The latest medical research on Geriatric Psychiatry
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about geriatric psychiatry gathered by our medical AI research bot.
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Request AccessCentiloid recommendations for clinical context-of-use from the AMYPAD consortium.
Alzheimers & DementiaAmyloid-PET quantification through the tracer-independent Centiloid (CL) scale has emerged as an essential tool for the accurate measurement of amy...
Comparative Post-Marketing Surveillance of Memantine and Cholinesterase Inhibitors: Cardiovascular Adverse Events With a Focus on Sex Differences Using the FDA Adverse Event Reporting System Database.
International Journal of EpidemiologyThe aim of this study was to conduct a comparative analysis of the proportion of cardiovascular adverse events (AEs) associated with the utilization of memantine and cholinesterase inhibitors and to highlight the potential impact of sex differences in these AEs.
Cardiac and vascular disorders AEs with antidementia medications were obtained from the FDA Adverse Event Reporting System database. The reporting odds ratio and its corresponding 95% confidence intervals were calculated. The chi-squared test was used to evaluate differences in categorical variables, and a two-way ANOVA followed by a Bonferroni post-test was used to compare the AEs reported for antidementia medications.
Memantine was associated with 544 selected cardiac and vascular disorder AEs. A signal for bradycardia, myocardial infarction, atrial fibrillation and cardiac arrest has been observed in patients receiving choline esterase inhibitors compared to those receiving memantine. On the other hand, cardiac failure and deep vein thrombosis AEs were found to be more common in patients receiving memantine. The majority of reported cardiac and vascular AEs were reported more frequently in female patients. More cases of cardiac failure, cardiac arrest, and deep vein thrombosis were reported in females than males taking memantine, but bradycardia was more common in males than females.
Healthcare professionals should be aware of the potential for cardiovascular AEs during treatment with antidementia medications and the possibility of sex differences in this regard. Memantine differs from cholinesterase inhibitors in terms of cardiovascular AEs, and there may be sex-related differences in the proportion of these AEs.
THE ASSOCIATION OF IMPAIRED VIBRATION SENSATION IN THE LOWER LIMB WITH TESTS OF COGNITION IN OLDER PEOPLE The Cardiovascular Health Study.
Dementia and Geriatric Cognitive DisordersThe prevalence of peripheral neuropathy (PN) in the lower limb increases with age and with the presence of diabetes. Studies show an association of PN with advanced cognitive impairment. Here we examine the association of PN with measures of early cognitive deficits in a cohort of older adults without apparent cognitive impairment, with or without diabetes.
A total of 2798 participants from the Cardiovascular Health Study were examined, mean age 80 years. All underwent tests of overall cognition (3MSE), executive function (DSST), and visual memory (BVRT). Impairment of vibration sensation in the toes, ankles, and tibial tuberosities was ascertained. Participants were graded according to the extent of impairment. Adjusted linear regression analyses of the extent of impaired vibration sensation with cognitive tests were performed. Results were further categorized by presence or absence of diabetes.
70% of participants had intact vibration sensation in the toes; 8% had no vibration sensation in the tibial tuberosities or below. Compared to participants with intact vibration sensation in the toes, those with no vibration sensation in the tibial tuberosities had lower 3MSE scores. Tests of executive function were lower in a stepwise manner with greater impaired vibration sensation. Visual memory was less strongly associated with impaired vibration sensation. Findings did not differ significantly by diabetes status.
In older adults, impaired vibration sensation in the lower limb is associated with impaired executive function and visual memory. These findings did not differ by diabetes status.
The Association Between Bilingual Animal Naming and Memory Among Bilingual Mexican American Older Adults.
Journal of Geriatric OncologyMonolingual cognitive assessments are standard for bilinguals; the value of bilingual assessment is unknown. Since declines in animal naming accompany memory declines in dementia, we examined the association between bilingual animal naming and memory among bilingual Mexican American (MA) older adults.
Bilingual MA (n = 155) completed the Harmonized Cognitive Assessment Protocol (HCAP) in a Texas community study. Regressions included HCAP memory score (English) as the outcome and English and Spanish animal naming trials as independent variables; demographics and language dominance were covariates.
English animal naming (b = 0.06, P = 0.004) was more reliably associated with memory than Spanish (b = 0.05, P = 0.06). Considered together, only English (b = 0.05, P = 0.02) was associated with memory, not Spanish (b = 0.01, P = 0.63). Conclusions: Spanish animal naming did not uniquely add to English animal naming in its association with memory among bilingual older MA.
Association of precuneus Aβ burden with default mode network function.
Alzheimers & DementiaIt remains unclear whether the local amyloid-beta (Aβ) burden in key regions within the default mode network (DMN) affects network and cognitive functions.
Participants included 1002 individuals from the Chinese Preclinical Alzheimer's Disease Study cohort who underwent 18F-florbetapir positron emission tomography resting-state functional magnetic resonance imaging scanning and neuropsychological tests. The correlations between precuneus (PRC) Aβ burden, DMN function, and cognitive function were investigated.
In individuals with high PRC Aβ burden, there is a bidirectional relationship between DMN local function or functional connectivity and PRC Aβ deposition across various cognitive states, which is also linked to cognitive function. Even below the PRC Aβ threshold, DMN function remains related to PRC Aβ deposition and cognitive performance.
Precuneus (PRC) Aβ burden impacts DMN function in different cognitive stages. High PRC Aβ burden is linked to early neural compensation and subsequent dysfunction. Low PRC Aβ burden correlates with neural changes before significant Aβ accumulation. Changes in DMN function and connectivity provide insights into AD progression. Early detection of regional Aβ burden can help monitor the risk of cognitive decline.
Neighborhood physical activity facilities predict risk of incident mixed and vascular dementia: The Cardiovascular Health Cognition Study.
Alzheimers & DementiaNeighborhood environments may promote neurocognitive health in part by providing amenities that encourage physical activity. We examined associations between quantity of walkable facilities, including specifically physical activity facilities (e.g., gyms, recreation centers), with risk of incident dementia.
Participants included 2923 adults ≥ 65 years old from the Cardiovascular Health Cognition Study (1992-1999), with clinically adjudicated dementia classified over a median 6.0 years of follow-up. Walkable facilities were measured within 1 km (Euclidean) of home. Self-reported baseline physical activity was considered a moderator.
In adjusted Cox models, participants with ≥ 2 (vs. 0) physical activity facilities had reduced risk of mixed/vascular dementia, but not Alzheimer's disease, particularly after excluding individuals in the bottom 20th percentile of physical activity (hazard ratio = 0.56, 95% confidence interval: 0.35-0.89).
We examined associations between nearby walkable facilities and incident dementia. Facilities within 1 km were counted via the National Establishment Time Series Database. More physical activity facilities predicted lower risk of mixed/vascular dementia. No associations were found between walkable facilities and incident Alzheimer's disease.
Visual read of [F-18]florquinitau PET that includes and extends beyond the mesial temporal lobe is associated with increased plasma pTau217 and cognitive decline in a cohort that is enriched with risk for Alzheimer's disease.
Alzheimers & DementiaPatterns of signal from tau positron emission tomography (tau-PET) confined to the medial temporal lobe (MTL) or extended into the neocortex may be relevant for Alzheimer's disease (AD) research if they are linked to differential biomarker levels and cognitive decline.
Visual assessment of Tau-PET [F-18]florquinitau (FQT) exams from 728 initially non-demented older adults yielded four uptake groups: tau-negative (T-), MTL-only (T+MTL), neocortex-only (T+Neo), or both (T+MTL&Neo). Mixed effects models assessed group differences in retrospective cognitive and plasma pTau217 trajectories.
T+MTL&Neo was the most common T+ group (n = 97; 93% A+) and exhibited the sharpest worsening in cognitive and pTau217 trajectories before tau PET.
Visual assessments of Tau-PET FQT revealed four distinct uptake groups: tau-negative (T-), MTL-only (T+MTL), neocortex-only (T+Neo), or both (T+MTL&Neo). Amyloid positive participants in the T+MTL and T+MTL&Neo categories showed a retrospectively faster decline in their cognitive trajectories, and a sharper increase in pTau217 levels in plasma, compared to T-. The T+MTL&Neo group displayed sharper trajectories compared with the other Tau positive groups in both their cognitive scores and pTau217 plasma levels. Our results suggest that participants with Tau present in both MTL and neocortex represent an intermediate to advanced stage of AD, whereas participants with signals confined to either MTL or neocortex could represent earlier AD stages.
Conversion to Alzheimer's disease dementia from normal cognition directly or with the intermediate mild cognitive impairment stage.
Alzheimers & DementiaProgression to Alzheimer's disease (AD) dementia from normal cognition (NC) can follow different trajectories, with most progressing through a recognizable mild cognitive impairment stage (NC-MCI-AD), while some individuals transition quickly from NC to AD dementia (NC-AD).
We compared demographic characteristics, health factors, and cognitive and functional assessments across three time points: the first NC visit, the last NC visit, and the first AD dementia visit.
The NC-MCI-AD group showed greater impairment in cognitive and functional scores at AD dementia diagnosis, despite maintaining better cognitive function during the NC stage. Analysis of yearly changes revealed negligible differences during NC. However, the yearly change during the AD dementia stage suggested potentially more rapid functional decline in the NC-AD group.
We investigated the disease progression difference between patients who converted to Alzheimer's disease (AD) dementia from normal cognition (NC) directly or through the mild cognitive impairment (MCI) stage. We found that the NC-MCI-AD group showed greater impairment in cognitive and functional scores at AD dementia diagnosis. We discovered that the NC-AD group had rapid functional decline once patients were confirmed with AD onset.
Plasma p-tau181 and GFAP reflect 7T MR-derived changes in Alzheimer's disease: A longitudinal study of structural and functional MRI and MRS.
Alzheimers & DementiaAssociations between longitudinal changes of plasma biomarkers and cerebral magnetic resonance (MR)-derived measurements in Alzheimer's disease (AD) remain unclear.
In a study population (n = 127) of healthy older adults and patients within the AD continuum, we examined associations between longitudinal plasma amyloid beta 42/40 ratio, tau phosphorylated at threonine 181 (p-tau181), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and 7T structural and functional MR imaging and spectroscopy using linear mixed models.
Increases in both p-tau181 and GFAP showed the strongest associations to 7T MR-derived measurements, particularly with decreasing parietal cortical thickness, decreasing connectivity of the salience network, and increasing neuroinflammation as determined by MR spectroscopy (MRS) myo-inositol.
This study leverages high-resolution 7T magnetic resonance (MR) imaging and MR spectroscopy (MRS) for Alzheimer's disease (AD) plasma biomarker insights. Tau phosphorylated at threonine 181 (p-tau181) and glial fibrillary acidic protein (GFAP) showed the largest changes over time, particularly in the AD group. p-tau181 and GFAP are robust in reflecting 7T MR-based changes in AD. The strongest associations were for frontal/parietal MR changes and MRS neuroinflammation.
The pathogenicity of PSEN2 variants is tied to Aβ production and homology to PSEN1.
Alzheimers & DementiaThough recognized as a potential cause of autosomal dominant Alzheimer's disease, the pathogenicity of many PSEN2 variants remains uncertain. We compared amyloid beta (Aβ) production across all missense PSEN2 variants in the AlzForum database and, when possible, to corresponding PSEN1 variants.
We expressed 74 PSEN2 variants, 21 of which had known, homologous PSEN1 pathogenic variants with the same amino acid substitution, in HEK293 cells lacking presenilin 1/2. Aβ production was compared to age at symptom onset (AAO) and between PSEN1/2 homologs.
Aβ42/40 and Aβ37/42 ratios correlated with AAO across all PSEN2 variants, strongly driven by the subset of PSEN2 variants with PSEN1 homologs. Aβ production across PSEN1/2 homologs was highly correlated. PSEN2 AAO correlated with AAO in PSEN1 homologs but was an average of 18.3 years later.
There were associations between the patterns of amyloid beta (Aβ) production across presenilin 2 (PSEN2) variants and age at symptom onset (AAO). PSEN2 variants for which there is a known, corresponding variant in presenilin 1 (PSEN1) are more likely to have abnormal Aβ production patterns that strongly correlate with AAO, compared to those that lack a known PSEN1 counterpart ("non-homologous PSEN2 variants"). Most PSEN2 variants lacking PSEN1 counterparts had Aβ42/40 ratios close to those of wild-type PSN2, arguing against their pathogenicity. Homologous PSEN1 and PSEN2 variants had correlated Aβ42/40 and Aβ37/42 ratios, indicating that the corresponding amino acid substitution in each presenilin may have largely similar biochemical effects on γ-secretase processivity.
Marmosets as model systems for the study of Alzheimer's disease and related dementias: Substantiation of physiological tau 3R and 4R isoform expression and phosphorylation.
Alzheimers & DementiaMarmosets spontaneously develop pathological hallmarks of Alzheimer's disease (AD) including amyloid beta plaques. However, tau expression in the marmoset brain has been understudied.
Isoforms of tau were examined by western blot, mass spectrometry, immunofluorescence, and immunohistochemical staining.
3R and 4R tau isoforms are expressed in marmoset brains at both the transcript and protein levels across ages. Mass spectrometry analysis revealed that tau peptides in marmoset corresponded to the 3R and 4R peptides in human brain, with 3R predominating at birth and an ≈40%:60% 3R:4R ratios in adolescents and adults; tau was distributed widely in neurons, with localization in the soma and synaptic regions. Phosphorylation residues were observed on Threonine (Thr) Thr181, Thr217, Thr231, Serine (Ser) Ser202/Thr205, and Ser396/Ser404.
Our results confirm both 3R and 4R tau isoform expression and phosphorylation residues in the marmoset brain, and emphasize the significance of marmosets with natural expression of AD-related hallmarks as important translational models for AD. Highlights We report comprehensive characterization of tau isoform expression in marmoset brains across the lifespan. 3R and 4R tau isoforms are expressed in marmoset brains at both the transcript and protein levels across ages. These data emphasize the significance of marmosets with natural expression of primate-specific traits that are important for the study of Alzheimer's disease.
Long-term effects of collaborative dementia care on quality of life and caregiver well-being.
Alzheimers & DementiaCollaborative dementia care models with care navigation, including the Care Ecosystem, improve outcomes for persons living with dementia (PLWDs) and their caregivers. The effects of continuous care over long periods have not been studied.
In this randomized clinical trial with 456 PLWD-caregiver dyads with high caregiver burden, we evaluated the cumulative 5-year treatment effect on PLWD quality of life, health care utilization, caregiver depression, self-efficacy, and burden.
Five-year participation was associated with higher quality of life, lower caregiver depression, and higher caregiver self-efficacy (all p's < 0.05) with a trend for lower burden (p = 0.07). Treatment effects were most robust during the first 2 years. The effects on emergency department visits and hospitalizations were not significant.
Collaborative dementia care with care navigation was evaluated over 5 years using a randomized clinical trial. The care was associated with better quality of life for the person with dementia and well-being for the caregiver. The most robust treatment effects were in the first 2 years.
