObjectiveWe aim to estimate the risk of perpetrating aggression in Alzheimer disease (AD) and mild cognitive impairment (MCI) by conducting a systematic review and meta-analysis of primary studies.MethodsA systematic search was conducted in six bibliographic databases according to a preregistered protocol. Studies that reported aggressive behaviors in individuals with AD and MCI compared with healthy individuals or those with other dementia etiologies were identified. Risks of aggressive behaviors were assessed using random effects models to calculate pooled odds ratios (ORs). Publication bias was examined.ResultsIn total, 17 studies involving 6,399 individuals with AD and 2,582 with MCI were identified. Compared with healthy individuals, significantly increased risks of aggressive behaviors were found in AD (OR, 4.9, 95% CI, 1.8–13.2) but not in MCI (OR, 1.8, 95% CI, 0.7–4.3). When comparing AD with MCI, the risk in AD was higher (OR, 2.6, 95% CI, 1.7–4.0). We found no differences in risk of aggressive behaviors between AD and other dementia subtypes or between amnestic and nonamnestic MCI.ConclusionIndividuals with AD are at higher risk of manifesting aggressive behaviors than healthy individuals or those with MCI. Our findings not only underscore the necessity of treatment of aggressive behaviors in AD but also highlight the importance of preventing the transition from MCI to AD.
       
  • Trends in Insomnia Diagnosis and Treatment Among Medicare Beneficiaries,
           2006–2013
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Jennifer S. Albrecht, Emerson M. Wickwire, Aparna Vadlamani, Steven M. Scharf, Sarah E. Tom ObjectiveInsomnia is an important clinical problem affecting the elderly. We examined trends in insomnia diagnosis and treatment among Medicare beneficiaries over an eight-year period.MethodsThis was a time-series analysis of Medicare administrative data for years 2006–2013. Insomnia was defined as the presence of at least one claim containing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 307.41, 307.42, 307.49, 327.00, 327.01, 327.09, 780.52, or V69.4 in any given year. Insomnia medications were identified by searching the Part D prescription drug files in each year for barbiturates, benzodiazepines, chloral hydrate, hydroxyzine, nonbenzodiazepine sedative hypnotics, and sedating antidepressants.ResultsPrevalence of physician-assigned insomnia diagnoses increased from 3.9% in 2006 to 6.2% in 2013. Prevalence of any insomnia medication use ranged from 21.0% in 2006 to 29.6% in 2013 but remained steady. A sharp increase in use of benzodiazepines from 2012–2013 (1.1% to 17.6%) drove up total insomnia medication use for 2013. Prevalence of both insomnia diagnosis and medication use ranged from 3.5% in 2006 to 5.5% in 2013, while prevalence of either insomnia diagnosis or medication use ranged from 22.7% in 2006 to 31.0% in 2013.ConclusionIn this large national analysis of Medicare beneficiaries, prevalence of physician-assigned insomnia diagnoses was low but increased over time. Prevalence of insomnia medication use was up to four-times higher than insomnia diagnoses and remained steady over time. Notably, prevalence of benzodiazepine use increased dramatically from 2012–2013 after these medications were included in the Medicare Part D formulary.
       
  • Association of Post-Traumatic Stress Disorder Symptoms Following Hurricane
           Katrina With Incident Cardiovascular Disease Events Among Older Adults
           With Hypertension
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Zachary Lenane, Erin Peacock, Cara Joyce, Edward D. Frohlich, Richard N. Re, Paul Muntner, Marie Krousel-Wood ObjectiveTo determine the association of post-traumatic stress disorder (PTSD) symptoms following Hurricane Katrina with incident cardiovascular disease (CVD) events in older, hypertensive, community-dwelling adults both overall and stratified by age, sex, and race.MethodsThis was a prospective cohort study performed in Southeastern Louisiana 12–24 months following Hurricane Katrina through February 2011. Participants were community-dwelling older adults (n = 2,073) enrolled in the Cohort Study of Medication Adherence Among Older Adults with no known history of CVD events. PTSD symptoms were assessed via telephone interview 12–24 months following Hurricane Katrina using the PTSD CheckList-Specific Version. The presence of PTSD symptoms was defined by scores greater than or equal to 37. Incident CVD events (stroke, myocardial infarction, hospitalization for congestive heart failure, or CVD death) were identified and adjudicated over a median 3.8-year follow-up period.ResultsOverall, 8.6% of participants screened positive for PTSD symptoms, and 11.6% had an incident CVD event during follow-up. PTSD symptoms were associated with an adjusted hazard ratio (aHR) for CVD events of 1.7 (95% confidence interval [CI], 1.1, 2.6). The association was present among blacks (aHR, 3.3, 95% CI, 1.7, 6.3) but not whites (aHR, 0.9, 95% CI, 0.4, 1.9); the interaction of PTSD symptoms and race on CVD events was statistically significant.ConclusionPTSD symptoms following Hurricane Katrina were associated with a higher risk of incident CVD in older adults with hypertension, with a stronger association in blacks compared with whites.
       
  • A Preliminary Study of Clinical Trial Enrollment Decisions Among People
           With Mild Cognitive Impairment and Their Study Partners
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Chelsea G. Cox, Mary M. Ryan, B.A., Daniel L. Gillen, Joshua D. GrillABSTRACTObjectiveAll Alzheimer disease (AD) clinical trials, including those enrolling patients with mild cognitive impairment (MCI), require dyadic participation. The purpose of this study was to elucidate how people with MCI and their study partners decide whether to enroll in clinical trials.MethodsThis was a mixed methods interview study. We interviewed patient participants with a consensus research diagnosis of MCI and their study partners. Interviews examined how dyads decide whether to enroll in a clinical trial and whether AD biomarker testing affects willingness to enroll.ResultsThough most MCI patients and study partners would decide in partnership whether to enroll in a clinical trial, agreement was lower among nonspousal, compared with spousal, dyads. Deterrents to enrollment included concerns about patient safety and inconvenience, especially for study partners. Motivators to enrollment included altruism, the desire to contribute to research, hope for patient benefit, and the desire to learn more about the patient's condition. When asked open-ended questions about motivators to enroll in trials, few patients cited access to biomarker testing specifically, though most expressed a desire to undergo biomarker testing when asked directly.ConclusionSpousal and nonspousal MCI dyads may approach clinical trial decisions differently. Future research should investigate how AD biomarker testing affects participants’ willingness to enroll in trials.
       
  • George Niederehe, Ph.D.: Tribute and Thanks
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Jovier D. Evans, Sarah Hollingsworth Lisanby, Joshua Gordon
       
  • Health-Promoting Strategies for the Aging Brain
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Stephen T. Chen, Dax Volle, Jason Jalil, Pauline Wu, Gary W. SmallABSTRACTAs the world's population ages and people live longer, the changes in the aging brain present substantial challenges to our health and society. With greater longevity come age-related diseases, many of which have direct and indirect influences on the health of the brain. Although there is some degree of predictable decline in brain functioning with aging, meaningful cognitive decline is not inevitable and is perhaps preventable. In this review, we present the case that the course of aging-related brain disease and dysfunction can be modified. We present the evidence for conditions and risk factors that may contribute to cognitive decline and dementia and for interventions that may mitigate their impact on cognitive functioning later in life, or even prevent them and their cognitive sequelae from developing. Although much work remains to be done to meet the challenges of the aging brain, strategies to promote its health have been demonstrated and offer much promise, which can only be realized if we mount a vigorous public health effort to implement these strategies.
       
  • Dementia Prevalence in Older Adults: Variation by Race/Ethnicity and
           Immigrant Status
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): Heehyul Moon, Adrian N.S. Badana, So-Yeon Hwang, Jeanelle S. Sears, William E. Haley ObjectiveTo examine differences in prevalence and risk factors of dementia by race/ethnicity and immigrant status using a nationally representative sample of Medicare beneficiaries.MethodsThis was a cross-sectional study performed in the United States among non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and other Medicare beneficiaries from round 1 of the National Health and Aging Trends Study (N = 7,609). The authors used log-binomial regression analyses to investigate risk factors and interactions between race/ethnicity and immigrant status and dementia. Stratified log-binomial regression analyses by race/ethnicity were used to interpret the results of interaction effects of immigrant status found in these surveys. Analyses were conducted in three forms: probable dementia versus possible and no dementia, probable and possible dementia versus no dementia; and probable dementia versus no dementia.ResultsConsistent with previous studies, U.S.-born NHBs have a higher prevalence of dementia than U.S.-born whites, Hispanics, and others. Immigrant status moderated the relationship between race/ethnicity and dementia. NHWs, Hispanics, and other immigrants had a higher prevalence of dementia compared with their U.S.-born counterparts. However, U.S.-born NHBs had a higher prevalence of dementia compared with NHB immigrants. Results were consistent across the three forms of analysis. Greater age predicted higher dementia across the four racial/ethnic groups.ConclusionImmigrant status may have complex effects on dementia risk. Selection factors affecting immigration—varied health and educational systems in diverse countries of origin, acculturative stress, and validity of dementia assessment across diverse groups—deserve further attention.
       
  • In This Issue
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s):
       
  • The limitations of using cognitive cutoff scores for enrollment in
           Alzheimer's trials
    • Abstract: Publication date: Available online 1 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Regan E. Patrick, Katherine Hobbs, Liana Mathias, David G. Harper, Brent P. Forester Many Alzheimer's disease (AD) drug trials now seek to enroll patients at early disease stages. To help identify patients who fall within the prodromal or mildly impaired range, specific cutoff scores/ranges on objective cognitive testing are commonly used as an inclusion criterion. However, such cutoffs do not adequately account for patients’ premorbid (i.e., pre-disease) cognitive ability level. Consequently, appropriate study candidates can be excluded if their premorbid baseline is above or below the population average for their age. This has likely contributed to high screen failure rates and slow pace of enrollment, both of which have hindered AD drug development. Moreover, failure to account for individual differences in premorbid ability raises concerns about the validity of AD trial data. Thus, alternative approaches to screening and inclusion are needed to better account for individual differences in premorbid ability.
       
  • Comments on the Use of “Inappropriate” Antidepressants in Older Adults
           With Dementia and Major Depressive Disorder
    • Abstract: Publication date: Available online 1 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): J. Craig Nelson
       
  • EFFECTIVENESS OF SHARED DECISION-MAKING FOR ELDERLY DEPRESSED MINORITY
           PRIMARY CARE PATIENTS
    • Abstract: Publication date: Available online 1 March 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Patrick J. Raue, Herbert C. Schulberg, Martha L. Bruce, Samprit Banerjee, Amanda Artis, Maria Espejo, Idalia Catalan, Sara RomeroABSTRACTObjectiveWe assessed the impact of a Shared Decision-Making intervention among elderly depressed minority primary care patients not currently receiving treatment.Methods202 English and Spanish-speaking primary care participants aged 65+ who scored positive on the PHQ-9 (≥10) were randomized at the physician level to receive a brief Shared Decision-Making intervention or Usual Care. Primary analyses focused on patient adherence to either psychotherapy or antidepressant medication, and reduction in depression severity (HAM-D) over 12 weeks.ResultsPatients randomized to physicians in the Shared Decision-Making condition were significantly more likely than patients of physicians randomized to Usual Care to receive a mental health evaluation or initiate some form of treatment (39% vs. 21%), and to adhere to psychotherapy visits over 12 weeks. There were no differences between groups in adherence to antidepressant medication or in reduction of depressive symptoms.ConclusionsAmong untreated elderly depressed minority patients from an inner-city municipal hospital, a brief Shared Decision-Making intervention was associated with greater initiation and adherence to psychotherapy. However, low treatment adherence rates across both groups and the intervention's lack of impact on clinical outcomes highlight the need to provide focused and accessible mental health services to patients choosing active treatments.
       
  • Promoting Health Behaviors For Aging Persons
    • Abstract: Publication date: March 2019Source: The American Journal of Geriatric Psychiatry, Volume 27, Issue 3Author(s): George S. Alexopoulos
       
  • Use of Actigraphy to Measure Symptoms of Agitation in Dementia
    • Abstract: Publication date: Available online 27 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Amber Knuff, Roxanne H. Leung, Dallas P. Seitz, Luljeta Pallaveshi, Amer M. BurhanABSTRACTObjectivesTo evaluate the feasibility and validity of actigraphy as a measurement of agitation in dementia.MethodsParticipants aged 65 and older, diagnosed with dementia, residing in a geriatric psychiatry inpatient unit or long-term care facility were included in a cross-sectional study. Agitation was assessed using Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI). Actigraphy was measured over seven days and compared across groups categorized as low or high agitation based on a CMAI cutoff score of 50.ResultsTwenty participants were enrolled (mean age=74.3 years, SD=8.69). The 24-hour mean motor activity as measured with actigraphy was significantly different between the low and high agitation groups (180.23, SD=86.34 vs. 81.51, SD=30.29, Z=2.29, P=0.02). Most actigraph variables had significant correlations with CMAI and NPI scores.ConclusionsActigraphy was highly correlated with informant-based methods for measuring agitation in individuals with dementia and actigraphy may be useful tool for measuring agitation.
       
  • May You Go Safely
    • Abstract: Publication date: Available online 22 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): David L. Coulter
       
  • Risk Aversion and Alzheimer's Disease in Old Age
    • Abstract: Publication date: Available online 21 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Robert S. Wilson, Lei Yu, Julie A. Schneider, David A. Bennett, Patricia A. BoyleABSTRACTObjectiveTo test the hypothesis that late-life risk aversion is partly a prodromal sign of dementia.DesignLongitudinal clinical-pathologic cohort study.SettingParticipants’ residences in Chicago area.ParticipantsA total of 874 older persons without dementia at enrollment.MeasurementsAt baseline, risk aversion was assessed with questions involving choices between certain smaller rewards and uncertain larger rewards. At annual intervals thereafter, participants underwent evaluations that included cognitive testing and diagnosis of mild cognitive impairment (MCI) and dementia. At death, a neuropathologic examination was done to quantify common pathologies linked to dementia.ResultsRisk aversion at study onset ranged from 0.05 to 0.91 (mean = 0.32, SD = 0.31). During a mean of 4.6 years of follow-up, 123 (of 874) developed dementia. Higher risk aversion was associated with higher dementia incidence (hazard ratio [HR] = 2.08, 95% confidence interval [CI]: 1.18, 3.65) and more rapid decline in episodic (estimate= -0.062, SE = 0.019, t[3677]=-3.33, p
       
  • Metabolic Syndrome: A Matter of The Heart and the Brain
    • Abstract: Publication date: Available online 21 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Neha Jain Metabolic syndrome is an emerging epidemic with increasing prevalence in the United States. Multiple studies have explored the relationship between metabolic syndrome, mild cognitive impairment, Alzheimer's disease and vascular dementia. Given recent evidence including the review and meta-analysis in this edition of the American Journal of Geriatric Psychiatry, we suggest that behavioral health specialists consider detection and aggressive management of metabolic syndrome an integral part of any cognitive health protocol.
       
  • Metabolic Syndrome (MetS), Mild Cognitive Impairment (MCI) and Dementia: a
           meta-analysis of longitudinal studies
    • Abstract: Publication date: Available online 15 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Anna Rita Atti, Stefano Valente, Antonia Iodice, Ilaria Caramella, Barbara Ferrari, Umberto Albert, Laura Mandelli, Diana De Ronchi The metabolic syndrome (MetS) is a cluster of unhealthy factors highly prevalent in Western societies including (1) abdominal obesity, (2) hypertriglyceridemia, (3) low high-density lipoprotein (HDL), (4) hypertension, and (5) hyperglycemia. So far, MetS has been investigated in relation to incident dementia in population-based and clinical studies yielding to mixed results. A systematic review and a meta-analysis of both clinical and population-based studies was undertaken according to PRISMA statement to clarify whether MetS is a risk or a protective factor for incident dementia, Alzheimer Disease (AD), and Vascular Dementia (VaD), and whether it's involved in progression to dementia in subjects affected by Mild Cognitive Impairment (MCI).Search terms included ("metabolic syndrome" OR "syndrome x" OR "plurimetabolic syndrome") AND ("dementia" OR "Alzheimer disease" OR "vascular dementia” OR “Mild cognitive impairment” OR “MCI”). Research was restricted to articles published in English between 1st January 2000 and 31st August 2018. No age limit was settled.At the end of the selection procedure, nine longitudinal studies were selected for the meta-analysis: six studies enrolled cognitively well-functioning participants and three studies involved MCI patients. A total of 18,313 participants aged>40 with mean MetS prevalence of 22.7% were followed on average for 9.41 years. Fixed model were used to estimate pooled Hazard Ratios (HR) and 95 % Confidence Intervals (95%CI).No statistically significant pooled association emerged between MetS and incident dementia and AD. MetS increased the incidence of pure VaD. MetS increased the risk of progression from MCI to dementia. Follow-up length might be a key factor in investigating further these associations. Since MetS is constituted by a set of potentially modifiable factors, further studies with longer follow-up and repeated assessment of both MetS and cognitive status are desirable to draw definite conclusions.
       
  • Mechanisms Underlying Exercise as a Treatment for Depression
    • Abstract: Publication date: Available online 14 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Vincent Koppelmans, Sara L. Weisenbach
       
  • Commentary on “Influence of Positive and Negative Dimensions of Dementia
           Caregiving on Caregiver Well-Being and Satisfaction with Life: Findings
           from the Ideal Study”
    • Abstract: Publication date: Available online 14 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Richard Schulz
       
  • Is Successful Dying or Good Death an Oxymoron'
    • Abstract: Publication date: Available online 13 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Dilip V. Jeste, Sarah Graham
       
  • Influence of positive and negative dimensions of dementia caregiving on
           caregiver well-being and satisfaction with life: Findings from the IDEAL
           study
    • Abstract: Publication date: Available online 11 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Catherine Quinn, Sharon M. Nelis, Anthony Martyr, Christina Victor, Robin G. Morris, Linda Clare, IDEAL study team ObjectiveThe aim of this study was to identify the potential impact of positive and negative dimensions of caregiving on caregiver well-being and satisfaction with life (SwL).MethodThis study utilised time-point 1 data from the IDEAL cohort study that involves 1283 informal caregivers of people in the mild-to-moderate stages of dementia recruited from 29 sites within Great Britain. Multivariate linear regression modelling was used to investigate the associations between positive dimensions of caregiving (measured by caregiving competence and perceptions of positive aspects of caregiving), negative dimensions of caregiving (measured by caregiving stress and role captivity) and caregiver well-being and SwL.ResultsLower well-being was associated with low caregiving competence (-13.77; 95% CI -16.67, -10.87), perceiving fewer positive aspects of caregiving (-7.67; 95% CI -10.26, -5.07), high caregiving stress (-24.45; 95% CI -26.94, -21.96), and high role captivity (-15.61; 95% CI -18.33, -12.89). Lower SwL was associated with low caregiving competence (-4.61; 95% CI -5.57, -3.66), perceiving fewer positive aspects of caregiving (-3.09; 95% CI -3.94, -2.25), high caregiving stress (-7.88; 95% CI -8.71, -7.06), and high role captivity (-6.41; 95% CI -7.27, -5.54). When these four measures were combined within the same model, only positive aspects of caregiving and caregiving stress retained independent associations with well-being and SwL.ConclusionsBoth positive and negative dimensions of caregiving were associated with caregiver well-being and SwL. Psychological therapies and interventions need to consider not only the negative aspects of caregiving but also positive caregiving experiences and their implications for caregiver well-being and SwL.
       
  • Precisely-Measured Hydration Status Correlates with Hippocampal Volume in
           Healthy Older Adults
    • Abstract: Publication date: Available online 11 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Tracy Butler, Anup Deshpande, Patrick Harvey, Yi Li, Henry Rusinek, Elizabeth Pirraglia, Ricardo S. Osorio, Lidia Glodzik, Mony J. de Leon, Guillaume Madelin, Wen W. Yu, Dympna Gallagher, John Masaeka
       
  • Applying Rigor: Intervention Studies for Behavioral and Psychological
           Symptoms of Dementia
    • Abstract: Publication date: Available online 8 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Amanda N. Leggett, Helen C. Kales
       
  • Extent and Predictors of Potentially Inappropriate Antidepressant Use
           among Older Adults with Dementia and Major Depressive Disorder
    • Abstract: Publication date: Available online 7 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Sandipan Bhattacharjee, Jeannie K. Lee, Asad E. Patanwala, Nina Vadiei, Daniel C. Malone, Shannon M. Knapp, Wei-Hsuan Lo-Ciganic, William J. BurkeABSTRACTOBJECTIVESTo quantify the extent and identify predictors of potentially inappropriate antidepressant use among older adults with dementia and newly diagnosed major depressive disorders (MDD).DESIGNRetrospective cohort studySETTINGMedicare 5% sample claims data (2012-2013)PARTICIPANTSOlder adults (age≥65 years) with dementia and newly diagnosed MDD.MEASUREMENTSBased on Healthcare Effectiveness Data and Information Set guidelines, intake period for new antidepressant medication use was from May 1, 2012 through April 30, 2013. Index prescription start date (IPSD) was the first date of antidepressant prescription claim during the intake period. Dependent variable of this study was potentially inappropriate antidepressant use as defined by the Beers and Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria. We conducted multiple logistic regression analysis to identify individual-level predictors of potentially inappropriate antidepressant use.RESULTSOur final study sample consisted of 7,625 older adults with dementia and newly diagnosed MDD, among which 7.59% (N=579) initiated treatment with a potentially inappropriate antidepressant. Paroxetine (N=394) was the most commonly initiated potentially inappropriate antidepressant followed by amitriptyline (N=104), nortriptyline (N=35), and doxepin (N=32). Initiation of a potentially inappropriate antidepressant was associated with age, region, provider specialty, anxiolytics, angiotensin II receptor blockers, and Elixhauser comorbidity index.CONCLUSIONSMore than 7% of older adults in our study sample initiated a potentially inappropriate antidepressant and we identified a few individual-level factors significantly associated it. Appropriately tailored interventions to address modifiable and non-modifiable factors significantly associated with potentially inappropriate antidepressant prescribing are required to minimize risks in this vulnerable population.
       
  • The Roles of Apathy and Depression in Predicting Alzheimer Disease: A
           Longitudinal Analysis in Older Adults With Mild Cognitive Impairment
    • Abstract: Publication date: Available online 7 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Myuri Ruthirakuhan, Nathan Herrmann, Danielle Vieira, Damien Gallagher, Krista L. LanctôtABSTRACTObjectiveApathy and depression have each been associated with an increased risk of conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD).These symptoms often co-occur and the contribution of each to risk of AD is not clear.MethodsNational Alzheimer's Coordinating Center participants diagnosed with MCI at baseline and followed until development of AD or loss to follow-up (n = 4,932) were included. The risks of developing AD in MCI patients with neuropsychiatric symptoms (NPS) (apathy only, depression only, or both) were compared to that in those without NPS in a multivariate Cox regression survival analysis adjusting for baseline cognitive impairment, years of smoking, antidepressant use, and AD medication use.ResultsThirty-seven percent (N = 1713) of MCI patients developed AD (median follow-up 23 months). MCI patients with both apathy and depression had the greatest risk (hazard ratio [HR] = 1.37; 95% confidence interval [CI]: 1.17–1.61; p < 0.0001; Wald χ2 = 14.70; df = 1). Those with apathy only also had a greater risk (HR = 1.24; 95% CI: 1.05–1.47; p = 0.01; Wald χ2 = 6.22; df = 1), but not those with depression only (HR = 1.08; 95% CI: 0.95–1.22; p=0.25; Wald χ2 = 1.30; df = 1). Post-hoc analyses suggested depression may exacerbate cognitive decline in MCI patients with apathy (odds ratio = 0.70; 95% CI 0.52–0.95; p = 0.02; Wald χ2 = 5.28; df = 1), compared to those without apathy.ConclusionMCI patients with apathy alone or both apathy and depression are at a greater risk of developing AD compared to those with no NPS. Interventions targeting apathy and depression may reduce risk of AD.
       
  • Physicians Are Less Likely to Assess and Manage Suicide Risk Among Older
           Adults: Broader Implications for Suicide Prevention Within Primary Care
    • Abstract: Publication date: Available online 5 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Patrick J. Raue
       
  • Chronology
    • Abstract: Publication date: Available online 2 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): J. Barrie Shepherd
       
  • Mild Behavioral Impairment as a Marker of Cognitive Decline in Cognitively
           Normal Older Adults
    • Abstract: Publication date: Available online 2 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Byron Creese, Helen Brooker, Zahinoor Ismail, Keith A. Wesnes, Adam Hampshire, Zunera Khan, Maria Megalogeni, Anne Corbett, Dag Aarsland, Clive BallardABSTRACTObjectiveMild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later life emergent neuropsychiatric symptoms (NPS) that represent an at-risk state for incident cognitive decline and dementia in people with mild cognitive impairment (MCI). We undertook a study to determine whether MBI was associated with progressive changes in neuropsychological performance in people without significant cognitive impairment.MethodsA total of 9,931 older adults enrolled in the PROTECT study who did not have MCI or dementia undertook a comprehensive neuropsychological battery measuring attention, reasoning, executive function, and working memory at baseline and 1 year. MBI was ascertained using self-administration of the Mild Behavioral Impairment Checklist at 1 year, and participants were grouped according to MBI status: No Symptoms, Intermediate NPS and MBI. All assessments were completed online, and data analyzed using mixed-effects model repeated measures analysis of covariance.ResultsA total of 949 (10%) people had MBI. These individuals had significantly worse cognitive performance at baseline and significantly greater decline over 1 year in the four composite cognitive scores measuring attentional intensity (F [2,8578] = 3.97; p = 0.019), sustained attention (F [2,8578] = 18.63; p
       
  • Exercise and Cognitive Training as a Strategy to Improve Neurocognitive
           Outcomes in Heart Failure: A Pilot Study
    • Abstract: Publication date: Available online 1 February 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Rebecca A. Gary, Sudeshna Paul, Elizabeth Corwin, Brittany Butts, Andrew H. Miller, Kenneth Hepburn, Bryan Williams, Drenna Waldrop-ValverdeABSTRACTObjectiveMild cognitive impairment, especially memory loss, is prevalent in patients with heart failure (HF) and contributes to poor clinical outcomes and higher mortality.MethodsThis study evaluated a combined aerobic exercise and cognitive training (EX/CT) program on memory, executive function, attention, processing speed and reaction time compared to exercise only or a usual care attention control (UCAC) stretching and flexibility program. Participants completed a standardized neurocognitive battery at baseline, 3 months, and 6 months along with demographic, clinical, and functional capacity (6-minute walk test). A linear mixed model analysis was used with comorbidity as a covariate.ResultsSixty-nine participants were enrolled, the mean age was 61 ± 10years, 54% were women, 55% were African American, and the mean left ventricular ejection fraction percentage was 35 ± 15. A significant group by time interaction for verbal memory was found at 3 months (F [2, 53] = 4.3, p = 0.018) but was not sustained at 6 months in the EX/CT group. Processing speed/attention differed across treatment groups between baseline and 6 months, but improvement occurred among UCAC participants. There were also significant group differences in the 6MWT distance occurring at 3 months (F [2, 52] = 3.5, p = 0.036); however, significant improvement was observed within the EX/CT group only. There were no significant differences in 6MWT in the other groups at 3 or 6 months.ConclusionAn EX/CT intervention was associated with improved memory in persons with HF and warrants further investigation in a larger trial. The relationship between functional capacity and cognitive function also needs further study.
       
  • Measuring and Intervening to Instill Purpose in Life for Older Adults to
           Prevent Cognitive Decline
    • Abstract: Publication date: Available online 30 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Dan Blazer
       
  • Improving Everyday Functioning in the Old-Old with Working Memory Training
    • Abstract: Publication date: Available online 29 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Erika Borella, Alessandra Cantarella, Barbara Carretti, Annalisa De Lucia, Rossana De BeniABSTRACTObjectiveThe aim of this study was to assess gains related to working memory (WM) training, in the short and long term (9 months after the training), in abilities required in everyday life, and in cognitive measures in old-old adults (aged ≥ 75 years).MethodsThirty-two community-dwelling older adults (aged 75–85 years) were randomly assigned to a training or an active control group. In addition to testing for any specific gains in a WM task similar to the one used in the training (criterion task), we sought transfer effects to: 1) abilities involved in everyday life using objective performance-based tasks (the Everyday Problem Test [EPT] and the Timed Instrumental Activities of Daily Living [TIADL] scale; 2) tasks demanding the comprehension and recall of spatial information and pairing names with faces; and 3) a measure of inhibitory control, that is, recall errors (intrusion errors).ResultsOnly the trained group showed specific gains in the criterion task, and in the TIADL in the short term. At follow-up, the trained group maintained gains in the criterion task, and showed transfer effects to everyday problem-solving (in the EPT), and in constructing spatial representations of an environment. The trained group also improved in a cognitive inhibition measure (intrusion errors) at follow-up. No such improvements were seen in the active control group.ConclusionWM training may be a valid way to help old-old adults preserve at least some abilities related to everyday functioning.
       
  • Age Differences in Suicide Risk Screening and Management Prior to Suicide
           Attempts
    • Abstract: Publication date: Available online 22 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Kelsey Simons, Kimberly Van Orden, Kenneth R. Conner, Courtney BaggeABSTRACTObjectiveThis study examined differences by age in suicide risk screening and clinical actions to reduce suicide risk among patients with visits to Veterans Health Administration (VHA) medical facilities in the year prior to an attempt.MethodsNinety-three VHA patient records were reviewed specific to the last visit before an attempt. Information was extracted regarding documentation of individual suicide risk factors and provider actions to reduce risk.ResultsThe authors examined differences by patient age (≥50 versus 18–49). Older patients’ medical records were less likely to have evidence of 1) screening for impulsivity and firearms access and 2) engagement in safety planning, referrals for mental health services, and consideration of psychiatric hospitalization. General medical providers were less likely to document these risk factors and action steps in comparison with mental health clinicians.ConclusionLethal means education and collaborative care are universal strategies that may improve identification of and lower suicide risk in older veterans.
       
  • Advice on How to Choose a Geriatric Psychiatry Fellowship
    • Abstract: Publication date: Available online 21 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Rajesh R. Tampi, Kristina F. Zdanys, Shilpa Srinivasan, Brandon C. YarnsABSTRACTThe population of older adults with mental health and substance use disorders in the United States is increasing at a significant rate. This growth creates a critical need for trained geriatric psychiatrists. Unfortunately, the number of psychiatrists choosing to receive subspecialty training in geriatric psychiatry has not kept pace with the growing needs of society. Many different methods for enhancing the recruitment of physicians interested in subspecialty training are being discussed nationally. One way to improve recruitment is to provide prospective residents a clear understanding of the process by which one may apply to and select a fellowship program. In this article, we discuss the process by which physicians interested in pursuing fellowship training in geriatric psychiatry can make an informed decision to apply to and choose programs that best fit their needs.
       
  • Purpose in Life Protects Against Cognitive Decline Among Older Adults
    • Abstract: Publication date: Available online 19 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Giyeon Kim, Su Hyun Shin, Monica A. Scicolone, Patricia ParmeleeABSTRACTObjectiveThis study examined whether having a sense of purpose in life protects against cognitive decline among older adults and whether purpose in life moderates the relationship between selected risk factors (age, sex, and race/ethnicity) and cognitive abilities.MethodsThis was a longitudinal analysis of existing secondary data of adults (N = 11,557) aged 50 or older using the 2006–2012 waves of the Health and Retirement Study. The study measured purpose in life, cognitive functioning score, and various covariates.ResultsGrowth curve modeling revealed that, after adjusting for covariates, purpose in life was positively associated with participants’ total cognition scores. Purpose in life significantly moderated the relationship between age and race/ethnicity and cognitive decline. Further, purpose in life was a protective factor against cognitive decline for those who were older and black. There was no significant interaction between purpose in life and sex.ConclusionHaving a purposeful life protects against cognitive decline in older adults, and the associations varied by age and race/ethnicity, but not by sex. Potential ways to increase purpose in life are discussed in a clinical context.
       
  • Increasing Social Activities Reduces Depression in Old Age, but Which
           Activities Matter'
    • Abstract: Publication date: Available online 17 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Gary J. Kennedy
       
  • Exercise for Depression: A Feasibility Trial Exploring Neural Mechanisms
    • Abstract: Publication date: Available online 17 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Swathi Gujral, Howard Aizenstein, Charles F. Reynolds, Meryl A. Butters, George Grove, Jordan F. Karp, Kirk I. EricksonABSTRACTObjectiveThe aim of this study was to test the feasibility of an exercise augmentation to pharmacotherapy in depressed younger and older adults while exploring neural mechanisms.MethodsA randomized, double-blind, controlled clinical trial was conducted in 15 inactive younger (20–39 years) and older (60–79 years) adults meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a major depressive episode (https://clinicaltrials.gov/ct2/show/NCT02407704). Participants were randomized to receive a 12-week regimen of venlafaxine XR or venlafaxine XR plus supervised exercise. Cardiorespiratory fitness was assessed using a submaximal Vo2 test, and neuroimaging assessments were conducted using a Siemans MAGNETOM 7-Tesla magnetic resonance scanner at the University of Pittsburgh.ResultsAttrition was 38% and 14% for the medication and exercise groups, respectively. Attendance was 91% for the exercise intervention. Exploratory analyses revealed an association between improvement in fitness and increased cortical thickness in the anterior cingulate cortex.ConclusionExercise augmentation to pharmacotherapy is feasible for depressed younger and older adults and may have neural benefits in a core brain region implicated in depression.
       
  • Commentary on “Accelerated DNA Methylation Aging in U.S. Military
           Veterans: Results From the National Health and Resilience in Veterans
           Study”
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): David Mischoulon
       
  • Grocery List
    • Abstract: Publication date: Available online 11 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Nancy R. Davison
       
  • Engagement in Socially and Interpersonally Rewarding Activities as a
           Predictor of Outcome in “Engage” Behavioral Activation Therapy for
           Late-Life Depression
    • Abstract: Publication date: Available online 10 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Nili Solomonov, Jennifer N. Bress, Jo Anne Sirey, Faith M. Gunning, Christoph Flückiger, Patrick J. Raue, Patricia A. Areán, George S. AlexopoulosABSTRACTObjectiveLoneliness and social isolation are associated with depressive symptoms, cognitive and physical disabilities, and increased risk of mortality among older adults. Socially rewarding activities reduce loneliness, and neurobiological evidence suggests that these activities may activate neural reward systems in older adults to a greater extent than other rewarding experiences. The current study was designed to investigate whether engagement in social and interpersonal activities (i.e., exposure to social rewards) predicts subsequent increase in behavioral activation and reduction in depressive symptoms in reward exposure treatment for late-life depression.MethodsForty-eight older adults without cognitive impairment and with major depression received nine sessions of “Engage” psychotherapy. Behavioral activation and depression severity were assessed by trained raters at baseline and weeks 6 and 9. Patients’ weekly behavioral plans were categorized into three groups: 1) solitary activities; 2) social-group activities (attending a social gathering or a social setting such as church or a senior center); and 3) interpersonal-individual activities (engaging in an interpersonal interaction with a specific friend or family member).ResultsMixed-effects models showed reduction in depression severity and increase in behavioral activation over time. In linear regression models, a higher percentage of interpersonal-individual activities (but not solitary or social-group activities) predicted subsequent increase in behavioral activation and improvement of depression.ConclusionThese findings highlight the importance of understanding the effects of engagement in specific types of rewarding activities in behavioral activation treatments for late-life depression. Exposure to socially rewarding interpersonal interactions could contribute to the efficacy of psychotherapy for late-life depression.
       
  • Depression Agency-Based Collaborative: Effect of Problem-Solving Therapy
           on Risk of Common Mental Disorders in Older Adults With Home Care Needs
    • Abstract: Publication date: Available online 10 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Steven M. Albert, Jennifer King, Stewart Anderson, Mary Amanda Dew, Jun Zhang, Sarah T. Stahl, Jordan F. Karp, Ariel G. Gildengers, Meryl A. Butters, Charles F. Reynolds IIIABSTRACTBackgroundInterventions to prevent depression in older adults have mainly focused on young-old ambulatory adults, not on the old-old with disabilities who receive supportive services in their homes.ObjectiveThe Depression Agency-Based Collaborative (Dep-ABC) is a single-blind pilot randomized controlled trial assessing the effect of an intervention-development strategy using problem-solving therapy (PST) on the risk of common mental health disorders in this vulnerable population.MethodsThe intervention involved six to eight sessions of PST over 12 weeks. Participants were followed up to 12 months postintervention.ResultsDep-ABC randomized 104 participants—68.4% of eligible and 17.5% of all older adults screened. The proportion of participants with incident major depressive disorder or generalized anxiety disorder was 11.4% in PST and 14.3% in the enhanced usual care control arm. A test of the interaction between time and intervention for anxiety symptoms favored the PST arm (p = 0.04).ConclusionPST did not lower the risk of incident common mental illness but did lower anxiety symptom burden. Apart from low power, the effects of PST may have been blunted by referral for medical and aging services in the enhanced usual care group.
       
  • Delusions in Alzheimer Disease: What Researchers Should Not Forget
    • Abstract: Publication date: Available online 9 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Konasale M. Prasad
       
  • The Promise of Technology-Driven Interventions for Older Adults: An
           Invited Commentary
    • Abstract: Publication date: Available online 9 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Daniel L. Segal, Katie L. Granier
       
  • Accelerated DNA Methylation Aging in U.S. Military Veterans: Results From
           the National Health and Resilience in Veterans Study
    • Abstract: Publication date: Available online 7 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Amanda J.F. Tamman, Janitza L. Montalvo-Ortiz, Steven M. Southwick, John H. Krystal, Becca R. Levy, Robert H. PietrzakABSTRACTObjectiveThe aim of this study was to identify how a broad range of sociodemographic, military, health, and psychosocial factors relate to accelerated DNA methylation aging (Δage) in a large, contemporary, nationally representative sample of male U.S. veterans.MethodsData were analyzed from a sample of U.S. male European-American veterans who participated in the National Health and Resilience in Veterans Study (N = 1,135).ResultsPsychosocial factors of lifetime trauma burden, child sexual trauma, and negative beliefs about aging were independently associated with Δage. Three health variables—diabetes, hypertension, and body mass index—emerged as additional correlates of Δage.ConclusionResults of the study build on prior work demonstrating associations between accelerated DNA methylation aging and traumatic stress, highlighting a role for child sexual abuse in particular. They further underscore the importance of targeting negative beliefs about aging, which are modifiable, in prevention efforts designed to forestall accelerated DNA methylation aging.
       
  • Effects of a Multidisciplinary Intervention on the Presence of
           Neuropsychiatric Symptoms and Psychotropic Drug Use in Nursing Home
           Residents WithYoung-Onset Dementia: Behavior and Evolution of Young-Onset
           Dementia Part 2 (BEYOND-II) Study
    • Abstract: Publication date: Available online 4 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Britt Appelhof, Christian Bakker, Marjolein E. de Vugt, Jeannette C.L. van Duinen-van den IJssel, Sandra A. Zwijsen, Martin Smalbrugge, Steven Teerenstra, Frans R.J. Verhey, Sytse U. Zuidema, Raymond T.C.M. KoopmansABSTRACTObjective: The effect of an intervention on neuropsychiatric symptoms (NPS), particularly agitation and aggression, and psychotropic drug use (PDU) in institutionalized people with young-onset dementia (YOD) was evaluated. Methods: A randomized controlled trial was conducted using a stepped wedge design. Thirteen YOD special care units were randomly assigned to three groups, which received the intervention at different time points. Four assessments took place every 6 months during a period of 18 months. Two hundred seventy-four people with YOD who resided in YOD special care units participated, of whom 131 took part in all assessments. The intervention consisted of an educational program combined with a care program, which structured the multidisciplinary process of managing NPS. The care program included the following five steps: evaluation of psychotropic drug prescription, detection, analysis, treatment, and evaluation of treatment of NPS. The Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version were used to assess NPS. Data on PDU were retrieved from residents’ medical files. Multilevel models were used to evaluate the effect of the intervention, which accounted for clustering of measurements in clients within units. Results: No significant differences were found in agitation, aggression, other NPS, or PDU after crossing over to the intervention condition. Conclusion: We found no evidence that the intervention for management of NPS in nursing home residents with YOD was more effective in reducing agitation, aggression, other NPS, or PDU compared with care as usual.
       
  • Commentary on “Depression Predicts Delirium After Coronary Artery Bypass
           Graft Surgery Independent of Cognitive Impairment and Cerebrovascular
           Disease: An Analysis of the Neuropsychiatric Outcomes After Heart Surgery
           Study”
    • Abstract: Publication date: Available online 2 January 2019Source: The American Journal of Geriatric PsychiatryAuthor(s): Carol K. Chan, Karin J. Neufeld
       
  • Prevalence of Hoarding in an Adult Inpatient Population and Its
           Association With Axis I Diagnoses
    • Abstract: Publication date: Available online 28 December 2018Source: The American Journal of Geriatric PsychiatryAuthor(s): Arnabh Basu, Nidhi Goel, Sowmya Puvvada, Theresa JacobABSTRACTObjectiveHoarding behavior is not limited to obsessive-compulsive disorder (OCD) alone. With the objective of highlighting the association between hoarding behavior and common psychiatric disorders, we explored its occurrence in psychiatric inpatients and co-occurrence with Axis I diagnoses.MethodsIn this prospective cohort study, we enrolled adult psychiatric inpatients by simple random sampling at an urban, community-based, academic medical center. Patients were screened for hoarding using the validated Hoarding Rating Scale-Interview, and those meeting criteria for clinically significant hoarding were assessed for Axis I disorders.ResultsClinically significant hoarding was observed in 33% of the 200 acute psychiatry patients admitted to the study. Mood disorders were positively associated with hoarding (p = 0.033), whereas psychotic spectrum disorders had a weaker association with it (p = 0.015).ConclusionThis study indicates a need for clinicians to be mindful that hoarding manifests in many forms of mental illness and is not limited to OCD alone.
       
  • Leaving It Behind and Letting Go
    • Abstract: Publication date: Available online 28 December 2018Source: The American Journal of Geriatric PsychiatryAuthor(s): David L. Coulter
       
  • Overcoming the Dual Stigma of Mental Illness and Aging: Preparing New
           Nurses to Care for the Mental Health Needs of Older Adults
    • Abstract: Publication date: Available online 27 December 2018Source: The American Journal of Geriatric PsychiatryAuthor(s): Ivy Benjenk, Portia Buchongo, Aitalohi Amaize, G. Sofia Martinez, Jie ChenABSTRACTObjectiveRegistered nurses are uniquely positioned to fill shortages in the geropsychiatric healthcare workforce. With training, nurses can coordinate both mental and physical healthcare and deliver mental health interventions. Our objective was to determine how nursing educators are preparing students to care for the mental health needs of older adults and to explore the challenges they face in this effort.MethodsThis was a qualitative study using semi-structured, in-depth interviews. Participants were undergraduate psychiatric nursing instructors recruited from schools of nursing in the Northeastern United States. Semistructured interviews focused on challenges and strategies related to preparing nursing students to meet the mental health needs of older patients.ResultsFourteen interviews were conducted. An overarching theme of bias against geropsychiatric care was identified as a challenge for educators. Educators reported that nursing students carry biases against patients with mental illness and older patients. Nursing students indicated negative perceptions of the psychiatric and geriatric nursing specialties. Most nursing students plan to work in nonpsychiatric settings and do not consider mental health a priority for their patients. To overcome these challenges, educators suggested increased exposure and integration. To prepare new nurses to care for the mental health needs of older patients, nursing schools should expose nursing students to older adults in a variety of settings and integrate mental health topics and training throughout the undergraduate nursing curriculum.ConclusionNursing schools should evaluate their curricula to ensure that mental health content is prioritized and sufficiently integrated with physical health topics. An increased focus on geropsychiatric and integrated mental health content should be supported by nursing programs and state boards of nursing.
       
  • Depression Predicts Delirium After Coronary Artery Bypass Graft Surgery
           Independent of Cognitive Impairment and Cerebrovascular Disease: An
           Analysis of the Neuropsychiatric Outcomes After Heart Surgery Study
    • Abstract: Publication date: Available online 25 December 2018Source: The American Journal of Geriatric PsychiatryAuthor(s): Mark A. Oldham, Keith A. Hawkins, I-Hsin Lin, Yanhong Deng, Qing Hao, Leslie M. Scoutt, David D. Yuh, Hochang B. LeeABSTRACTObjectiveAlthough depression is a known risk factor for delirium after coronary artery bypass graft (CABG) surgery, it is unclear whether this risk is independent of delirium risk attributable to cognitive impairment or cerebrovascular disease. This study examines depression, mild cognitive impairment (MCI), and cerebrovascular disease as post-CABG delirium risk factors.MethodsThis prospective observational cohort study was performed in a tertiary-care academic hospital. Subjects were without dementia and undergoing CABG surgery. Preoperative cognitive assessment included Clinical Dementia Rating and neuropsychological battery; depression was assessed using Depression Interview and Structured Hamilton. Baseline intracranial stenosis was evaluated by transcranial Doppler of bilateral middle cerebral arteries (MCAs). Study psychiatrists assessed delirium on postoperative days 2–5 using the Confusion Assessment Method.ResultsOur analytic sample comprised 131 subjects (average age: 65.8 ± 9.2 years, 27% women). MCI prevalence was 24%, preoperative depression 10%, lifetime depression 35%, and MCA stenosis (≥50%) 28%. Sixteen percent developed delirium. Multivariate analysis revealed that age, MCI (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 1.3–20.1), and preoperative depression (OR: 9.9; 95% CI: 1.3–77.9)—but not lifetime depression—predicted delirium. MCA stenosis and severity predicted delirium in univariate but not multivariate analysis. Right MCA stenosis severity predicted delirium severity, but left-sided stenosis severity did not.ConclusionWe established that the risk of delirium attributable to depression extends beyond the potential moderating influence of cognitive impairment and cerebrovascular disease alone. Even mild depression and cognitive impairment before CABG deserve recognition for their effect on post-CABG cognitive health.
       
  • Psychosocial Interventions for Community-Dwelling People Following
           Diagnosis of Mild to Moderate Dementia: Findings of a Systematic Scoping
           Review
    • Abstract: Publication date: Available online 24 December 2018Source: The American Journal of Geriatric PsychiatryAuthor(s): Fiona Keogh, Gail Mountain, Philip Joddrell, Kathryn LordABSTRACTNational policies and evidence reviews recommend psychosocial interventions (PIs) as an essential support, particularly in the period following dementia diagnosis. However, availability and uptake of these interventions are comparatively low. One of the reasons for this is that clinicians lack information about what might be provided and the potential benefits of different interventions. This article identifies and describes PIs for community-dwelling people following diagnosis of mild to moderate dementia and presents the available evidence to inform practice decisions. A systematic scoping review was employed to map the evidence relating to PIs for this group. This identified 63 relevant studies, testing 69 interventions, which could be grouped into 6 intervention categories: 20 cognition-oriented, 11 behavior-oriented, 11 stimulation-oriented, 13 emotion-oriented, 5 social-oriented, and 9 multimodal. There were three targets for outcome measurement of these PIs: the person with dementia, the family caregiver, and the person–caregiver dyad. Over 154 outcome measures were identified in the studies, with outcomes measured across 11 main domains. The lack of a classification framework for PIs means it is difficult to create a meaningful synthesis of the breadth of relevant evidence to guide clinical practice. Possible dimensions of a classification framework are proposed to begin to address this gap.
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 18.210.28.227
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-