Low-Dose Lithium to Delay Dementia?

Topics: Alzheimers | Cognitive Decline | Dementia | Lithium

Your 65-year-old patient Mr. Hoffman recently saw his father through a devastating course of Alzheimer’s disease. Mr. Hoffman had his own risk assessed with ApoE genotyping, and the result—E4/E4—indicates a high risk. He comes to your office after reading an online article about low-dose lithium for dementia prevention and asks if you can prescrib

The 3 Ds of Geriatric Psychiatry: Depression, Delirium, and Dementia

Topics: Apathy | Confusion Assessment Method (CAM) | Delirium | Dementia | Depression | Geriatric Depression Scale (GDS) | MMSE | MOCA | SLUMS

Both common yet elusive, symptoms of depression, dementia, and delirium may overlap in older adults, proving a diagnostic challenge. Even more confounding, these three disorders—the 3 Ds—frequently present simultaneously (Downing LJ et al, Curr Psychiatry Rep 2013;15(6):365). This article will review key features to help distinguish between these di

Assessing and Treating Delirium in Older Adults

Topics: Altered Mental Status (AMS) | Confusion | Confusion Assessment Method (CAM) | Delirium | Dementia | Disorganization

Delirium is one of the most perplexing psychiatric findings in older adults. It is defined as a disturbance of attention and a change in cognition. Delirium can be a cause of altered mental status (AMS), which is a general term defined as a change in mental functioning affecting cognition, consciousness (from slight confusion to coma), or both. Delirium

Annual Flu Vaccines

Topics: Dementia | Flu Shot | Immune System | Influenza vaccination | Microglia

Review of: Wiemken TL et al, Vaccine 2021;39(39):5524–5531 Study Type: Retrospective cohort study A growing body of literature links various vaccinations (eg, diphtheria, tetanus, polio, and influenza) to a lower risk of dementia through unclear mechanisms—one theory is that vaccines activate microglia, which clear amyloid-beta. However, many

Benzodiazepines in Older Adults

Topics: Addiction | Anxiety | Ashton manual | Beers criteria | Benzodiazepines | Cognitive Behavioral Therapy for Insomnia | Dementia | Fall risk | Hypnotics | Insomnia | Opioids | Overdose | Silexan | taper | Withdrawal

CGPR: When do you start benzodiazepines in older adults? Dr. Aiken: The best evidence for benzodiazepines in the elderly is in panic disorder, followed by phobias, social anxiety disorder, and generalized anxiety disorder. Benzodiazepines are also the mainstay of treating catatonia, rapid eye movement sleep behavior disorder, and alcohol withdrawal. Ho

An Update on Neuromodulation Techniques for Older Adults

Topics: Anxiety | Deep brain stimulation (DBS) | Dementia | Depression | ECT | Electroconvulsive therapy | magnetic seizure therapy (MST) | mild cognitive impairment | Neuromodulation | Obsessive compulsive disorder/OCD | Personality Disorders | SAINT protocol | Theta burst stimulation | TMS | Transcranial direct current stimulation (TDCS) | Transcranial Magnetic Stimulation | Vagus nerve stimulation (VNS)

CGPR: One of the more interesting neuromodulation interventions is magnetic seizure therapy (MST). How does it work? Dr. Lisanby: MST is an investigational form of treatment for depression. Similar to electroconvulsive therapy (ECT), MST induces seizures with the intention of therapeutic benefit, but the big difference between MST and ECT is how the se

Treating Agitation in Patients with Dementia

Topics: Agitation | Alzheimers | Antipsychotics | Benzodiazepines | BPSD (behavioral and psychological symptoms of dementia) | Dementia | Lewy Body Dementia | Parkinson’s Disease | Pharmacotherapy | Sundowning

CHPR: Can you tell us about yourself and your background? Dr. Metzger: I’m the medical director of psychiatry at Hebrew SeniorLife and an assistant professor of psychiatry at Harvard Medical School. My work also includes training residents and geriatric medicine fellows who rotate through our facility. CHPR: You participated in the psychopharmacol

Anticholinergic Drugs and Risk of Cognitive Impairment and Dementia

Topics: Alzheimers | Anticholinergic burden scale | Anticholinergics | Benzodiazepines | Cognitive Decline | Cognitive impairment | Dementia | Healthy aging | Pharmacotherapy

CHPR: Can you tell us about your research? Dr. Gray: My research uses large databases to examine medication safety issues in older adults with the goal of optimizing healthy aging. My focus is on examining medications and risk for dementia, falls, and fractures—the types of outcomes that are not easily addressed in randomized controlled trials. CH

Note From the Editor-in-Chief

Topics: Agitation | Anticholinergics | Cognitive functioning | Dementia | Geriatrics | Psychotherapy

One of the most challenging aspects of hospital psychiatry is the management of acute psychotic agitation. Sometimes we have little choice but to administer sedating medications to a combative patient who is putting others at risk of injury. Which medications work most quickly, safely, and effectively? Dr. Carlat and I combed through the literature to n

In the News: Aducanumab (Aduhelm)

Topics: Aducanumab | Aduhelm | Cognition | Cognitive Decline | Complementary treatments | Dementia | Neurology | News of Note | Novel drug

Alzheimer’s disease (AD) is devastating. There is no cure and existing treatments don’t slow or stop its progression. In June 2021, the FDA approved aducanumab (pronounced a-due-KAN-you-mab, brand name Aduhelm) for the treatment of AD. It’s the first new AD med since 2003 and is the only treatment that directly attacks a component of AD’s purpor

In Brief: Meds in the Fast Lane

Topics: Aducanumab | Cognition | Dementia | FDA | Neurology | Novel drug

In the last five years, more psychotropics have gained approval through the FDA’s expedited pathways than the slow and cautious routes we’ve grown used to. These “fast-track” and “breakthrough therapy” approvals allow drugs to enter the market on the basis of more efficient (ie, smaller) clinical trials. Instead of the typical 2000 participa

Rest Easy: Benzos, Z-Drugs, and Dementia

Topics: Anxiety | Benzodiazepines | Dementia | Deprescribing | Generalized Anxiety Disorder | Geriatric Psychiatry | Hypnotics

Review of: Osler M and Jorgensen MB, Am J Psych 2020;177(6):497–505 Study TYPE: Epidemiologic case-control Few psychotropics stir controversy like the benzodiazepines. While they work well for anxiety and insomnia, their risks of abuse and dependence have always nagged at us. More recently, some research has suggested that long-term use increase

Nuedexta in Agitated Dementia

Topics: Agitation | Dementia | Generics | Nuedexta | Pharmaceutical Industry | pseudobulbar affect

Treating agitation in dementia is no easy task. Behavioral interventions are first line, but they are difficult to implement and often insufficient. Psychotropics show modest benefits, but they are prone to causing adverse events. Benzodiazepines can precipitate falls, disinhibition, and confusion. Antipsychotics have a black box warning about an increa

In Brief: Antipsychotic Update

Topics: Dementia | Risperidone

Outdoor activity, massage, and touch therapy ranked most effective for agitation in dementia. In a meta-analysis of 163 randomized controlled trials, nonpharmacologic interventions were more effective than antipsychotics for aggression and agitation in dementia (Watt JA, Ann Intern Med 2019 Oct 15). Risperidone doesn’t appear to cause fractures. Ri

The Aging Brain: Preventing Cognitive Decline

Topics: Cognitive Decline | Dementia | Geriatric Psychiatry

We’ve all been there. A 63-year-old patient comes to you with a chief complaint of memory loss. She tells you that she has a hard time remembering people’s names and forgets where she puts her keys. She lives and drives on her own without a problem, but asks, “Isn’t there some memory pill I can take?” What advice can we give her? The first

Screening Tests for Cognitive Decline

Topics: Cognitive Decline | Dementia | Geriatric Psychiatry

Screening tests can also help distinguish normal aging from a Neurocognitive Disorder. The popular Mini Mental Status Exam is being replaced by more sensitive tests like the Montreal Cognitive Assessment (MOCA) and the Saint Louis University Mental Status Examination (SLUMS). Both of these can be completed in 10 minutes and are normed for Mild and Major

Moderate Alcohol Use Associated With Reduced Risk of Dementia

Topics: Alcohol Use | Dementia | Geriatric Psychiatry | Research Update

Review of: Sabia S et al, BMJ 2018;362:k2927 Type of study: Prospective cohort study Excessive alcohol use is neurotoxic, but some studies have found that moderate alcohol intake might actually reduce the risk of dementia. Most of these studies, however, have focused on geriatric patients. What about the cumulative impact of alcohol over one’s lifet

Neurobiology Concepts for Psychiatrists

Topics: Dementia | Neuroscience in Psychiatry

TCPR: I think that a lot of psychiatrists, myself included, could use a refresher course on Parkinson disease and how to distinguish its symptoms from those induced by antipsychotics (parkinsonism). What exactly is parkinsonism? Dr. Kaufman: Parkinsonism is a clinical syndrome comprised primarily of rigidity, tremor, and bradykinesia (slowed movements)

Managing Behavioral and Psychological Symptoms of Dementia (BPSD)

Topics: Dementia | Practice Tools and Tips | Psychotherapy

Richard is an 88-year-old former airline pilot who was diagnosed with Alzheimer’s dementia 5 years ago. He managed well at home with his wife initially, but a year ago he required admission to a skilled nursing facility because of worsening symptoms. His transition was difficult. Sometimes he hovered around the exit door and elevators and tried to lea

Determining Dementia

Topics: Dementia | Diagnostic Testing | Laboratory Testing in Psychiatry

TCPR: The big question for general psychiatrists is how do we go about efficiently assessing memory in a clinical environment that only allows for a 15- to 20-minute visit? Dr. Budson: If people are actually raising a concern about their memory, that is already something to take seriously. There used to be this rule of thumb that you don’t need to