STUDY:
Tachibana, A., Iga, Ji., Ozaki, T. et al. Behavioral and psychological symptoms and brain volumes in community-dwelling older persons from the Nakayama Study. Sci Rep 14, 26097 (2024). https://doi.org/10.1038/s41598-024-77477-5

This research paper describes a multicenter randomized controlled trial called The HOME Study, which investigated the effectiveness and cost-effectiveness of a novel approach to psychiatric care called Proactive Integrated Consultation-Liaison Psychiatry (PICLP) for older medical inpatients. The study compared PICLP to usual care, and although the findings did not show a statistically significant reduction in the time older patients spent in the hospital, there were hints that PICLP could be beneficial in increasing the discharge rate and potentially lowering mortality. Additionally, the study found that PICLP was likely to be cost-saving in the short term, suggesting that the positive experiences reported by patients and staff could be achieved without additional costs to the hospital.

STUDY:
Sharpe M, Walker J, van Niekerk M, Toynbee M, Magill N, Frost C, White IR, Walker S, Duarte A, Owens C, Dickens C. Proactive integrated consultation-liaison psychiatry and time spent in hospital by older medical inpatients in England (The HOME Study): a multicentre, parallel-group, randomised controlled trial. The Lancet Psychiatry. 2024 Sep 1;11(9):684-95.

This research investigates the relationship between changes in white matter microstructure and cognitive decline in individuals with major depressive disorder (MDD). The study follows a large cohort of participants with MDD and healthy controls over a two-year period, analyzing cognitive performance and white matter integrity using neuropsychological tests and diffusion-weighted imaging. The authors found that individuals with MDD showed a greater decline in white matter integrity in the superior longitudinal fasciculus, a brain region important for information processing, compared to healthy controls. Furthermore, the study found a robust association between cognitive decline and the decline in white matter integrity across all participants. While changes in white matter integrity did not mediate the relationship between disease course and cognitive performance, the authors suggest that this could be due to the relatively short follow-up period and the mild disease course in their sample. The study emphasizes the crucial role of white matter microstructure and disease progression in depression-related cognitive dysfunction, highlighting the need for future research to investigate these complex relationships further.

STUDY:
Flinkenflügel K, Meinert S, Hirtsiefer C, Grotegerd D, Gruber M, Goltermann J, Winter NR, Stein F, Brosch K, Leehr EJ, Böhnlein J. Associations between white matter microstructure and cognitive decline in major depressive disorder versus controls in Germany: a prospective case-control cohort study. The Lancet Psychiatry. 2024 Nov 1;11(11):899-909.

This research article investigates the link between amyloid beta (Aβ), a hallmark protein associated with Alzheimer's disease (AD), and ferroptosis, a type of programmed cell death. The researchers analyzed post-mortem brain tissue from individuals with AD and found that Aβ pathology is associated with changes in the expression of proteins related to ferroptosis. They also conducted experiments with brain organoids derived from human induced pluripotent stem cells (iPSCs), demonstrating that inhibiting ferroptosis can mitigate Aβ-related effects. The study provides evidence suggesting that ferroptosis plays a crucial role in the progression of AD, and that targeting this pathway could potentially be a therapeutic strategy for preventing or slowing down the disease.

STUDY:
Majerníková, N., Marmolejo-Garza, A., Salinas, C.S. et al. The link between amyloid β and ferroptosis pathway in Alzheimer’s disease progression. Cell Death Dis 15, 782 (2024). https://doi.org/10.1038/s41419-024-07152-0

Studies:
Spector A, Thorgrimsen L, Woods BO, Royan L, Davies S, Butterworth M, Orrell M. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. The British Journal of Psychiatry. 2003 Sep;183(3):248-54.

Woods B, O'Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia. Cochrane database of systematic reviews. 2018(3).

Douglas S, James I, Ballard C. Non-pharmacological interventions in dementia. Advances in psychiatric treatment. 2004 May;10(3):171-7.

Dyer SM, Harrison SL, Laver K, Whitehead C, Crotty M. An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia. International psychogeriatrics. 2018 Mar;30(3):295-309.

STUDY:
Sattarov, R., Havers, M., Orbjörn, C. et al. Phosphorylated tau in cerebrospinal fluid-derived extracellular vesicles in Alzheimer’s disease: a pilot study. Sci Rep 14, 25419 (2024). https://doi.org/10.1038/s41598-024-75406-0

Findings: This research paper investigates the potential of extracellular vesicles (EVs), tiny membrane-bound sacs secreted by cells, as biomarkers for Alzheimer's disease (AD). The study used a novel technique called acoustic trapping to isolate EVs from cerebrospinal fluid (CSF) of AD patients and cognitively unimpaired controls. The researchers found that the levels of phosphorylated tau (P-tau), a protein associated with AD pathology, differed significantly between the two groups in EVs isolated from CSF. Specifically, EVs from AD patients showed higher levels of P-tau181 and lower levels of P-tau217, leading to a higher P-tau181/P-tau217 ratio compared to controls. These findings suggest that EVs could play a role in the spread of AD pathology and may serve as potential biomarkers for early disease detection.

Timeline
0:00:00 Intro
0:00:34 BPSD Guidelines Intro
0:01:28 Agitation management: Non-pharmacologic & Pharmacologic
0:03:27 Psychosis management: Non-pharmacologic & Pharmacologic
0:04:22 Depression management: Non-pharmacologic & Pharmacologic
0:05:16 Anxiety management: Non-pharmacologic & Pharmacologic
0:05:45 Disinhibited Sexual expressions: Best scale
0:06:10 Deprescribing medications: Suggestions
Medication mentioned: Citalopram, Aripiprazole, Brexpiprazole, Risperidone

STUDY:
Canadian Coalition for Seniors’ Mental Health. (2024). Canadian Clinical Practice Guidelines for Assessing and Managing Behavioural and Psychological Symptoms of Dementia (BPSD). Toronto, Canada.

STUDIES:

Laws SM, Hone E, Gandy S, Martins RN. Expanding the association between the APOE gene and the risk of Alzheimer's disease: possible roles for APOE promoter polymorphisms and alterations in APOE transcription. Journal of neurochemistry. 2003 Mar;84(6):1215-36.

Roses AD, Saunders AM. APOE is a major susceptibility gene for Alzheimer's disease. Current opinion in biotechnology. 1994 Dec 1;5(6):663-7.

Montagne A, Nation DA, Sagare AP, Barisano G, Sweeney MD, Chakhoyan A, Pachicano M, Joe E, Nelson AR, D’Orazio LM, Buennagel DP. APOE4 leads to blood–brain barrier dysfunction predicting cognitive decline. Nature. 2020 May 7;581(7806):71-6.

Safieh M, Korczyn AD, Michaelson DM. ApoE4: an emerging therapeutic target for Alzheimer’s disease. BMC medicine. 2019 Dec;17:1-7.

Conejero-Goldberg C, Gomar JJ, Bobes-Bascaran T, Hyde TM, Kleinman JE, Herman MM, Chen S, Davies P, Goldberg TE. APOE2 enhances neuroprotection against Alzheimer’s disease through multiple molecular mechanisms. Molecular psychiatry. 2014 Nov;19(11):1243-50.

Huang YW, Zhou B, Wernig M, Südhof TC. ApoE2, ApoE3, and ApoE4 differentially stimulate APP transcription and Aβ secretion. Cell. 2017 Jan 26;168(3):427-41.