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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 332, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 129, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 309, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Geriatric Psychiatry
  [SJR: 1.653]   [H-I: 93]   [16 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1064-7481 - ISSN (Online) 1545-7214
   Published by Elsevier Homepage  [3043 journals]
  • Regional 18F-Fluorodeoxyglucose Hypometabolism is Associated with Higher
           Apathy Scores Over Time in Early Alzheimer Disease
    • Authors: Jennifer R. Gatchel; Nancy J. Donovan; Joseph J. Locascio; J. Alex Becker; Dorene M. Rentz; Reisa A. Sperling; Keith A. Johnson; Gad A. Marshall
      Pages: 683 - 693
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Jennifer R. Gatchel, Nancy J. Donovan, Joseph J. Locascio, J. Alex Becker, Dorene M. Rentz, Reisa A. Sperling, Keith A. Johnson, Gad A. Marshall
      Objectives Apathy is among the earliest and most pervasive neuropsychiatric symptoms in prodromal and mild Alzheimer disease (AD) dementia that correlates with functional impairment and disease progression. We investigated the association of apathy with regional 18F-fluorodeoxyglucose (FDG) metabolism in cognitively normal, mild cognitive impairment, and AD dementia subjects from the Alzheimer's Disease Neuroimaging Initiative database. Design Cross-sectional and longitudinal studies. Setting 57 North American research sites. Participants 402 community dwelling elders. Measurements Apathy was assessed using the Neuropsychiatric Inventory Questionnaire. Baseline FDG metabolism in five regions implicated in the neurobiology of apathy and AD was investigated in relationship to apathy at baseline (cross-sectional general linear model) and longitudinally (mixed random/fixed effect model). Covariates included age, sex, diagnosis, apolipoprotein E genotype, premorbid intelligence, cognition, and antidepressant use. Results Cross-sectional analysis revealed that posterior cingulate hypometabolism, diagnosis, male sex, and antidepressant use were associated with higher apathy scores. Longitudinal analysis revealed that the interaction of supramarginal hypometabolism and time, posterior cingulate hypometabolism, and antidepressant use were associated with higher apathy scores across time; only supramarginal hypometabolism was positively related to rate of increase of apathy. Conclusions Results support an association of apathy with hypometabolism in parietal regions commonly affected in early stages of AD, rather than medial frontal regions implicated in the neurobiology of apathy in later stages. Further work is needed to substantiate whether this localization is specific to apathy rather than to disease stage, and to investigate the potential role of AD proteinopathies in the pathogenesis of apathy.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2016.12.017
       
  • Neuropsychiatric Symptoms and Neuroimaging Biomarkers in Alzheimer
           Disease: “Which is the Cart and Which is the Horse'”
    • Authors: Yonas E. Geda; Janina Krell-Roesch; Nathalie Sambuchi; Bernard F. Michel
      Pages: 694 - 696
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Yonas E. Geda, Janina Krell-Roesch, Nathalie Sambuchi, Bernard F. Michel


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.03.007
       
  • Antipsychotic Use and Physical Morbidity in Parkinson Disease
    • Authors: Daniel Weintraub; Claire Chiang; Hyungjin Myra Kim; Jayne Wilkinson; Connie Marras; Barbara Stanislawski; Eugenia Mamikonyan; Helen C. Kales
      Pages: 697 - 705
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Daniel Weintraub, Claire Chiang, Hyungjin Myra Kim, Jayne Wilkinson, Connie Marras, Barbara Stanislawski, Eugenia Mamikonyan, Helen C. Kales
      Objective To determine if antipsychotic (AP) use in Parkinson disease (PD) patients is associated with increased physical morbidity. Methods Veterans Health Administration data (1999–2010) was used to examine physical morbidity risk associated with AP use in idiopathic PD patients with stable recent physical health. We compared 180-day morbidity rates in patients initiating an AP with matched non-AP users who survived for 180 days (matched on age, sex, race, index year, presence and duration of dementia, PD duration, delirium, hospitalization, Charlson Comorbidity Index, and new non-psychiatric medications; covarying for psychosis). Outcomes were 180-day emergency department (ED), and inpatient and outpatient visits. Results There were 6,679 matched PD pairs. Any AP use was associated with an increased risk of ED visit (HR: 1.64, 95% CI: 1.51, 1.77), inpatient care (HR: 1.58, 95% CI: 1.46, 1.71), and outpatient visits (IRR: 1.08, 95% CI: 1.05, 1.12). The risk was significantly higher for atypical AP use compared with nonuse for all three morbidity outcomes, and was similar for atypical and typical AP use. Conclusions Any AP use, and atypical AP use, are associated with significantly increased physical morbidity risk in PD patients, as evidenced by increased ED, inpatient, and outpatient visits. These findings, which require replication, extend the risk associated with use of APs in this population from mortality to a broader range of adverse outcomes, and further highlight the need to use APs cautiously in PD patients.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.01.076
       
  • Antipsychotics Use in Parkinson Disease: Separating Appropriate Therapies
           from Treating Inappropriately
    • Authors: Eric Martin McDade
      Pages: 706 - 707
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Eric Martin McDade


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.03.001
       
  • Lack of Early Improvement with Antipsychotics is a Marker for Subsequent
           Nonresponse in Behavioral and Psychological Symptoms of Dementia: Analysis
           of CATIE-AD Data
    • Authors: Kazunari Yoshida; Rachel Roberts; Takefumi Suzuki; Barry Lebowitz; Suzanne Reeves; Robert Howard; Takayuki Abe; Masaru Mimura; Hiroyuki Uchida
      Pages: 708 - 716
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Kazunari Yoshida, Rachel Roberts, Takefumi Suzuki, Barry Lebowitz, Suzanne Reeves, Robert Howard, Takayuki Abe, Masaru Mimura, Hiroyuki Uchida
      Objective Prediction of response or nonresponse to antipsychotics is especially important in patients with behavioral and psychological symptoms of dementia (BPSD) in whom antipsychotic exposure increases risks of death. This study examined whether the presence or absence of early improvement of BPSD with antipsychotics is associated with subsequent response or nonresponse. Methods In a post-hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) study (2001–2004) (clinicaltrials.gov; NCT00015548) in 45 U.S. sites, 245 subjects (olanzapine, N = 90; quetiapine, N = 81; risperidone, N = 74) with a DSM-IV diagnosis of dementia of the Alzheimer type who presented with a score of 1 or more in the Brief Psychiatric Rating Scale (BPRS) at baseline (phase I of CATIE-AD) were randomly assigned to treatment with olanzapine, quetiapine, risperidone, or placebo in a double-blind manner. Associations were examined between response at week 8 and demographic and clinical characteristics, including BPRS total score reduction at week 2, using logistic regression analyses. Prediction performance of binary classification (presence or absence) of improvement or no improvement at week 2 for response at week 8 was examined. Results BPRS total score reduction at week 2 (mean percentage score reduction: 12.6%) was significantly associated with response at week 8 (odds ratio: 1.18; 95% CI: 1.11–1.26). The 5% score reduction cut-off at week 2 showed the highest accuracy (0.71), with sensitivity, specificity, and positive and negative predictivevalues of 0.76, 0.65, 0.69, and 0.72, respectively. Conclusion Lack of even a very small early improvement with antipsychotic treatment may be a marker of subsequent nonresponse in BPSD.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.01.016
       
  • Prediction of Response to Antipsychotics in Patients with Dementia Remains
           a Conundrum
    • Authors: D.P. Devanand
      Pages: 717 - 718
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): D.P. Devanand


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.04.005
       
  • CADASIL as a Useful Medical Model and Genetic Form of Vascular Depression
    • Authors: Joon Hyuk Park; Bong-Hee Jeon; Jung Seok Lee; Paul A. Newhouse; Warren D. Taylor; Brian D. Boyd; Ki Woong Kim; Moon-Doo Kim
      Pages: 719 - 727
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Joon Hyuk Park, Bong-Hee Jeon, Jung Seok Lee, Paul A. Newhouse, Warren D. Taylor, Brian D. Boyd, Ki Woong Kim, Moon-Doo Kim
      Objective The main magnetic resonance imaging (MRI) findings of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are white matter hyperintensities (WMHs), lacunar infarctions, and cerebral microbleeds (CMBs). The purpose of this study was to investigate the effects of these three neuroimaging markers of CADASIL on depression to determine whether CADASIL is a useful medical model supporting the vascular depression hypothesis. Methods Eighty-four subjects with CADASIL, aged 34–86 years, participated in this study. They underwent comprehensive clinical evaluation, including 3T MRI and genotyping of NOTCH3. The effects of WMH, lacunar infarctions, and CMBs were analyzed by path analyses and multivariate logistic regression analyses. Results Patients with CADASIL exhibited frequencies of 17.9% for major depressive disorder (MDD) and 10.7% for minor depressive disorder. The frequency of MDD increased from 5.0% to 46.2% as WMH volume increased from first quartile to fourth quartile. WMH volume (OR: 1.03, 95% CI: 1.003–1.06) in patients with CADASIL was associated with the current depressive disorder. Path analyses demonstrated that only WMH volume was associated with the Korean version of the short form Geriatric Depression Scale score, Center for Epidemiologic Studies Depression Scale score, and 17-item Hamilton depression scale score. The effects of lacunar infarctions and CMBs on depression were not significant in path analyses and multivariate logistic regression analyses. Conclusions This study demonstrates that WMHs are closely associated with depression in patients with CADASIL. This supports that CADASIL might be a useful medical model and genetic form of vascular depression.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.03.013
       
  • The Implications of CADASIL as a Genetic Model of Vascular Depression
    • Authors: Sara N. Rushia; Ernst Garcon; Joel R. Sneed
      Pages: 728 - 729
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Sara N. Rushia, Ernst Garcon, Joel R. Sneed


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.03.009
       
  • Neural Basis of Cognitive Assessment in Alzheimer Disease, Amnestic Mild
           Cognitive Impairment, and Subjective Memory Complaints
    • Authors: Jordi A. Matías-Guiu; María Nieves Cabrera-Martín; María Valles-Salgado; Alicia Pérez-Pérez; Teresa Rognoni; Teresa Moreno-Ramos; José Luis Carreras; Jorge Matías-Guiu
      Pages: 730 - 740
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Jordi A. Matías-Guiu, María Nieves Cabrera-Martín, María Valles-Salgado, Alicia Pérez-Pérez, Teresa Rognoni, Teresa Moreno-Ramos, José Luis Carreras, Jorge Matías-Guiu
      Introduction Interpreting cognitive tests is often challenging. The same test frequently examines multiple cognitive functions, and the functional and anatomical basis underlying test performance is unknown in many cases. This study analyses the correlation of different neuropsychological test results with brain metabolism in a series of patients evaluated for suspected Alzheimer disease. Methods 20 healthy controls and 80 patients consulting for memory loss were included, in which cognitive study and 18F-fluorodeoxyglucose PET were performed. Patients were categorized according to Reisberg's Global Deterioration Scale. Voxel-based analysis was used to determine correlations between brain metabolism and performance on the following tests: Free and Cued Selective Reminding Test (FCSRT), Boston Naming Test (BNT), Trail Making Test, Rey-Osterrieth Complex Figure test, Visual Object and Space Perception Battery (VOSP), and Tower of London (ToL) test. Results Mean age in the patient group was 73.9 ± 10.6 years, and 47 patients were women (58.7%). FCSRT findings were positively correlated with metabolism in the medial and anterior temporal region bilaterally, the left precuneus, and posterior cingulate. BNT results were correlated with metabolism in the middle temporal, superior, fusiform, and frontal medial gyri bilaterally. VOSP results were related to the occipital and parietotemporal regions bilaterally. ToL scores were correlated to metabolism in the right temporoparietal and frontal regions. Conclusions These results suggest that different areas of the brain are involved in the processes required to complete different cognitive tests. Ascertaining the functional basis underlying these tests may prove helpful for understanding and interpreting them.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.02.002
       
  • Unraveling the Biologic Basis for Domain-Specific Cognitive Decline
    • Authors: Shannon L. Risacher
      Pages: 741 - 743
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Shannon L. Risacher


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.04.007
       
  • Steeper Slope of Age-Related Changes in White Matter Microstructure and
           Processing Speed in Bipolar Disorder
    • Authors: Sheena I. Dev; Tanya T. Nguyen; Benjamin S. McKenna; Ashley N. Sutherland; Hauke Bartsch; Rebecca J. Theilmann; Lisa T. Eyler
      Pages: 744 - 752
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Sheena I. Dev, Tanya T. Nguyen, Benjamin S. McKenna, Ashley N. Sutherland, Hauke Bartsch, Rebecca J. Theilmann, Lisa T. Eyler
      Objectives Bipolar disorder (BD) is associated with compromised white matter (WM) integrity and deficits in processing speed (PS). Few studies, however, have investigated age relationships with WM structure and cognition to understand possible changes in brain health over the lifespan. This investigation explored whether BD and healthy counterpart (HC) participants exhibited differential age-related associations with WM and cognition, which may be suggestive of accelerated brain and cognitive aging. Design Cross-sectional study. Setting University of California San Diego and the Veterans Administration San Diego Healthcare System. Participants 33 euthymic BD and 38 HC participants. Measurements Diffusion tensor imaging was acquired as a measure of WM integrity, and tract-specific fractional anisotropy (FA) was extracted utilizing the Johns Hopkins University probability atlas. PS was assessed with the Number and Letter Sequencing conditions of the Delis-Kaplan Executive Function System Trail Making Test. Results BD participants demonstrated slower PS compared with the HC group, but no group differences were found in FA across tracts. Multiple linear regressions revealed a significant group-by-age interaction for the right uncinate fasciculus, the left hippocampal portion of the cingulum, and for PS, such that older age was associated with lower FA values and slower PS in the BD group only. The relationship between age and PS did not significantly change after accounting for uncinate FA, suggesting that the observed age associations occur independently. Conclusions Results provide support for future study of the accelerated aging hypothesis by identifying markers of brain health that demonstrate a differential age association in BD.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.02.014
       
  • Commentary for “Steeper Slope of Age-Related Changes in White Matter
           Microstructure and Processing Speed in Bipolar Disorder”
    • Authors: Ariel Gildengers
      Pages: 753 - 754
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Ariel Gildengers


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.04.002
       
  • A Longitudinal Analysis of Quality of Life and Associated Factors in Older
           Adults with Schizophrenia Spectrum Disorder
    • Authors: Carl I. Cohen; Aninditha Vengassery; Elena F. Garcia Aracena
      Pages: 755 - 765
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Carl I. Cohen, Aninditha Vengassery, Elena F. Garcia Aracena
      Objectives Self-perceived quality of life (QOL) is an important outcome indicator in schizophrenia and a predictor of symptomatic and functional improvement. This study provides the first large scale longitudinal study of the fluctuations, predictors, and impact of QOL in older adults with schizophrenia spectrum disorder (SSD). Methods The sample consisted of 104 community-dwelling persons with SSD aged 55 and over (mean age: 61years) who developed the disorder prior to age 45. Mean follow-up was 52.5 months (range 12–116 months); 55% were men; 55% were white. We identified 22 potential predictor variables and used the Quality of Life Index (QLI) to assess QOL. Results There were no significant group differences in the QLI at baseline and follow-up. However, 33%, 24% and 43% of persons exhibited > 0.5 effect size increase or decrease, or no change, respectively. In multivariable analysis, there were 5 baseline predictors of QLI at follow-up: QLI, Center for Epidemiological Studies-Depression Scale (CES-D) scores, religiousness, perceived well-being versus others/past self, and time from initial interview. Baseline QLI predicted 5 variables at follow-up: the Positive and Negative Syndrome Scale (PANSS) anxiety score, PANSS positive score, CES-D score, insight, and perceived well-being versus others/past self. Conclusion In many persons with SSD, QOL is not static in later life and one third improved their QOL. Effectively treating depressive symptoms and encouraging religious participation may improve QOL. QOL had two pivotal roles: As a relatively independent dynamic outcome measure and as a critical variable affecting clinical outcomes such as anxiety, depressive and positive symptoms.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.01.013
       
  • Influence of Negative Life Events and Widowhood on Risk for Dementia
    • Authors: Lotte Gerritsen; Hui-Xin Wang; Chandra A. Reynolds; Laura Fratiglioni; Margaret Gatz; Nancy L. Pedersen
      Pages: 766 - 778
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Lotte Gerritsen, Hui-Xin Wang, Chandra A. Reynolds, Laura Fratiglioni, Margaret Gatz, Nancy L. Pedersen
      Objective The aim of the current study was to examine the effect of negative life events and widowhood on the incidence of dementia. Methods Data were from four Swedish longitudinal cohort studies with a total of nearly 2,000 participants and 8–25 years of follow-up. Seven stressful events were examined for which data were available in all cohorts. Clinical dementia diagnoses were made through medical and psychological examinations. Cox proportional hazards models were used to estimate the association between life events and dementia, adjusting for lifestyle and cardiovascular risk factors. Results The experience of one stressful life event was not associated with dementia incidence, but two or more negative life events at baseline predicted higher risk for dementia (pooled HR: 2.00). This was most apparent for the incidence of vascular dementia (pooled HR: 3.60) but not for Alzheimer disease (pooled HR: 1.29). Moreover, persons who were widowed and had experienced one or more negative life events were found to have a threefold risk for dementia. Conclusion Widowhood augments the effect of negative life events on dementia incidence and negative life events specifically increase the risk for vascular dementia.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.02.009
       
  • Antipsychotic Use and Hospitalization Among Older Assisted Living
           Residents: Does Risk Vary by Frailty Status'
    • Authors: Kathryn J. Stock; David B. Hogan; Kate Lapane; Joseph E. Amuah; Suzanne L. Tyas; Susan E. Bronskill; Andrew M. Morris; Chaim M. Bell; Lianne Jeffs; Colleen J. Maxwell
      Pages: 779 - 790
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Kathryn J. Stock, David B. Hogan, Kate Lapane, Joseph E. Amuah, Suzanne L. Tyas, Susan E. Bronskill, Andrew M. Morris, Chaim M. Bell, Lianne Jeffs, Colleen J. Maxwell
      Objective To examine associations between baseline frailty measures, antipsychotic use, and hospitalization over 1 year and whether hospitalization risk associated with antipsychotic use varies by frailty level. Methods In this prospective cohort study of 1,066 residents (mean age: 85 years; 77% women) from the Alberta Continuing Care Epidemiological Studies, trained research nurses conducted comprehensive resident assessments at baseline (2006–2007) for sociodemographic characteristics, health conditions, frailty status, behavioral problems, and all medications consumed during the past 3 days. Two separate measures of frailty were assessed, the Cardiovascular Health Study (CHS) phenotype and an 86-item Frailty Index (FI). Time to first hospitalization during follow-up was determined via linkage with the Alberta Inpatient Discharge Database. Results Baseline frailty status (both measures), but not antipsychotic use, was significantly associated with hospitalization over 1 year. When stratified by frailty, FI-defined frail residents using antipsychotics showed a significantly increased risk for hospitalization (adjusted HR: 1.54; 95% CI: 1.01–2.36) compared with frail nonusers. CHS-defined frail antipsychotic users versus frail nonusers also showed an elevated risk (adjusted HR: 1.67; 95% CI: 0.96–2.88). Nonfrail residents using antipsychotics were significantly less likely to be hospitalized compared with nonfrail nonusers whether defined by the FI (adjusted HR: 0.62; 95% CI: 0.39–0.99) or CHS criteria (adjusted HR: 0.62; 95% CI: 0.40–0.96). Conclusion Frailty measures may be helpful in identifying those who are particularly vulnerable to adverse effects and those who may experience benefit with treatment.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.02.013
       
  • Suvorexant in Elderly Patients with Insomnia: Pooled Analyses of Data from
           Phase III Randomized Controlled Clinical Trials
    • Authors: W. Joseph Herring; Kathryn M. Connor; Ellen Snyder; Duane B. Snavely; Ying Zhang; Jill Hutzelmann; Deborah Matzura-Wolfe; Ruth M. Benca; Andrew D. Krystal; James K. Walsh; Christopher Lines; Thomas Roth; David Michelson
      Pages: 791 - 802
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): W. Joseph Herring, Kathryn M. Connor, Ellen Snyder, Duane B. Snavely, Ying Zhang, Jill Hutzelmann, Deborah Matzura-Wolfe, Ruth M. Benca, Andrew D. Krystal, James K. Walsh, Christopher Lines, Thomas Roth, David Michelson
      Objective Suvorexant is an orexin receptor antagonist approved for treating insomnia at doses of 10–20 mg. Previously reported phase III results showed that suvorexant was effective and well-tolerated in a combined-age population (elderly and nonelderly adults). The present analysis evaluated the clinical profile of suvorexant specifically in the elderly. Methods Prespecified subgroup analyses of pooled 3-month data from two (efficacy) and three (safety) randomized, double-blind, placebo-controlled, parallel-group trials. In each trial, elderly (≥65 years) patients with insomnia were randomized to suvorexant 30 mg, suvorexant 15 mg, and placebo. By design, fewer patients were randomized to 15 mg. Patient-reported and polysomnographic (subset of patients) sleep maintenance and onset endpoints were measured. Results Suvorexant 30 mg (N = 319) was effective compared with placebo (N = 318) on patient-reported and polysomnographic sleep maintenance, and onset endpoints at Night 1 (polysomnographic endpoints)/Week 1 (patient-reported endpoints), Month 1, and Month 3. Suvorexant 15 mg (N = 202 treated) was also effective across these measures, although the onset effect was less evident at later time points. The percentages of patients discontinuing because of adverse events over 3 months were 6.4% for 30 mg (N = 627 treated), 3.5% for 15 mg (N = 202 treated), and 5.5% for placebo (N = 469 treated). Somnolence was the most common adverse event (8.8% for 30 mg, 5.4% for 15 mg, 3.2% for placebo). Conclusion Suvorexant generally improved sleep maintenance and onset over 3 months of nightly treatment and was well-tolerated in elderly patients with insomnia (clinicaltrials.gov; NCT01097616, NCT01097629, NCT01021813).

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.03.004
       
  • Prevalence, Patterns, and Predictors of Depression Treatment among
           
    • Authors: Sandipan Bhattacharjee; Yeum Mok Oh; Eric M. Reiman; William J. Burke
      Pages: 803 - 813
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): Sandipan Bhattacharjee, Yeum Mok Oh, Eric M. Reiman, William J. Burke
      Objectives Co-occurring dementia and depression exerts a substantial burden on the elderly. This study utilizes data from a nationally representative cohort of community-dwelling individuals 65 years and older to examine the prevalence, patterns, and predictors of depression treatment among elderly individuals with co-occurring dementia and depression. Design Retrospective, cross-sectional study. Setting Multiple years of Medical Expenditure Panel Survey (2002, 2004, 2006, 2008, 2010, and 2012) data. Participants The study sample consisted of elderly (age ≥65 years) individuals who 1) had dementia, 2) were alive during the calendar year, and 3) had co-occurring depression. Measurements The dependent variable of this study was depression treatment, identified by antidepressant medication with or without psychotherapy use. Individual level factors associated with depression treatment among elderly individuals with dementia and co-occurring depression were evaluated by conducting multinomial logistic regression. Results Co-occurring depression prevalence among community-dwelling elderly individuals with dementia was approximately 22%. An overwhelming majority (nearly 88%) of the study sample reported receipt of depression treatment. Antidepressants only and combination therapy (antidepressant with psychotherapy) was reported by 75% and 13%, respectively, of the study sample. Age, race/ethnicity, marital status, limitations of instrumental activities of daily living, perceived mental health status, and pain were significantly associated with the reporting of receipt of depression treatment. Conclusions An overwhelming majority of the study sample received depression treatment and several subgroup differences (such as in terms of age) existed in terms of reporting the use of depression treatment was observed.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.03.003
       
  • Crossing the Bar
    • Authors: J. Barrie Shepherd
      First page: 814
      Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7
      Author(s): J. Barrie Shepherd


      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.01.004
       
  • Internet Delivery and Peer Support: New Venues for Psychosocial
           Interventions of Late-Life Depression
    • Authors: Dimitris N. Kiosses
      Abstract: Publication date: Available online 8 July 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Dimitris N. Kiosses


      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.024
       
  • Family Caregiving: a Vision for the Future
    • Authors: Richard Schulz; Sara J. Czaja
      Abstract: Publication date: Available online 4 July 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Richard Schulz, Sara J. Czaja
      The authors of this review both served on the National Academy of Science, Engineering, and Medicine Committee which produced the report, “Caring for an Aging America”. In this commentary we summarize key findings and recommendations most relevant to clinicians and researchers in geriatric psychiatry and related disciplines. The report notes the growing prevalence of family caregiving in the U.S, especially those caring for high need patients with multiple chronic conditions, disability, and/or cognitive impairment. To support the capacity of family caregivers to perform critical caregiving tasks, the report recommends a major shift in health care policy toward collaborative partnerships among patients, their defined family, and providers of care. Optimizing the role of family caregivers will minimally require systematic attention to the identification, assessment, and support of family caregivers throughout the care delivery process. Research is needed to develop the tools and protocols to efficiently assess caregivers, and identify ways in which they can be integrated into existing clinical practices. We also need research to identify how to best implement, maintain and evaluate caregiver support programs within clinical and community settings. The Centers for Medicare and Medicaid Services should be charged with developing, testing, and implementing provider payment reforms that motivate providers to engage and support family caregivers. Payment reforms should include clearly articulated performance standards that hold providers accountable for caregiver engagement, training, and support by explicitly including caregiver outcomes in quality measures.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.023
       
  • Purpose in Life and Hospitalization for Ambulatory Care-Sensitive
           Conditions in Old Age
    • Authors: Robert S. Wilson; Ana W. Capuano; Bryan D. James; Priscilla Amofa; Zoe Arvanitakis; Raj Shah; David A. Bennett; Patricia A. Boyle
      Abstract: Publication date: Available online 30 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Robert S. Wilson, Ana W. Capuano, Bryan D. James, Priscilla Amofa, Zoe Arvanitakis, Raj Shah, David A. Bennett, Patricia A. Boyle
      Objective To test the hypothesis that higher level of purpose in life is associated with lower subsequent odds of hospitalization. Design Longitudinal cohort study. Setting Participants' residences in the Chicago metropolitan area. Participants A total of 805 older persons who completed uniform annual clinical evaluations. Measurements Participants annually completed a standard self-report measure of purpose in life, a component of well-being. Hospitalization data were obtained from Part A Medicare claims records. Based on previous research, ICD-9 codes were used to identify ambulatory care-sensitive conditions (ACSCs) for which hospitalization is potentially preventable. The relation of purpose (baseline and follow-up) to hospitalization was assessed in proportional odds mixed models. Results During a mean of 4.5 years of observation, there was a total of 2,043 hospitalizations (442 with a primary ACSC diagnosis, 1,322 with a secondary ACSC diagnosis, 279 with no ACSCs). In initial analyses, higher purpose at baseline and follow-up were each associated with lower odds of more hospitalizations involving ACSCs but not hospitalizations for non-ACSCs. Results were comparable when those with low cognitive function at baseline were excluded. Adjustment for chronic medical conditions and socioeconomic status reduced but did not eliminate the association of purpose with hospitalizations involving ACSCs. Conclusions In old age, higher level of purpose in life is associated with lower odds of subsequent hospitalizations for ambulatory care-sensitive conditions.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.022
       
  • A Complex Clinical Intersection: Palliative Care in Patients with Dementia
    • Authors: Ellen E. Lee; Beverly Chang; Steven Huege; Jeremy Hirst
      Abstract: Publication date: Available online 29 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Ellen E. Lee, Beverly Chang, Steven Huege, Jeremy Hirst
      Due to the rapidly growing older population and increases in longevity, rates of dementia have been rising. Clinical challenges of treating dementia include limited resources and lack of curative therapies. Palliative care approaches improve quality of life and alleviate suffering for dementia patients at the end of life, though implementation may be limited by societal acceptance and feasibility. This review examines the published literature on pain assessments, pain and behavior interventions, tools for advance care planning, and clinical concerns in dementia patients. Ultimately, modification of the traditional palliative care model may improve outcomes and functioning for dementia patients at all stages of their illness.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.015
       
  • English Language Proficiency, Hearing Impairment and Functional Change in
           Mild Cognitive Impairment
    • Authors: Paul J Regal
      Abstract: Publication date: Available online 29 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Paul J Regal


      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.021
       
  • Post-Intensive Care Syndrome: the Role of Geriatric Psychiatry in
           Research, Practice, and Policy
    • Authors: Leslie P. Scheunemann; Elizabeth R. Skidmore; Charles F. Reynolds
      Abstract: Publication date: Available online 29 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Leslie P. Scheunemann, Elizabeth R. Skidmore, Charles F. Reynolds


      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.017
       
  • Measuring Loneliness: Are There Method Factors'
    • Authors: Rafael J. Engel
      Abstract: Publication date: Available online 29 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Rafael J. Engel


      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.05.022
       
  • Validating the 11-Item R-UCLA Scale to Assess Loneliness among Older
           Adults: An Evaluation of Factor Structure and Other Measurement Properties
           
    • Authors: Joonyup Lee; John G. Cagle
      Abstract: Publication date: Available online 29 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Joonyup Lee, John G. Cagle
      Objective To examine the measurement properties and factor structure of the short version of Revised University of California Los Angeles (R-UCLA) loneliness scale from the Health and Retirement Study (HRS). Methods Based on data from 3,706 HRS participants aged 65+ who completed the 2012 wave of the HRS and its Psychosocial Supplement, we examined the measurement properties and factorability of the R-UCLA by conducting an Exploratory Factor Analysis (EFA) and the Confirmatory Factor Analysis (CFA) on randomly split halves. Results The average score for the 11-item loneliness scale was 16.4 (SD=4.5). An evaluation of the internal consistency produced a Cronbach's alpha of .87. Results from the EFA showed that two- and three-factor models were appropriate. However, based on the results of the CFA, only a two-factor model was determined to be suitable because there was a very high correlation between two of the factors identified in the three-factor model, available social connections and sense of belonging. Conclusion This study provides important data on the properties of the 11-item R-UCLA scale by identifying a two-factor model of loneliness: feeling isolated and available social connections. Our findings suggest the 11-item R-UCLA has good factorability and internal reliability.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.004
       
  • ¡HOLA, Amigos! Towards Preventing Anxiety and Depression in Older
           Latinos
    • Authors: Daniel E. Jimenez; Shariful Syed; Doris Perdomo-Johnson; Joseph F. Signorile
      Abstract: Publication date: Available online 29 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Daniel E. Jimenez, Shariful Syed, Doris Perdomo-Johnson, Joseph F. Signorile
      Given the prevalence and morbidity of depression and anxiety in later life, the inadequacies of current treatment approaches for averting years living with disability, the disparities in access to the mental health care delivery system, and the workforce shortages to meet the mental health needs of older Latinos, development and testing of innovative strategies to prevent depression and anxiety are of great public health significance and have the potential to change practice. While impediments to good depression and anxiety outcomes exist for all older adults, they are even more pronounced for older Latinos, who tend to have fewer socioeconomic resources. These factors underscore the need for prevention-based interventions that are effective, scalable, relevant, respectful, and specific to this population. The Happy Older Latinos are Active (HOLA) program is a community health worker (CHW)-led, multicomponent, health promotion intervention. The diverse needs and circumstances of older Latinos (highly sedentary, culture-specific health beliefs, service disparities) were incorporated into the design of HOLA in order to reduce risk factors and improve health-related outcomes associated with common mental disorders in this group. The authors describe HOLA (highlighted in this case example) and why health promotion interventions like HOLA may hold promise as effective, practical, and non-stigmatizing interventions for preventing common mental disorders in older Latinos who are at risk for developing these disorders.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.020
       
  • Predictors of Mental Health Services Use Across the Life Course among
           Racially-Ethnically Diverse Adults
    • Authors: Amy L. Byers; Amy X. Lai; Craig Nelson; Kristine Yaffe
      Abstract: Publication date: Available online 28 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Amy L. Byers, Amy X. Lai, Craig Nelson, Kristine Yaffe
      Objective: Little is known about key factors associated with use of mental health services across the life course. This study determined key socioeconomic, social support, psychiatric, and medical predictors of services use in younger, middle, and older age. Design, Setting, Participants, Measurements: The sample included 3,708 adults with DSM-IV-based mood, anxiety, and substance use disorders in the Collaborative Psychiatric Epidemiology Surveys. Key predictors of mental health services use for each age group were systematically determined by multivariable models, and exploratory analyses examining potential effect modification by race-ethnicity and gender were assessed by interaction terms. Statistical analyses included complex design-corrected and weighted logistic regression analyses that provide results generalizable to the United States. Results: Psychiatric and medical issues such as prior suicidal behavior, comorbid psychiatric disorders, and perceived cognitive impairment increased odds of mental health services use in younger, middle, and older age. Chronic medical conditions also influenced services use in younger and older age, with their impact on use across age potentially modified by racial-ethnic disparities (p interaction=.01). Moreover, socioeconomic factors like marital status influenced use in middle and older age, where being divorced, separated, widowed, or never married encouraged use. The effect of marital status on use across age was also potentially modified by racial-ethnic disparities (p interaction=.02). Conclusions: Key socioeconomic, social support, psychiatric, and medical predictors uniquely influence use of mental health services across the life course. These findings will help inform efforts to encourage greater services use by adults across the life course in need of care.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.018
       
  • MRI Markers of Neurodegenerative and Neurovascular Changes in Relation to
           Postoperative Delirium and Postoperative Cognitive Decline
    • Authors: Ilse M.J. Kant; Jeroen de Bresser; Simone J.T. van Montfort; Arjen J.C. Slooter; Jeroen Hendrikse
      Abstract: Publication date: Available online 28 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Ilse M.J. Kant, Jeroen de Bresser, Simone J.T. van Montfort, Arjen J.C. Slooter, Jeroen Hendrikse
      Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common in elderly patients. The aim of the present review was to explore the association of neurodegenerative and neurovascular changes with the occurrence of POD and POCD. Fifteen MRI studies were identified by combining multiple search terms for POD, POCD and brain imaging. These studies described a total of 1422 patients and were all observational in design. Neurodegenerative changes (global and regional brain volumes) did not show a consistent association with the occurrence of POD (four studies) or POCD (two studies). In contrast, neurovascular changes (white matter hyperintensities and cerebral infarcts) were more consistently associated with the occurrence of POD (seven studies) and POCD (five studies). In conclusion, neurovascular changes appear to be consistently associated with the occurrence of POD and POCD, and may identify patients at increased risk of these conditions. However, larger prospective studies are needed to study the consistency of these findings and to unravel the underlying pathophysiological mechanisms.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.016
       
  • Beyond the Buzz: The Maturing of Technology Use in Geriatric Psychiatry
    • Authors: Ipsit V. Vahia; Kerry J. Ressler
      Abstract: Publication date: Available online 28 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Ipsit V. Vahia, Kerry J. Ressler


      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.014
       
  • Acute Affective Reactivity and Quality of Life in Older Adults with
           Amnestic Mild Cognitive Impairment: a Functional MRI Study
    • Authors: Ping Ren; Kathi Heffner; Alanna Jacobs; Feng Lin
      Abstract: Publication date: Available online 27 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Ping Ren, Kathi Heffner, Alanna Jacobs, Feng Lin
      Objectives Poor quality of life (QoL) is a major concern among older adults with amnestic mild cognitive impairment (MCI). Maladaptive affective regulation and its relevant frontal dysfunction that are often observed in older adults with MCI may provide an insight into the understanding of their QoL. Methods In this case-controlled study, participants (MCI, n = 18; and healthy comparisons [HC], n = 21) completed cognitive tasks, and underwent resting-state functional magnetic resonance imaging (rs-fMRI) immediately before and after the tasks. The amplitude of low-frequency fluctuations (ALFF) of rs-fMRI signals was calculated to examine the brain's spontaneous activity. The change in valence from the Self-Assessment Manikin indexed affective reactivity. QoL was assessed using Quality of Life-AD measure. Multiple mediator model was used to examine the mediating effect of frontal regions' ALFF reactivity between the affective reactivity and QoL. Results The MCI group had significantly worse QoL and more negative affective reactivity than HC group. Less negative affective reactivity was significantly associated with better QoL in MCI not HC. ALFF in the anterior cingulate cortex, medial prefrontal cortex (MPFC), and superior frontal gyrus (SFG) increased significantly less after cognitive tasks in MCI than HC. For the entire sample, greater increases of ALFF in MPFC and SFG were significantly associated with better QoL; and SFG alone significantly mediated the association between affective reactivity and QoL. Conclusions Enhancing SFG activation, especially among those with MCI, may provide a therapeutic target for addressing the negative impact of maladaptive affective regulation on QoL.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.019
       
  • Anxious Depression and Neurocognition among Middle-Aged and Older
           Hispanic/Latino Adults: Hispanic Community Health Study/Study of Latinos
           (HCHS/SOL) Results
    • Authors: Alvaro Camacho; Wassim Tarraf; Daniel E. Jimenez; Linda C. Gallo; Patricia Gonzalez; Robert C. Kaplan; Melissa Lamar; Tasneem Khambaty; Bharat Thyagarajan; Krista M. Perreira; Rosalba Hernandez; Jianwen Cai; Martha L. Daviglus; Sylvia Wassertheil-Smoller; Hector M. González
      Abstract: Publication date: Available online 6 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Alvaro Camacho, Wassim Tarraf, Daniel E. Jimenez, Linda C. Gallo, Patricia Gonzalez, Robert C. Kaplan, Melissa Lamar, Tasneem Khambaty, Bharat Thyagarajan, Krista M. Perreira, Rosalba Hernandez, Jianwen Cai, Martha L. Daviglus, Sylvia Wassertheil-Smoller, Hector M. González
      Objective The purpose of this study is to examine the association between verbal learning, fluency, and processing speed with anxious depression symptomatology (ADS) among diverse Hispanics. We hypothesized an inverse association of anxious depression with neurocognition among Hispanics of different heritage. Design Data are from the Hispanic Community Health Study/Study of Latinos. The sample included 9,311participants aged 45–74 years (mean: 56.5 years). A latent class analysis of items from the Center for Epidemiological Studies for Depression scale and the Spielberger Trait Anxiety Inventory was used to derive an anxious depression construct. Neurocognitive measures included scores on the Brief Spanish English Verbal Learning Test (B-SEVLT, learning and recall trials), Word Fluency (WF), Digit Symbol Substitution (DSS) test, and a Global Cognitive Score (GCS). We fit survey linear regression models to test the associations between anxious depression symptomatology and cognitive function. We tested for effect modification by sex, Hispanic heritage, and age groups. Results Among men, 71.6% reported low, 23.3% moderate, and 5.1% high ADS. Among women, 55.1% reported low, 33.2% moderate, and 11.8% high ADS. After controlling for age, sex, sociodemographic characteristics, cardiovascular risk factors and disease, and antidepressant use, we found significant inverse associations between moderate and high anxious depression (ref:low) with B-SEVLT learning and recall, DSS and GCS. Moderate, but not high, anxious depression was inversely associated with WF. Associations were not modified by sex, Hispanic heritage, or age. Conclusions Increased anxious depression symptomatology is associated with decreased neurocognitive function among Hispanics. Longitudinal studies are needed to establish temporality and infer if negative emotional symptoms precede cognitive deficits.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.002
       
  • White Matter Lesions are Associated with Specific Depressive Symptom
           Trajectories among Incident Depression and Dementia Populations:
           Three-City Dijon MRI Study
    • Authors: Phillip J. Tully; Stephanie Debette; Bernard Mazoyer; Christophe Tzourio
      Abstract: Publication date: Available online 6 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Phillip J. Tully, Stephanie Debette, Bernard Mazoyer, Christophe Tzourio
      Objective Evidence is mixed as to whether periventricular or deep white matter hyperintensities (WMHs) increase the risk for depressive symptoms, partly because of heterogeneity in depression measurement, short follow-up, and confounding by prodromal dementia. The study objective was to evaluate WMH volume in relation to discrete depressive symptoms over 10 years, stratifying by incident depression and dementia. Methods In this prospective longitudinal cohort study of a representative population sample from Dijon, France, 1,440 participants aged 65–80 years (median age: 72 years; 59.5% women) without depression, dementia, or stroke at baseline were studied. Baseline T2-weighted images were obtained in a 1.5-T scanner to quantify WMHs (log cm3). Clinic visits were performed up to five times in a 10-year period to assess incident neurologic diseases and comorbidities. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale and converted to factor z scores, representing somatic symptoms, depressed affect, low positive affect, and interpersonal problems. Results Periventricular WMH volume was uniquely associated with low positive affect among incident depression cases (β = 0.15; 95% confidence interval [CI]: 0.02–0.29; p = 0.026). Deep WMH volume was uniquely associated with depressed affect among incident dementia cases (β = 0.36; 95% CI: 0.05–0.68; p = 0.025). WMH volume (periventricular, deep, and total) was associated with interpersonal problems among persons who developed dementia with depression. Conclusion The findings highlight that regional WMH volumes and specific depressive symptoms have clinical and prognostic relevance to help differentiate between persons at risk for depression and dementia.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.06.003
       
  • Additive Role of a Potentially Reversible Cognitive Frailty Model and
           Inflammatory State on the Risk of Disability: The Italian Longitudinal
           Study on Aging
    • Authors: Vincenzo Solfrizzi; Emanuele Scafato; Madia Lozupone; Davide Seripa; Michele Giannini; Rodolfo Sardone; Caterina Bonfiglio; Daniela I. Abbrescia; Lucia Galluzzo; Claudia Gandin; Marzia Baldereschi; Antonio Di Carlo; Domenico Inzitari; Antonio Daniele; Carlo Sabbà; Giancarlo Logroscino; Francesco Panza; E. Scafato; G. Farchi; L. Galluzzo; C. Gandin; A. Capurso; F. Panza; V. Solfrizzi; V. Lepore; P. Livrea; L. Motta; G. Carnazzo; M. Motta; P. Bentivegna; S. Bonaiuto; G. Cruciani; D. Postacchini; D. Inzitari; L. Amaducci; A. Di Carlo; M. Baldereschi; C. Gandolfo; M. Conti; N. Canal; M. Franceschi; G. Scarlato; L. Candelise; E. Scapini; F. Rengo; P. Abete; F. Cacciatore; G. Enzi; L. Battistin; G. Sergi; G. Crepaldi; S. Maggi; N. Minicucci; M. Noale; F. Grigoletto; E. Perissinotto; P. Carbonin
      Abstract: Publication date: Available online 6 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Vincenzo Solfrizzi, Emanuele Scafato, Madia Lozupone, Davide Seripa, Michele Giannini, Rodolfo Sardone, Caterina Bonfiglio, Daniela I. Abbrescia, Lucia Galluzzo, Claudia Gandin, Marzia Baldereschi, Antonio Di Carlo, Domenico Inzitari, Antonio Daniele, Carlo Sabbà, Giancarlo Logroscino, Francesco Panza
      Objective Cognitive frailty is a condition recently defined by operationalized criteria describing the simultaneous presence of physical frailty and mild cognitive impairment (MCI). Two subtypes for this clinical construct have been proposed: “potentially reversible” cognitive frailty (physical frailty plus MCI) and “reversible” cognitive frailty (physical frailty plus pre-MCI subjective cognitive decline). Here the prevalence of a potentially reversible cognitive frailty model was estimated. It was also evaluated if introducing a diagnosis of MCI in older subjects with physical frailty could have an additive role on the risk of dementia, disability, and all-cause mortality in comparison with frailty state or MCI condition alone, with analyses separately performed for inflammatory state. Methods In 2,373 individuals from the population-based Italian Longitudinal Study on Aging with a 3.5-year-follow-up, we operationally categorized older individuals without dementia into four groups: non-frail/non-MCI, non-frail/MCI, frail/non-MCI, and frail/MCI. Results The prevalence of potentially reversible cognitive frailty was 1%, increasing with age and more represented in women than in men, and all groups were associated with significant increased incident rate ratios of dementia, disability, and mortality. A significant difference in rates of disability has been found between the MCI and non-MCI groups (contrasts of adjusted predictions: 0.461; 95% confidence interval: 0.187–0.735) in frail individuals with high inflammatory states (fibrinogen >339 mg/dL). Conclusion In older individuals without dementia and with elevated inflammation, a potentially reversible cognitive frailty model could have a significant additional predictive effect on the risk of disability than the single conditions of frailty or MCI.

      PubDate: 2017-07-12T08:49:08Z
      DOI: 10.1016/j.jagp.2017.05.018
       
  • Risk of Motor Vehicle Collision and Driving Impairment with Dementia:
           Clinical Implications
    • Authors: C. Dan Allison; Amy Lane
      Abstract: Publication date: Available online 19 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): C. Dan Allison, Amy Lane


      PubDate: 2017-06-23T07:34:14Z
      DOI: 10.1016/j.jagp.2017.06.010
       
  • Whistling Past the Graveyard
    • Authors: David L. Coulter
      Abstract: Publication date: Available online 19 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): David L. Coulter


      PubDate: 2017-06-23T07:34:14Z
      DOI: 10.1016/j.jagp.2017.06.013
       
  • Depressive Symptoms in Recipients of Home- and Community-Based Services in
           the United States: Are Older Adults Receiving the Care They Need'
    • Authors: Renee Pepin; Amanda Leggett; Amanda Sonnega; Shervin Assari
      Abstract: Publication date: Available online 19 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Renee Pepin, Amanda Leggett, Amanda Sonnega, Shervin Assari
      Objective To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the U.S. Methods Participants included 5,582 adults aged 60 and over from the 2010-2012 waves of the nationally representative Health and Retirement Study (HRS). Weighted bivariate analyses were used to examine the frequency of depressive symptoms (CES-D) and psychiatric treatment among HCBS recipients compared to non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use. Results HCBS recipients had a higher frequency of depressive symptoms compared to non-recipients (27.5% vs 10.4%). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5%). HCBS recipients with depressive symptoms were no more likely than non-recipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors. Conclusions Depressive symptoms are more frequent among HCBS recipients compared to non-recipients, however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions.

      PubDate: 2017-06-23T07:34:14Z
      DOI: 10.1016/j.jagp.2017.05.021
       
  • Information for Subscribers
    • Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7


      PubDate: 2017-06-17T07:23:53Z
       
  • In This Issue
    • Abstract: Publication date: July 2017
      Source:The American Journal of Geriatric Psychiatry, Volume 25, Issue 7


      PubDate: 2017-06-17T07:23:53Z
       
  • Apathy Mediates Cognitive Difficulties in Geriatric Depression
    • Authors: Cynthia M. Funes; Helen Lavretsky; Linda Ercoli; Natalie St. Cyr; Prabha Siddarth
      Abstract: Publication date: Available online 16 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Cynthia M. Funes, Helen Lavretsky, Linda Ercoli, Natalie St. Cyr, Prabha Siddarth
      Objective Cognitive impairment associated with late-life depression can persist after remission of mood symptoms. Apathy, a common symptom of late-life depression, often leads to worse clinical outcomes. We examined if severity of apathy mediates cognitive difficulties in a cohort of older adults with major depression. Methods One hundred and thirty-eight older adults with depression (54.4% female; mean age=69.7(7.4) years; mean education=15.6(2.7) years) were recruited to participate in a treatment study, and only baseline data were analyzed. All participants received a comprehensive evaluation of depression, apathy, and cognition. We examined whether apathy mediated the relationship between depression and cognition, focusing our attention on memory and cognitive control. We then explored whether the mediation effects differed across females and males. Results Increased apathy was significantly associated with worse depression and lower performance in the cognitive control domain but not in memory. Higher depressive scores were significantly associated with worse cognitive control but not memory. Mediation analyses revealed a significant indirect effect on cognitive control by depression through increased apathy scores with the mediator accounting for 21% of the total effect. Stratifying by sex, we found that females exhibited a significant indirect effect, with the mediator accounting for 47% of the total effect, while there was no mediation by apathy in males. Conclusion The findings imply that increased apathy mediates the relationship between cognition and depression. The identification of mediating effects may inform future treatment strategies and preventive interventions that can focus on decreasing apathy to improve cognition in late-life depression.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.06.012
       
  • Depression among Older Adults: a 20-Year Update on Five Common Myths and
           Misconceptions
    • Authors: Emily A.P. Haigh; Olivia E. Bogucki; Sandra T. Sigmon; Dan G. Blazer
      Abstract: Publication date: Available online 16 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Emily A.P. Haigh, Olivia E. Bogucki, Sandra T. Sigmon, Dan G. Blazer
      Is depression among older adults symptomatically different than younger adults' Is it more common or chronic or difficult to treat' Is depression in late life more likely to be attributed to psychological problems' Twenty-years ago, Dan Blazer1, a pioneer known for his groundbreaking work on depression in older adulthood2 conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggest that when compared to their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. While some studies have suggested that depression in late-life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults; however, evidence suggests that antidepressants are less efficacious in late-life. Finally, compared to middle aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.06.011
       
  • 6/7/17 Lessons From the Lives of Celebrated Musicians: What Armstrong,
           Cash, Dylan, Ellington, Fitzgerald, and Sinatra Can Teach Us About
           Creative Resilience and Aging
    • Authors: Jeffrey M. Lyness
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Jeffrey M. Lyness
      For a decade the author has delivered presentations using techniques from the humanities, principally biography, to elucidate themes of creative resilience and aging in the lives of well-known musicians, illustrated with excerpted images, audio clips, and videos. The goal has been to stimulate discussions about the potential for creative growth in later years, even in the face of the professional and personal setbacks inevitable in the course of life, with implications for clinical work with older adults and for ourselves as we age. This summary describes key ‘take-home’ points that have recurred across these varied artists' stories and the interactions they have sparked with audiences and colleagues.

      PubDate: 2017-06-17T07:23:53Z
      DOI: 10.1016/j.jagp.2017.06.009
       
  • Personality and Survival in Older Age: the Role of Lifestyle Behaviors and
           Health Status
    • Authors: Debora Rizzuto; Enrico Mossello; Laura Fratiglioni; Giola Santoni; Hui-Xin Wang
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Debora Rizzuto, Enrico Mossello, Laura Fratiglioni, Giola Santoni, Hui-Xin Wang
      Objective We intended to assess the relationship between personality and survival in an older population and to explore the role of lifestyle behaviors and health status as potential mediators. Design Population-based cohort study. Setting Swedish National study of Aging and Care in Kungsholmen, Sweden. Participants 2298 adults aged 60 or more years, without dementia or depression, followed for 11 years. Measurements Personality (extraversion, neuroticism, and openness) was assessed with a shortened version of the NEO-Five Factor Inventory. We tested whether personality affected mortality and examined the potential mediating effect of health status (body mass index, number of chronic diseases, impairment in instrumental activities of daily living, and C-reactive protein) and lifestyle behaviors (leisure activities, social network, smoking, and alcohol consumption). Results Over 11 years of follow-up, higher levels of extraversion were associated with a 14% reduction in mortality. Examination of different combinations of personality traits showed that independent of levels of neuroticism and openness, high extraversion was associated with up to 65% lower mortality. Decomposing the effect of extraversion on mortality, we found that the majority (44%) of the beneficial effect was mediated by healthy lifestyle behaviors. Health status accounted for 5% of the association. Conclusion Extroverted people, who are characterized by higher optimism and high self-efficacy, are prone to healthier behaviors and better health, which may result in longer survival. These results highlight the importance of a healthy lifestyle in survival.

      PubDate: 2017-06-13T07:13:10Z
      DOI: 10.1016/j.jagp.2017.06.008
       
  • When Did Old Age Stop Being Depressing? Depression Trajectories of Older
           Americans and Britons 2002-2012
    • Authors: Gindo Tampubolon; Asri Maharani
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Gindo Tampubolon, Asri Maharani
      Objective This study aims to investigate the implications of the heterogeneous cohort composition on depression trajectories of older adults in the United States and England. Design Growth curve models were employed to identify depressive symptom trajectories. Setting Data spanning six waves over ten years (2002-2012) were drawn from the U.S. Health Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA). Participants Community-dwelling Americans and Britons aged 50 years and older. Measurement Depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression Scale (CES-D). Results The sample included 11,919 respondents (7,095 [59.53%] women) in the U.S. and 10,606 respondents (5,802 [54.7%] women) in England aged 50 and older. Older cohorts were shown to have higher depressive symptoms than younger cohorts in the U.S. and England. The trajectories of depression of older cohorts, particularly those of the pre-war cohorts in both countries and the war cohort in England, followed a U-shape. Differently, the trajectories of depression of younger cohort, particularly those of the post-war cohorts in both countries and the war cohort in the U.S., took an inverted U-shape. Conclusions The trajectories of depression in later life between cohorts took different shapes. This finding may lead to the development of more cost-effective policies for treating depression in later life.

      PubDate: 2017-06-13T07:13:10Z
      DOI: 10.1016/j.jagp.2017.06.006
       
  • The Validity and Usefulness of the Hospital Anxiety and Depression Scale
           in Carers of People with Dementia: Evidence From Confirmatory Factor
           Analysis, Concurrent Validity and Measurement Invariance in a Large Sample
           
    • Authors: Joshua Stot; Martin Orrell; Georgina Charlesworth
      Abstract: Publication date: Available online 7 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Joshua Stot, Martin Orrell, Georgina Charlesworth
      Objectives The Hospital Anxiety and Depression Scale (HADS) is a self-report measure of anxiety and depression. It is recommended for clinical assessment and has been used as the primary outcome in large clinical trials with carers of people with dementia. Its validity and utility have never been examined in this population. The current study addresses this. Design Secondary data analysis of baseline data from a recent intervention trial (N = 284) with cross-validation in baseline data from a second trial (N=230). Methods We used confirmatory Factor Analysis to test whether a one, two or three factor structure best fit the data and used indices of model misspecification to re-specify. We assessed internal consistency, concurrent validity of obtained factors and measurement invariance across gender, age, kinship and cohabitation status. Results A three-factor structure best fit the data. Removal of one item improved model fit. The factors showed good internal consistency and high levels of concurrent validity. Measurement invariance was adequate across gender and kinship, but not age or cohabitation status. Results were replicated in the cross-validation sample, enhancing reliability. Conclusions In this group, the HADS measures three factors; depression, anxiety and negative affectivity. The depression scale can be used as originally intended, supporting results of large clinical trials. The HADS does not validly measure distress or anxiety. Consequently, clinical practice recommendations could be revisited and future research trials should not use HADS anxiety or distress as outcomes. Researchers should pay attention to measurement invariance when using HADS to compare carer subgroups

      PubDate: 2017-06-08T06:51:19Z
      DOI: 10.1016/j.jagp.2017.05.017
       
  • Self- Versus Caregiver-Rated Health for Patients with Mild Dementia as
           Predictors of Patient Mortality
    • Authors: Thien Kieu Thi Phung; Volkert Siersma; Asmus Vogel; Frans Boch Waldorff; Gunhild Waldemar
      Abstract: Publication date: Available online 7 June 2017
      Source:The American Journal of Geriatric Psychiatry
      Author(s): Thien Kieu Thi Phung, Volkert Siersma, Asmus Vogel, Frans Boch Waldorff, Gunhild Waldemar
      Objectives Self assessment of health is a strong and independent predictor of mortality for cognitively intact people. As the ability of patients with dementia to rate their own health is questionable, caregiver-rated health for the patients may serve as a proxy. We aimed to validate and compare self- and caregiver-rated health for the patients with dementia as independent predictors of patient mortality. Design Post-hoc analysis of data from The Danish Alzheimer's Disease Intervention Study, a randomized controlled trial of psychosocial intervention for patients with mild dementia and their caregivers with a 36-month follow-up. Setting Multi-centered study in Denmark. Participants 330 patients with mild dementia and their caregivers Measurements Patients and caregivers rated patients' health on the Euro Quality of Life Visual Analog Scale (EQ-VAS) from 0 (worst) to 100 (best). The ability of self- and caregiver-rated health for the patient to predict patient mortality was analyzed as hazard ratios (HR) from Cox proportional hazard regression models, controlling for age, depression, co-morbidities, functional level, quality of life, and randomization group. Results . Compared to the highest scores 80-100, caregiver-rated EQ-VAS scores <50 had a HR of 9.8 (95% CI 2.9 to 33.1), scores between 50-64 had a HR of 3.8 (95% CI 1.2 to 12.3), and scores between 65-79 had a HR of 4.6 (95% CI 1.4 to 14.7). Self-rated EQ-VAS did not statistically significantly predict mortality. Conclusions Caregiver-rated health for the patients with mild dementia using EQ-VAS was shown to be an independent predictor of patient mortality with a dose-response pattern while patient-rated EQ-VAS was not.

      PubDate: 2017-06-08T06:51:19Z
      DOI: 10.1016/j.jagp.2017.06.005
       
 
 
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