Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society最新文献

Older adults often experience rapid cognitive decline following hospitalization, especially those with severe illness and extended stays. Despite known links between increasing patient age and cognitive decline, 30% of older adults without major pre-existing conditions prior to medical admission show potential undiagnosed cognitive decline. This scoping review aims to map the prevalence, assessment methods, and associated factors of cognitive decline among hospitalized older adults. We conducted an exploratory review in accordance with the Joanna Briggs Institute (JBI) methodological framework and the PRISMA-ScR guidelines. The review targeted studies published between January 2018 and March 2025 in English or Spanish that reported in-hospital cognitive assessments in individuals aged 65 years and older. 'Cognitive decline' was operationally defined as performance below established cut-off scores on validated tools, such as the Mini-Mental State Examination (MMSE ≤ 23) or the Montreal Cognitive Assessment (MoCA < 26), administered during hospitalization. Databases consulted included PubMed, Web of Science, and ScienceDirect. A narrative synthesis was undertaken to organise findings by study design, cognitive instruments, prevalence rates, and associated factors. A total of thirty studies met the inclusion criteria. Most employed cross-sectional or prospective cohort designs, with wide variability in hospital settings, timing of assessments, and cognitive tools used. The reported prevalence of cognitive impairment ranged from 10% to 85%, depending on the assessment tools and population characteristics. MMSE and MoCA were the most frequently used tools. Associated factors included advanced age, comorbidities, pre-existing cognitive decline, and frailty. Methodological heterogeneity hindered meta-analysis, but it also revealed important limitations in the comparability of the studies. This review identifies substantial heterogeneity in the assessment and reporting of cognitive decline among hospitalized older adults. The findings highlight the need for standardized screening protocols and improved methodological consistency to optimise the detection, cross-study comparability, and clinical relevance of cognitive assessments in hospital settings.

Constipation is highly prevalent (30%-60%) in older adults taking atypical antipsychotics (AAPs), a rate insufficiently explained by anticholinergic effects alone. This paper proposes an integrated model centered on the impaired defecation reflex, which weakens with age and is further compromised by AAP-induced multi-neurotransmitter imbalance. AAPs interfere with the descending pain inhibitory pathway, disrupting the central dopamine (DA) and serotonin (5-HT) systems vital for initiating the defecation reflex via the sacral parasympathetic nuclei (SPN). Furthermore, enhanced GABAergic inhibition is implicated, potentially contributing to observed sex differences. This central impairment is compounded by gut dysbiosis-common in this population-which is hypothesized to damage neural circuits and weaken the reflex via the gut-brain axis. We advocate for a holistic management approach beyond traditional laxatives. Targeting the gut microbiota with specific butyrate-producing probiotics represents a novel, hypothesis-generating strategy. This intervention may restore central dopaminergic function, thereby strengthening the compromised defecation reflex. This integrated framework-addressing monoaminergic and gut microbiota mechanisms-provides a more complete understanding for future research and clinical strategies.

Background: This study aimed to evaluate Hasegawa Dementia Scale-Revised (HDS-R) cutoff scores that correspond to Mini-Mental State Examination (MMSE) thresholds for identifying candidates for anti-amyloid β (Aβ) therapies. Additionally, we conducted exploratory analyses to examine the cognitive subdomains associated with Aβ status.

Methods: This retrospective cross-sectional study included consecutive patients with amnesia who underwent neuropsychological examinations and Aβ assessment through cerebrospinal fluid analysis or positron emission tomography. Diagnostic accuracy for MMSE thresholds (≥ 20, ≥ 22 and ≥ 24) was assessed, and two HDS-R cutoffs (high-sensitivity, high-specificity) were determined for each threshold. We examined differences in cognitive subdomains between Aβ-positive and Aβ-negative patients with MMSE score ≥ 20.

Results: Of 234 patients, 143 (61.1%) were Aβ-positive. The area under the receiver operating characteristic curve for predicting MMSE score ≥ 20, ≥ 22 and ≥ 24 was 0.92, 0.90 and 0.91, respectively. High-sensitivity cutoffs, defined as scores that maximised specificity while maintaining sensitivity ≥ 80%, were HDS-R score ≥ 16, ≥ 17 and ≥ 18. Conversely, high-specificity cutoffs, defined as scores that maximised sensitivity while maintaining specificity ≥ 80%, were HDS-R score ≥ 19, ≥ 20 and ≥ 21, respectively. Subdomain analysis of MMSE and HDS-R showed Aβ-positive patients had lower scores in delayed recall and higher scores in calculation than Aβ-negative patients (all p < 0.01). In HDS-R subdomains, visual memory scores were also lower in Aβ-positive patients than in Aβ-negative patients (p < 0.01).

Conclusions: The identified HDS-R cutoff scores were associated with MMSE-defined cognitive thresholds and may serve as a potential reference for identifying patients who could be eligible for anti-Aβ therapies. The cognitive profile observed in Aβ-positive patients was characterised by deficits in delayed recall and in visual memory and by relatively preserved calculation ability, suggesting a selective vulnerability pattern in early Alzheimer's disease.

Background: Social participation in work-related activities can improve the mental well-being of individuals with dementia or mild cognitive impairment (MCI). However, research on the effects of work-related activities on the mental well-being of individuals with dementia or MCI is limited. This study aimed to investigate the influence of participation in work-related activities on mental well-being and the associated factors in individuals with dementia or MCI.

Methods: This was a multicentre cross-sectional study. We administered questionnaires and measurements to participants who were users of a day care service and had dementia or MCI. We used the World Health Organization-Five Well-Being Index (WHO-5) as the main outcome and its confounders. These data were compared between the work-related activity and usual care groups, and multiple regression analysis was performed with WHO-5 as the dependent variable and the presence or absence of participation in work-related activities and WHO-5 covariates as independent variables.

Results: A total of 128 participants were compared between the two groups. The work-related activity group exhibited better mental well-being (p < 0.001) than the usual care group. The same results were obtained after adjusting for the participants' backgrounds using propensity score matching. Multiple regression analysis identified participation in work-related activities (p < 0.001) and physical pain (p < 0.05) as factors that potentially influence mental well-being.

Conclusions: Participation in work-related activities positively influenced the mental well-being of individuals with dementia or MCI. Longitudinal studies are needed to investigate the effects of work-related activities on the mental well-being of individuals with dementia or MCI.

Background: Social restrictions during the novel coronavirus 2019 disease (COVID-19) pandemic negatively impacted the mental health of older adults. This study aimed to examine the associations of loneliness and depression with sociodemographic characteristics and internet use among older adults during the COVID-19 pandemic.

Methods: This cross-sectional study included 330 geriatric patients between September 1, 2021, and June 1, 2022. Data were collected through face-to-face interviews using a questionnaire consisting of a personal information form, the Loneliness Scale for Elderly, and the Geriatric Depression Scale Short Form-15 (GDS-15).

Results: The participants had a mean age of 71.3 years, 60.3% were female, and regarding internet use, 52.4% reported never using it, 18.8% used it occasionally, and 28.8% used it daily. The most common internet activities were video calls with relatives/friends (39.4%) and sharing messages, photos, or videos via messaging apps (38.2%). In the multivariate linear regression analysis, being married, having low income, living alone, having fewer than five friends, and not using the internet at all were significantly associated with higher levels of loneliness, while higher depression scores were observed among females compared to males and among individuals with low income compared to those with middle or high income.

Conclusions: The findings suggest that internet use may have a protective role against loneliness in older adults; however, its effect on reducing depression appears to be limited.

To critically appraise, compare and summarise the measurement properties of existing instruments that assess dementia fear among older adults (≥ 60 years). Structured searches in six English electronic databases and two Chinese databases. Additionally, ProQuest Dissertations and Theses, DART Europe, and Google Scholar were searched from their inception to August 2024. Two researchers independently identified eligible studies. They assessed the methodological quality of the studies (rated 'very good', 'adequate', 'doubtful' and 'inadequate') and quality of measurement properties (rated 'sufficient', 'insufficient' or 'indeterminate') using the COSMIN guidelines. Among the 4104 studies identified, eight studies reported on the psychometric properties of five identified patient-reported outcome measures. The methodological quality of content validity for relevance, comprehensiveness, and comprehensibility of all instruments in this review was doubtful or inadequate. The methodological quality of structural validity in the majority of the studies was adequate, whereas the quality of hypothesis testing for construct validity was doubtful. The internal consistency was assessed by calculating Cronbach's alpha coefficient in all studies. The measurement properties that were not conducted were measurement invariance, measurement error and responsiveness. This study suggests that existing research and evidence supporting the selection of dementia fear instruments suitable for older adults are insufficient. All included instruments have the potential to be recommended, whereas none of the identified dementia fear instruments for older adults appears to be generally superior to the others. Therefore, further research is needed to validate the measurement properties of existing dementia fear instruments for older adults, with a particular focus on content validity as guided by COSMIN.

The dopaminergic system may be at the base of some neurobehavioral symptoms, as apathy and depression, and extrapyramidal symptoms, often seen in Alzheimer's disease patients. It can also have an impact on cognitive decline, as extrapyramidal symptoms, classically linked with dopamine dysfunction, are associated with increased risk of cognitive impairment and Alzheimer's disease progression. We review the knowledge of the dopaminergic system, emphasizing changes in Alzheimer's disease. Both animal models, post-mortem and in vivo human studies, point to a dopaminergic system dysfunction in this disease. Dopamine dysfunction seems more associated with neuronal loss, modification of dopamine receptors and anomalies in terminal function, including irregularities in dopamine metabolism, than with neurofibrillary tangles or β-amyloid plaques depositions. This dysfunction has an impact on both cognitive and non-cognitive symptoms. A better understanding of the dopaminergic system may help in understanding the pathophysiology of Alzheimer's disease and assist in the diagnosis. Clinical trials aimed at modulating the dopaminergic system may be promising in the treatment of symptoms associated with Alzheimer's disease.

Objective: This study aimed to evaluate the nutritional status, perceived health, and adaptation to aging of older adults and to examine the relationships among these variables.

Methods: This descriptive, cross-sectional study included 386 older adults receiving care at the outpatient clinics of a public hospital in northeastern Turkey. Data were collected using a sociodemographic questionnaire, the Standardised Mini-Mental State Examination, the Mini Nutritional Assessment-Short Form (MNA-SF), the Perception of Health Scale, and the Assessment Scale of Adaptation Difficulty for the Elderly. Statistical analyses included independent samples t-tests, one-way ANOVA, Pearson correlation analysis, and path analysis.

Results: The mean MNA-SF score was 11.52 ± 1.96; the mean health perception score was 48.07 ± 5.53; and the mean adaptation difficulty score was 0.99 ± 0.04. Health perception significantly predicted adaptation difficulty in older adults. MNA-SF scores varied significantly by age, body mass index (BMI), marital status, place of residence, and regular medication use (p < 0.01). Similarly, health perception scores differed significantly based on age, BMI, place of residence, educational level, income status, and the presence of chronic disease (p < 0.05). Adaptation difficulty scores also showed significant variation by age (p < 0.001).

Conclusion: The findings revealed that 38.6% of participants were at risk of malnutrition, while 3.9% were malnourished. Although participants' overall health perception was moderate, their adaptation to aging was generally high. A more positive health perception was associated with better adaptation to aging. Targeted health and nutrition programs are recommended for high-risk groups, particularly older adults with lower socioeconomic status or those residing in rural areas.

Background: Increasing life expectancy will lead to more people living with dementia (PLwD) and, consequently, more caregivers experiencing burden. Caregivers burden is influenced by characteristics of both PLwD and caregivers themselves, as well as healthcare services organisation. The COVID-19 pandemic and lockdown measures implemented in Italy worsened PLwD and their caregivers' well-being. Recognising the importance of understanding the profiles and care needs of PLwD and their caregivers, a national survey was conducted within the Italian Fund for Alzheimer's and Dementias to investigate the sociodemographic characteristics of PLwD caregivers and their care recipients in Italy. This study aimed to describe the characteristics of Italian caregivers of PLwD, their use of services, and satisfaction with the latter.

Methods: A cross-sectional national survey was conducted. A self-administered questionnaire was developed consisting mainly of multiple-choice questions.

Results: A total of 2369 caregivers participated in the survey. Most of them resided in Northern Italy (60.1%), were females (73.4%) and care recipients' children (74.1%). Median diagnostic delay ranged from 7 to 36 months. Diagnosis was formulated mainly by a physician from a Centre for Cognitive Disorders and Dementia. Caregiver training was poorly reported (34.1%). PLwD clinical condition worsened during the pandemic. The mean degree of satisfaction with services dedicated to dementia was "acceptable". Negative/very negative degree of satisfaction was associated with not living in the North, increased caregiver's age, not having received training, severe degree of disease, having received the diagnosis suspicion from a private doctor, and not having used day care centres or Centres for Cognitive Disorders and Dementia.

Conclusions: Differences in the sociodemographic profile of caregivers and disparity in services across Italy emerged. The establishment of a comprehensive, accessible, and well-integrated network of services across all stages of the disease progression is needed.