Journal of Geriatric Psychiatry and Neurology

Istradefylline, a selective adenosine A2A receptor antagonist, is used as an adjunct therapy to levodopa to improve motor symptoms in Parkinson’s disease (PD) patients, particularly those experiencing wearing-off phenomena. This study integrates safety data on istradefylline for the treatment of PD from randomized controlled trials (RCTs) and the FDA Adverse Event Reporting System (FAERS).

We performed a systematic search of PubMed, EMBASE, Ovid, MEDLINE, and ClinicalTrials.gov for RCTs on istradefylline safety in PD patients up to September 2024. A random-effects meta-analysis estimated the Peto odds ratio (OR) with 95% confidence intervals (CIs). FAERS data were analyzed through disproportionality measures, including the proportional reporting ratio (PRR) and reporting odds ratio (ROR), with signal refinement to primary suspect cases.

The safety meta-analysis, encompassing data from 8 RCTs, reveals a significant association between istradefylline treatment and an increased risk of dyskinesia (odds ratio [OR] 1.77, 95% CI 1.32-2.36; P = 0.01), hallucinations (OR 2.08, 95% CI 1.11-3.90; P = 0.02), and nausea, when compared with placebo. In the FAERS database, 2597 patients were identified with adverse events (AEs) linked to istradefylline. Disproportionality analysis of istradefylline revealed 39 AEs strongly associated with its use, all of which were substantiated through signal refinement. The most commonly reported AEs were primarily associated with nervous system and psychiatric disorders.

This study highlights distinct AE patterns for istradefylline in trials vs real-world data, underscoring the importance of post-marketing surveillance to detect underreported AEs and validate new safety signals effectively.

We aimed to evaluate the effects of 12 weeks of resistance training (RT) on cardiovascular disease (CVD) risk factors in older women with and without history of depression.

We included 79 older women, 52 without depression and 27 with a history of depression. 79 participants formed the waitlist control group and were instructed to maintain their habitual routine. The participants were reevaluated and attended 12 weeks of RT. The Beck Anxiety Inventory (BAI) and Patient Health Questionnaire-9 (PHQ-9). The serum levels of high-sensitivity C-reactive protein (CRP), glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density cholesterol (LDL-c), and triglycerides (TG) were used as cardiovascular risk factors. The Linear Mixed Model (LMM) was used to compare between groups.

The average age of the sample was 69.3 ± 5.7 and the body mass index was 28.5 ± 4.5. The 12 weeks of RT resulted in a reduction in BAI (−3.9 [-7.1; −0.6], P < 0.05) and PHQ-9 scores (−1.4 [-3.2; −0.5] P < 0.05) in the Training group with depressive disorders. In the training group with depressive disorders, it was observed an improvement in TG (−17.1 [-43.0; −8.8]), TC (−18.6 [-35.9; −1.3]), LDL-c (−10.3 [-26.8; −6.2]), and CRP (−0.4 [-1.3; −0.5]). Similar results were found for TG, TC, and LDL-c in the Training group without depressive symptoms. No difference between RT groups was observed.

Our results suggest that RT is effective in improving CVD risk factors, anxiety, and depressive symptoms in older women with history of depression.

Caregiving for people with dementia poses emotional, social, and ethical challenges, which are intensified by socio-cultural factors and limited external support.

This study explores the complex challenges, ethical dilemmas and socio-cultural factors, faced by informal caregivers of individuals with dementia in Albania, focusing on their experiences, views, and attitudes towards caregiving responsibilities and decision-making processes.

Qualitative research using interpretative phenomenological analysis, was conducted through in-depth, semi-structured interviews with 12 family caregivers.

Three main themes emerged: (1) The Heavy Burden of Family Caregiving; (2) Balancing Autonomy, Safety, Dignity, and Well-being and (3) Injustice in Care: The Plight of Dementia Caregivers in Albania.

This study underscores the necessity for systemic changes that prioritize the health and well-being of both caregivers and people with dementia highlighting the impact of cultural norms, family dynamics, and insufficient external support on caregivers.

Parkinson’s disease (PD) exerts a significant impact on mental well-being due to its disease process and associated social and economic consequences. Therefore, assessing the prevalence of poor mental well-being, identifying manifestations of mental illness, and examining context-specific determinants in sub-Saharan Africa are essential to informing current practices and future research. Findings from this study reveal that nearly three-fourths of individuals with PD experience poor mental well-being in Ethiopia. Additionally, they exhibit a range of psychiatric manifestations, including severe conditions such as hopelessness and suicidal ideation. PD-related stigma is an independent determinant of mental well-being. People with PD face significant stigma and discrimination, largely driven by societal misconceptions about the causes of the disease. Routine screening and treatment of mental disorders, alongside the integration of mental health care into routine PD management, are essential to addressing the mental health needs of individuals with PD. Community awareness initiatives on the causes of PD are critically needed to reduce stigma and promote mental well-being. Given the high burden of mental disorders and the impact of stigma and discrimination, mental health and psychosocial interventions should prioritize individuals with PD.

Subjective memory complaints (SMC) are common in older adults and may indicate an increased risk of cognitive decline. Polypharmacy and anticholinergic burden have been associated with cognitive impairment, but their specific contribution to SMC remains unclear. The aim of this study was to investigate the association between polypharmacy, anticholinergic burden and SMC in community-dwelling older adults.

This cross-sectional study included 652 participants aged 65 years and older from geriatric outpatient clinics. SMC was assessed via a structured clinician-administered question, and cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Polypharmacy was defined as the concomitant use of five or more medications, while anticholinergic burden was determined using the Anticholinergic Burden Classification (ABC). Logistic regression models were used to examine the independent effects of polypharmacy and anticholinergic burden on SMC, adjusting for demographic variables, comorbidities and depressive symptoms.

SMC was reported by 48% of participants. Polypharmacy (OR = 2.10, 95% CI: 1.43-3.08, P < 0.001) and higher anticholinergic burden (OR = 2.39, 95% CI: 1.72-3.32, P < 0.001) were independently associated with increased SMC. Chronic obstructive pulmonary disease (COPD) was also identified as a significant predictor (OR = 2.90, 95% CI: 1.41-5.98, P = 0.004).

Polypharmacy and anticholinergic burden are significant risk factors for SMC in older adults. Reducing unnecessary medication use and minimizing anticholinergic burden may help to alleviate cognitive complaints. Future longitudinal studies are needed to determine causal relationships and possible interventions.

Delirium is a common yet preventable complication of hospitalization, surgery and illness that is associated with poor outcomes. Older adults with Alzheimer’s Disease and Related Dementias (ADRD) are especially vulnerable to delirium and experience greater delirium severity, yet no existing assessment tool is specifically designed to evaluate this vulnerable population. This study will validate two new delirium severity instruments, the Delirium Severity (DEL-S) rating for all older adults and the Delirium Severity Rating in ADRD (DEL-S-AD) for patients with dementia.

The Better ASsessment of ILlness II (BASIL II) study is an innovative prospective cohort study that measures cognitive function, delirium, delirium severity, demographics, clinical and functional variables and clinical outcomes. Participants include older adults from 3 unique yet complementary clinical sites: medical inpatients, elective surgery inpatients, or skilled nursing facility residents.

Performance of DEL-S and DEL-S-AD items in older adults with cognition ranging from no impairment to moderate impairment will be determined. Analyses will include psychometric characteristics of DEL-S and DEL-S-AD items, harmonization of the two scales and validation against reference standard diagnoses.

Results from this study will help accurately measure delirium severity, a critically important, graded outcome. The DEL-S-AD instrument holds broad applications in persons with and without ADRD to monitor delirium severity in clinical settings, and as an outcome measure in future clinical treatment trials and pathophysiologic studies. Ultimately, the DEL-S and DEL-S-AD have the potential to improve health care for the vulnerable, growing population of older adults with cognitive impairment worldwide.

This study assessed the prevalence, characteristics, and contributing factors of violent behaviors in patients with frontotemporal dementia (FTD) as reported by their caregivers.

A nationwide survey was conducted in France targeting caregivers of FTD patients. The survey was disseminated online between July and September 2022 through the French FTD association communications channels. It collected data on the frequency, types and targets of violent behaviors, and associated behavioral and psychological symptoms of dementia (BPSD). Associations between violent behaviors, BPSD, and demographic factors were explored.

167 answers were analyzed. Violent behaviors were reported in 56.29% of patients with FTD, predominantly verbal (83.2%), often directed at caregivers (68.1%). Factors associated with violence included higher proxy NPI, delusions, agitation/aggression, and irritability scores. Violent behaviors were underreported, with only 48.8% of caregivers having disclosed them to health professionals.

Violent behaviors in patients suffering from FTD appear often underreported. Systematic screening during medical appointments is recommended to ensure early intervention and better management.