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    <title><![CDATA[American Journal of Geriatric Psych - Most Popular Articles]]></title>
    <link>http://journals.lww.com/ajgponline/pages/viewallmostpopulararticles.aspx</link>
    <description><![CDATA[The American Journal of Geriatric Psychiatry (AJGP) is the authoritative source of information for the rapidly developing field of geriatric psychiatry. The Journal contains peer-reviewed articles on the diagnosis and classification of psychiatric disorders of later life, epidemiological and biological correlates of mental health of older adults, and psychopharmacology and other somatic treatments.]]></description>
    <language>en-us</language>
    <lastBuildDate>Sun, 22 Nov 2009 13:49:35 -0600</lastBuildDate>
    <generator>Wolters Kluwer Health RSS Generator</generator>
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      <url>http://images.journals.lww.com/ajgponline/XLargeThumb.00019442-200912000-00000.CV.jpeg</url>
      <title><![CDATA[American Journal of Geriatric Psych - Most Popular Articles]]></title>
      <link>http://journals.lww.com/ajgponline/pages/viewallmostpopulararticles.aspx</link>
    </image>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2007/01000/The_Effects_of_Postoperative_Pain_and_Its.7.aspx</link>
      <author>Wang, Yun; Sands, Laura P.; Vaurio, Linnea; Mullen, E Ann; Leung, Jacqueline M.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[The Effects of Postoperative Pain and Its Management on Postoperative Cognitive Dysfunction]]></title>
      <description><![CDATA[To determine risks for postoperative cognitive dysfunction (POCD), the authors conducted a prospective cohort study of 225 patients >=65 years of age undergoing noncardiac surgery. Cognitive testing using the Word List, Verbal Fluency, and Digit Symbol tests was conducted for each patient preoperatively and 1 and 2 days postoperatively in patients without postoperative delirium. POCD was defined as meeting statistical criteria for decline from the patient's preoperative performance levels on at least two of the three cognitive tests. Multivariate logistic regression analysis determined the association between pain and postoperative analgesia with POCD after controlling for demographics, comorbidities, preoperative level of cognitive and daily functioning, preoperative medications, duration and type of anesthesia, and adverse events. Patients were on average 72 years old and 13% of patients experienced POCD on day 1, 7% on day 2, and 15% had POCD on either day 1 or day 2 after the surgery. Multivariate regression analyses revealed that only postoperative analgesia was associated with the development of POCD. Compared with those receiving postoperative analgesia through a patient-controlled analgesia device that administered opioids intravenously, those who received postoperative analgesia orally were at significantly lower risk for the development of POCD (odds ratio: 0.22; 95% confidence interval: 0.06-0.80; Wald chi-square = 5.36, df = 1, p = 0.02). Older patients undergoing noncardiac surgery who are not delirious can experience significant declines in cognitive functioning postoperatively. Those at least risk of experiencing POCD were those who received postoperative analgesia orally.
Copyright (C) 2007 American Association for Geriatric Psychiatry]]></description>
      <pubDate>1/1/2007 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200701000-00007</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2004/05000/Family_Caregiving_of_Persons_With_Dementia_.2.aspx</link>
      <author>Schulz, Richard; Martire, Lynn M.</author>
      <category>Clinical Review</category>
      <title><![CDATA[Family Caregiving of Persons With Dementia: Prevalence, Health Effects, and Support Strategies]]></title>
      <description><![CDATA[The authors summarize the dementia caregiving literature and provide recommendations regarding practice guidelines for health professionals working with caregivers. Family caregiving of older persons with disability has become commonplace in the United States because of increases in life expectancy and the aging of the population, with resulting higher prevalence of chronic diseases and associated disabilities, increased constraints in healthcare reimbursement, and advances in medical technology. As a result, family members are increasingly being asked to perform complex tasks similar to those carried out by paid health or social service providers, often at great cost to their own well-being and great benefit to their relatives and society as a whole. The public health significance of caregiving has spawned an extensive literature in this area, much of it focused on dementia caregiving because of the unique and extreme challenges associated with caring for someone with cognitive impairment. This article summarizes the literature on dementia caregiving, identifies key issues and major findings regarding the definition and prevalence of caregiving, describes the psychiatric and physical health effects of caregiving, and reviews various intervention approaches to improving caregiver burden, depression, and quality of life. Authors review practice guidelines and recommendations for healthcare providers in light of the empirical literature on family caregiving.
Copyright (C) 2004 American Association for Geriatric Psychiatry]]></description>
      <pubDate>5/1/2004 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200405000-00002</guid>
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    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Dimensions_Underlying_the_Mini_Mental_State.7.aspx</link>
      <author>Castro-Costa, Erico; Fuzikawa, Cintia; Ferri, Cleusa; Uchoa, Elizabeth; Firmo, Joselia; Lima-Costa, Maria Fernanda; Dewey, Michael E.; Stewart, Robert</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Dimensions Underlying the Mini-Mental State Examination in a Sample With Low-Education Levels: The Bambui Health and Aging Study]]></title>
      <description><![CDATA[Objectives: To investigate the validity of previously suggested dimensions underlying the Mini-Mental State Examination (MMSE) and differences in associations of these dimensions with sociodemographic and health characteristics in an older Latin-American community sample with low levels of education.
Design: Secondary analysis of baseline data from a population-based cohort study.
Setting: Bambui, Brazil.
Participants: Of 1,742 total residents aged 60 years or older, 1,558 (89.4%) participated at this study.
Measurements: A standard Brazilian version of the MMSE.
Results: A five-factor solution (Concentration, Language/Praxis, Orientation, Attention, and Memory) for the MMSE was generated from Principal Components Analysis, and the five-factor solutions proposed in previous studies of developed nation samples were tested in this sample by Confirmatory Factor Analysis. In the adjusted linear regression models, MMSE factors varied in their correlates: for example, female gender was associated with higher concentration, orientation, and attention but lower Language/Praxis; increased age was inversely associated only with language and attention; and activity of daily living impairment was principally associated with lower Language/Praxis.
Conclusion: This study provides support for the cross-sectional equivalence of the MMSE, suggesting that most of the items and underlying constructs remain meaningful after alteration and translation in a low-education sample with lower overall distribution of scores.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00007</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/07000/Alcohol_Consumption_as_a_Risk_Factor_for_Dementia.3.aspx</link>
      <author>Anstey, Kaarin J.; Mack, Holly A.; Cherbuin, Nicolas</author>
      <category>Critical Review Article</category>
      <title><![CDATA[Alcohol Consumption as a Risk Factor for Dementia and Cognitive Decline: Meta-Analysis of Prospective Studies]]></title>
      <description><![CDATA[The relationships between alcohol consumption and dementia and cognitive decline were investigated in a systematic review including meta-analyses of 15 prospective studies. Follow-ups ranged from 2 to 8 years. Meta-analyses were conducted on samples including 14,646 participants evaluated for Alzheimer disease (AD), 10,225 participants evaluated for vascular dementia (VaD), and 11,875 followed for any type of dementia (Any dementia). The pooled relative risks (RRs) of AD, VaD, and Any dementia for light to moderate drinkers compared with nondrinkers were 0.72 (95% CI = 0.61-0.86), 0.75 (95% CI = 0.57-0.98), and 0.74 (95% CI = 0.61-0.91), respectively. When the more generally classified "drinkers," were compared with "nondrinkers," they had a reduced risk of AD (RR = 0.66, 95% CI = 0.47-0.94) and Any dementia (RR = 0.53, 95% CI = 0.53-0.82) but not cognitive decline. There were not enough data to examine VaD risk among "drinkers." Those classified as heavy drinkers did not have an increased risk of Any dementia compared with nondrinkers, but this may reflect sampling bias. Our results suggest that alcohol drinkers in late life have reduced risk of dementia. It is unclear whether this reflects selection effects in cohort studies commencing in late life, a protective effect of alcohol consumption throughout adulthood, or a specific benefit of alcohol in late life.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200907000-00003</guid>
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    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/09000/Prazosin_for_the_Treatment_of_Behavioral_Symptoms.5.aspx</link>
      <author>Wang, Lucy Y.; Shofer, Jane B.; Rohde, Kirsten; Hart, Kim L.; Hoff, David J.; McFall, Yun H.; Raskind, Murray A.; Peskind, Elaine R.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Prazosin for the Treatment of Behavioral Symptoms in Patients With Alzheimer Disease With Agitation and Aggression]]></title>
      <description><![CDATA[Objectives: Agitation/aggression in Alzheimer disease (AD) is a major cause of patient distress, caregiver burden, and institutionalization. Enhanced behavioral responsiveness to central nervous system norepinephrine (NE) release may contribute to the pathophysiology of agitation/aggression in AD. Prazosin, a nonsedating generic medication used for hypertension and benign prostatic hypertrophy, antagonizes NE effects at brain postsynaptic alpha-1 adrenoreceptors. This pilot study examined the efficacy and tolerability of prazosin for behavioral symptoms in patients with agitation/aggression in AD.
Design: Double-blind, placebo controlled, parallel group study.
Setting: A university AD center and a nursing home in Seattle, WA.
Participants: Twenty-two nursing home and community-dwelling participants with agitation/aggression and probable or possible AD (mean age: 80.6 +/- 11.2).
Intervention: Randomization to placebo (N = 11) or prazosin (N = 11). Medication was initiated at 1 mg/day and increased up to 6 mg/day using a flexible dosing algorithm.
Measurements: The Brief Psychiatric Rating Scale (BPRS) and Neuropsychiatric Inventory (NPI) at Weeks 1, 2, 4, 6, and 8. The Clinical Global Impression of Change (CGIC) at Week 8.
Results: Participants taking prazosin (mean dose: 5.7 +/- 0.9 mg/day) had greater improvements than those taking placebo (mean dose: 5.6 +/- 1.2 mg/day) on the NPI (mean change: -19 +/- 21 versus -2 +/- 15, [chi]2 = 6.32, df = 1, p = 0.012) and BPRS (mean change: -9 +/- 9 versus -3 +/- 5, [chi]2 = 4.42, df = 1, p = 0.036) based on linear mixed effects models and the CGIC (mean: 2.6 +/- 1.0 versus 4.5 +/- 1.6, z = 2.57, p = 0.011 [Mann-Whitney test]). Adverse effects and blood pressure changes were similar between prazosin and placebo groups.
Conclusion: Prazosin was well tolerated and improved behavioral symptoms in patients with agitation/aggression in AD.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200909000-00005</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2000/05000/Exposing_Financial_Exploitation_of_Impaired.4.aspx</link>
      <author>Tueth, Michael J.</author>
      <category>Special Article</category>
      <title><![CDATA[Exposing Financial Exploitation of Impaired Elderly Persons]]></title>
      <description><![CDATA[There is a dearth of medical publications on financial exploitation of elderly persons, but a significant amount of information on this subject is contained in the literature of other disciplines. Financial abuse accounts for up to one-half of all types of elder abuse in the United States, accounting for over 500,000 victims. Psychological abuse, including deception, intimidation, and threats, always accompanies financial exploitation. Despite the devastating emotional and financial losses incurred, physicians are reluctant to recognize, diagnose, and assist impaired elderly victims of financial exploitation.
Copyright (C) 2000 American Association for Geriatric Psychiatry]]></description>
      <pubDate>5/1/2000 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200005000-00004</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/02000/Your_Brain_on_Google__Patterns_of_Cerebral.4.aspx</link>
      <author>Small, Gary W.; Moody, Teena D.; Siddarth, Prabha; Bookheimer, Susan Y.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Your Brain on Google: Patterns of Cerebral Activation during Internet Searching]]></title>
      <description><![CDATA[Objective: Previous research suggests that engaging in mentally stimulating tasks may improve brain health and cognitive abilities. Using computer search engines to find information on the Internet has become a frequent daily activity of people at any age, including middle-aged and older adults. As a preliminary means of exploring the possible influence of Internet experience on brain activation patterns, the authors performed functional magnetic resonance imaging (MRI) of the brain in older persons during search engine use and explored whether prior search engine experience was associated with the pattern of brain activation during Internet use.
Design: Cross-sectional, exploratory observational study
Participants: The authors studied 24 subjects (age, 55-76 years) who were neurologically normal, of whom 12 had minimal Internet search engine experience (Net Naive group) and 12 had more extensive experience (Net Savvy group). The mean age and level of education were similar in the two groups.
Measurements: Patterns of brain activation during functional MRI scanning were determined while subjects performed a novel Internet search task, or a control task of reading text on a computer screen formatted to simulate the prototypic layout of a printed book, where the content was matched in all respects, in comparison with a nontext control task.
Results: The text reading task activated brain regions controlling language, reading, memory, and visual abilities, including left inferior frontal, temporal, posterior cingulate, parietal, and occipital regions, and both the magnitude and the extent of brain activation were similar in the Net Naive and Net Savvy groups. During the Internet search task, the Net Naive group showed an activation pattern similar to that of their text reading task, whereas the Net Savvy group demonstrated significant increases in signal intensity in additional regions controlling decision making, complex reasoning, and vision, including the frontal pole, anterior temporal region, anterior and posterior cingulate, and hippocampus. Internet searching was associated with a more than twofold increase in the extent of activation in the major regional clusters in the Net Savvy group compared with the Net Naive group (21,782 versus 8,646 total activated voxels).
Conclusion: Although the present findings must be interpreted cautiously in light of the exploratory design of this study, they suggest that Internet searching may engage a greater extent of neural circuitry not activated while reading text pages but only in people with prior computer and Internet search experience. These observations suggest that in middle-aged and older adults, prior experience with Internet searching may alter the brain's responsiveness in neural circuits controlling decision making and complex reasoning.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>2/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200902000-00004</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/03000/Can_Cognitive_Exercise_Prevent_the_Onset_of.2.aspx</link>
      <author>Valenzuela, Michael; Sachdev, Perminder</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Can Cognitive Exercise Prevent the Onset of Dementia? Systematic Review of Randomized Clinical Trials with Longitudinal Follow-up]]></title>
      <description><![CDATA[Objectives: Epidemiological and preclinical studies suggest that mental activity levels may alter dementia risk. Clinical trials are now beginning to address the key issues of persistence of effect over extended follow-up and transfer of effect to nontrained domains. The aim of this report was to therefore systematically review results from clinical trials, which have examined the effect of cognitive exercise on longitudinal cognitive performance in healthy elderly individuals.
Methods: MEDLINE, PubMed, and key references were used to generate an initial list of relevant studies (N = 54). These were reviewed to identify randomized controlled trials, which tested the effect of a discrete cognitive exercise training regime on longitudinal (>3 months) posttraining neuropsychological performance in healthy older adults. Seven RCTs met entry criteria. Prechange and postchange scores were integrated using a random effects weighted mean difference (WMD) meta-analytic approach (Review Manager Version 4.2).
Results: A strong effect size was observed for cognitive exercise interventions compared with wait-and-see control conditions (WMD = 1.07, CI: 0.32-1.83, z = 2.78, N = 7, p = 0.006, N = 3,194). RCTs with follow-up greater than 2 years did not appear to produce lower effect size estimates than those with less extended follow-up. Quality of reporting of trials was in general low.
Conclusion: Cognitive exercise training in healthy older individuals produces strong and persistent protective effects on longitudinal neuropsychological performance. Transfer of these effects to dementia-relevant domains such as general cognition and daily functioning has also been reported in some studies. Importantly, cognitive exercise has yet to be shown to prevent incident dementia in an appropriately designed trial and this is now an international priority.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>3/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200903000-00002</guid>
    </item>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2007/03000/Aging_Well.2.aspx</link>
      <author>Vaillant, George E.</author>
      <category>Editorial</category>
      <title><![CDATA[Aging Well]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>3/1/2007 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200703000-00002</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2001/11000/Animal_Assisted_Therapy_for_Elderly_Schizophrenic.13.aspx</link>
      <author>Barak, Yoram; Savorai, Osnat; Mavashev, Svetlana; Beni, Avshalom</author>
      <category>Brief Report</category>
      <title><![CDATA[Animal-Assisted Therapy for Elderly Schizophrenic Patients: A One-Year Controlled Trial]]></title>
      <description><![CDATA[Animal-assisted therapy (AAT) has been used as a therapeutic tool in various psychiatric populations, but there have been no published studies with elderly schizophrenic patients. The authors evaluated, in a blinded, controlled manner, the effects of AAT in a closed psychogeriatric ward over 12 months. Subjects were 10 elderly schizophrenic patients and 10 matched patients (mean age: 79.1+/-6.7 years). The outcome measure was the Scale for Social Adaptive Functioning Evaluation (SAFE). AAT was conducted in weekly 4-hour sessions. Treatment encouraged mobility, interpersonal contact, and communication and reinforced activities of daily living (ADLs), including personal hygiene and independent self-care, through the use of cats and dogs as "modeling companions." The SAFE scores at termination showed significant improvement compared with baseline scores and were significantly more positive for the AAT group on both Total SAFE score and on the Social Functions subscale. AAT proved a successful tool for enhancing socialization, ADLs, and general well-being.
Copyright (C) 2001 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/1/2001 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200111000-00013</guid>
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    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/09000/Prevalence_of_Mood,_Anxiety,_and_Substance_Abuse.8.aspx</link>
      <author>Gum, Amber M.; King-Kallimanis, Bellinda; Kohn, Robert</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Prevalence of Mood, Anxiety, and Substance-Abuse Disorders for Older Americans in the National Comorbidity Survey-Replication]]></title>
      <description><![CDATA[Objectives: Current information on the prevalence of psychiatric disorders among older adults in the United States is lacking. Prevalence of anxiety, mood, and substance disorders was examined by age (18-44, 45-64, 65-74, and 75 years and older) and sex. Covariates of disorders for older adults (65 years and older) were explored.
Design: Cross-sectional epidemiologic study, using data from the National Comorbidity Survey-Replication.
Setting: Community-based epidemiologic survey.
Participants: Representative national sample of community-dwelling adults in the United States.
Measurements: The World Health Organization Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders.
Results: Prevalence of 12-month and lifetime mood, anxiety, and substance-use disorders was lower for older adults (65 years and older) than younger age groups: 2.6% for mood disorder, 7.0% for anxiety disorder, 0 for any substance-use disorder, and 8.5% for any of these disorders (for any disorder, 18-44 years = 27.6%, 45-64 years = 22.4%). Among older adults, presence of a 12-month anxiety disorder was associated with female sex, lower education, being unmarried, and three or more chronic conditions. Presence of a 12-month mood disorder was associated with disability. Similar patterns were noted for lifetime disorders (any disorder: 18-44 years = 46.4%, 45-64 years = 43.7%, and 65 years and older = 20.9%).
Conclusions: This study documents the continued pattern of lower rates of formal diagnoses for elders. These rates likely underestimate the burden of late-life psychiatric disorders, given the potential for underdiagnosis, clinical significance of subthreshold symptoms, and lack of representation from high-risk older adults (e.g., medically ill, long-term care residents).
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200909000-00008</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/07000/Comorbid_Depression_in_Dementia_on_Psychogeriatric.5.aspx</link>
      <author>Verkaik, Renate; Francke, Anneke L.; van Meijel, Berno; Ribbe, Miel W.; Bensing, Jozien M.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Comorbid Depression in Dementia on Psychogeriatric Nursing Home Wards: Which Symptoms are Prominent?]]></title>
      <description><![CDATA[Objective: To provide insight into the prevalence and clinically relevant symptoms of comorbid depression among dementia patients in psychogeriatric nursing home wards, to enhance depression recognition.
Design: Cross-sectional analyses of multicenter diagnostic data.
Setting: Psychogeriatric wards of Dutch nursing homes.
Participants: Five hundred and eighteen residents with dementia.
Measurements: 1) Diagnosis of depression in dementia (Provisional Diagnostic Criteria for Depression of Alzheimer disease [PDC-dAD]), 2) dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-PC), and 3) stage of dementia (Geriatric Depression Scale).
Results: The point prevalence of comorbid depression in dementia (Stages 2-6) on psychogeriatric nursing home wards was 19%. "Depressed mood," "irritability," and "fatigue" were the most prevalent depressive symptoms. Residents taking antidepressants at the time of the PDC-dAD depression diagnosis showed more depressive symptoms than residents who were not. The mean number of depressive symptoms was 5.6 (SD 1.84), which did not differ between the dementia stages. Also, no differences were found in the point prevalence of the shown symptoms between dementia stages.
Conclusion: Irritability was put forward by the developers of the PDC-dAD, as one of the specific symptoms of depression in Alzheimer disease. This study shows that irritability is one of the most prevalent depressive symptoms in psychogeriatric nursing home residents diagnosed with comorbid depression. Irritability should therefore alert caregivers to the presence of depression and could help early recognition. The high-prevalence rate of comorbid depression in dementia in this setting justifies attention to early recognition and intervention.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200907000-00005</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2006/12000/Vitamin_D_Deficiency_Is_Associated_With_Low_Mood.7.aspx</link>
      <author>Wilkins, Consuelo H.; Sheline, Yvette I.; Roe, Catherine M.; Birge, Stanley J.; Morris, John C.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Vitamin D Deficiency Is Associated With Low Mood and Worse Cognitive Performance in Older Adults]]></title>
      <description><![CDATA[Background: Vitamin D deficiency is common in older adults and has been implicated in psychiatric and neurologic disorders. This study examined the relationship among vitamin D status, cognitive performance, mood, and physical performance in older adults.
Methods: A cross-sectional group of 80 participants, 40 with mild Alzheimer disease (AD) and 40 nondemented persons, were selected from a longitudinal study of memory and aging. Cognitive function was assessed using the Short Blessed Test (SBT), Mini-Mental State Exam (MMSE), Clinical Dementia Rating (CDR; a higher Sum of Boxes score indicates greater dementia severity), and a factor score from a neuropsychometric battery; mood was assessed using clinician's diagnosis and the depression symptoms inventory. The Physical Performance Test (PPT) was used to measure functional status. Serum 25-hydroxyvitamin D levels were measured for all participants.
Results: The mean vitamin D level in the total sample was 18.58 ng/mL (standard deviation: 7.59); 58% of the participants had abnormally low vitamin D levels defined as less than 20 ng/mL. After adjusting for age, race, gender, and season of vitamin D determination, vitamin D deficiency was associated with presence of an active mood disorder (odds ratio: 11.69, 95% confidence interval: 2.04-66.86; Wald [chi]2 = 7.66, df = 2, p = 0.022). Using the same covariates in a linear regression model, vitamin D deficiency was associated with worse performance on the SBT (F = 5.22, df = [2, 77], p = 0.044) and higher CDR Sum of Box scores (F = 3.20, df = [2, 77], p = 0.047) in the vitamin D-deficient group. There was no difference in performance on the MMSE, PPT, or factor scores between the vitamin D groups.
Conclusions: In a cross-section of older adults, vitamin D deficiency was associated with low mood and with impairment on two of four measures of cognitive performance.
Copyright (C) 2006 American Association for Geriatric Psychiatry]]></description>
      <pubDate>12/1/2006 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200612000-00007</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/11000/Ethnic_Differences_in_Beliefs_Regarding_Alzheimer.4.aspx</link>
      <author>Gray, Heather L.; Jimenez, Daniel E.; Cucciare, Michael A.; Tong, Hui-Qi; Gallagher-Thompson, Dolores</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Ethnic Differences in Beliefs Regarding Alzheimer Disease Among Dementia Family Caregivers]]></title>
      <description><![CDATA[Objective: The purpose of this study was to examine ethnic differences in female dementia family caregivers' knowledge, attitudes, and beliefs about Alzheimer disease (AD).
Methods: Baseline data were collected from 215 female caregivers before their participation in various psychoeducational intervention programs. Caregivers were questioned about the epidemiology, etiology, and treatment of AD. Logistic regressions and one-way analysis of variance were conducted to assess ethnic differences.
Results: Hispanic and Chinese caregivers were more likely to believe that AD is a normal part of aging and that AD can be diagnosed by a blood test than the white group. These beliefs about AD may delay help-seeking activities for these patients and their family caregivers.
Conclusion: Increased public education about AD is needed in these communities. Results are discussed in terms of barriers to accessing information about AD and ways to improve public informational outreach activities, so that the intended audiences are reached more effectively.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200911000-00004</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/05000/Determinants_of_Successful_Aging_Using_a.8.aspx</link>
      <author>Ng, Tze Pin; Broekman, Birit F.P.; Niti, Matthew; Gwee, Xinyi; Kua, Ee Heok</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Determinants of Successful Aging Using a Multidimensional Definition Among Chinese Elderly in Singapore]]></title>
      <description><![CDATA[Objective: Most studies of successful aging have used restricted definitions based on the absence of disability and identified a small number of predictors. The authors aimed to examine whether a broad multidimensional definition of successful aging has good construct validity and identified a wider range of predictors that are relevant for multifaceted interventions.
Methods: Cross-sectional and longitudinal data analyses were performed on 1,281 community-living Chinese elderly of 65 years and above in the Singapore Longitudinal Aging Study cohort. Successful aging was measured in multiple dimensions of functioning and wellness: cognitive and affective status, physical health, social functioning and engagement and life satisfaction, and a summary composite measure created across dimensions to form a dichotomous variable. Potential determinants included sociodemographic, psychosocial, behavioral variables.
Results: Successful aging was determined in 28.6% of respondents and in multivariate models was significantly (p <0.05) associated with age (OR = 0.90), female gender (OR = 1.37), >=6 years of education (OR = 2.31), better housing (OR = 1.41), religious or spiritual beliefs (OR = 1.64), physical activities and exercise (OR = 1.90), and low or no nutritional risk (OR = 2.16).
Conclusion: In contrast to findings based on more restricted biomedical definitions of successful aging, a multidimensional definition of successful aging identified more variables including demographic status, psychosocial support, spirituality, and nutrition as salient determinants.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200905000-00008</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/06000/Cognitive_Impairment_in_Early_and_Late_Bipolar.10.aspx</link>
      <author>Schouws, Sigfried N.T.M.; Comijs, Hannie C.; Stek, Max L.; Dekker, Jack; Oostervink, Frits; Naarding, Paul; van der Velde, Iet; Beekman, Aartjan T. F.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Cognitive Impairment in Early and Late Bipolar Disorder]]></title>
      <description><![CDATA[Background: Late onset disorders are often associated with cerebral disfunctioning and cognitive impairment in elderly patients. It is unknown whether the age of onset affects cognition in patients with bipolar disorder. The authors compare cognition and clinical characteristics of early- and late-onset bipolar patients in a stable and euthymic condition.
Method: One hundred and nineteen older patients (age >60) with an early- (<40 years) or late-onset bipolar disorder and a group of 78 comparison subjects were extensively tested for cognitive functioning.
Results: Bipolar subjects scored lower on most cognitive measures. The late-onset patients were more impaired in psychomotor performance and mental flexibility than the early-onset patients. These differences could not be explained by differences in exposure to cerebrovascular risk factors.
Conclusions: Older patients with bipolar disorder have substantial cognitive impairments. Late onset bipolar disorder is associated with more severe cognitive impairment than early-onset bipolar disorder. For clinical practice, it is important to develop treatment strategies which take this into account.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>6/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200906000-00010</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/02000/Intelligent_Assistive_Technology_Applications_to.2.aspx</link>
      <author>Bharucha, Ashok J.; Anand, Vivek; Forlizzi, Jodi; Dew, Mary Amanda; Reynolds, Charles F. III; Stevens, Scott; Wactlar, Howard</author>
      <category>Special Article</category>
      <title><![CDATA[Intelligent Assistive Technology Applications to Dementia Care: Current Capabilities, Limitations, and Future Challenges]]></title>
      <description><![CDATA[The number of older Americans afflicted by Alzheimer disease and related dementias will triple to 13 million persons by 2050, thus greatly increasing healthcare needs. An approach to this emerging crisis is the development and deployment of intelligent assistive technologies that compensate for the specific physical and cognitive deficits of older adults with dementia, and thereby also reduce caregiver burden. The authors conducted an extensive search of the computer science, engineering, and medical databases to review intelligent cognitive devices, physiologic and environmental sensors, and advanced integrated sensor networks that may find future applications in dementia care. Review of the extant literature reveals an overwhelming focus on the physical disability of younger persons with typically nonprogressive anoxic and traumatic brain injuries, with few clinical studies specifically involving persons with dementia. A discussion of the specific capabilities, strengths, and limitations of each technology is followed by an overview of research methodological challenges that must be addressed to achieve measurable progress to meet the healthcare needs of an aging America.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>2/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200902000-00002</guid>
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    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Change_in_Cognitive_Functioning_Following_Acute.9.aspx</link>
      <author>Culang, Michelle E.; Sneed, Joel R.; Keilp, John G.; Rutherford, Bret R.; Pelton, Gregory H.; Devanand, D P.; Roose, Steven P.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Change in Cognitive Functioning Following Acute Antidepressant Treatment in Late-Life Depression]]></title>
      <description><![CDATA[Objective: Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medications for geriatric depression. The association of late-life depression and cognitive impairment has been well documented. However, there have been few placebo-controlled trials examining the impact of SSRIs on cognitive functioning.
Design: Prepost neuropsychological (NP) data collected as part of an 8-week, double-blind, placebo-controlled trial of citalopram in depressed patients aged 75 years and older were used to examine change in cognitive functioning.
Setting: University-affiliated outpatient psychiatry clinics.
Participants: One hundred seventy-four community-dwelling men and women aged 75 years or older with nonpsychotic unipolar depression.
Measurements: NP assessments included mental status (Mini-Mental State Examination), psychomotor speed (Wechsler Adult Intelligence Scale-III Digit Symbol Subtest), reaction time (Choice Reaction Time), visual-spatial skill (Judgment of Line Orientation), executive functioning (Stroop Color/Word Test), and memory (Buschke Selective Reminding Test).
Results: Differences in the pattern of change by treatment group depended on responder status. Citalopram nonresponders were the only group to decline on verbal learning and psychomotor speed. Citalopram responders showed significant improvement in visuospatial functioning, when compared with nonresponders in either condition, but their improvement was not greater than responders on placebo. Citalopram responders showed greater improvement on psychomotor speed than citalopram nonresponders, but their improvement was not greater than placebo responders or nonresponders.
Conclusions: Medication may have a deleterious effect on some aspects of cognition among patients aged 75 years and older who have not responded. This suggests that patients should not be maintained on a medication if they have not had an adequate response.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00009</guid>
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    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2006/11000/Comparison_of_the_Saint_Louis_University_Mental.3.aspx</link>
      <author>Tariq, Syed H.; Tumosa, Nina; Chibnall, John T.; Perry, Mitchell H. III; Morley, John E.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Comparison of the Saint Louis University Mental Status Examination and the Mini-Mental State Examination for Detecting Dementia and Mild Neurocognitive Disorder-A Pilot Study]]></title>
      <description><![CDATA[Context: The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions.
Objective: The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.
Methods: Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison.
Results: Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups.
Conclusion: These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.
Copyright (C) 2006 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/1/2006 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200611000-00003</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/09000/Measuring_Impairments_in_Memory_and_Executive.10.aspx</link>
      <author>Kessels, Roy P.C.; Mimpen, Gerdy; Melis, René; Olde Rikkert, Marcel G.M.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Measuring Impairments in Memory and Executive Function in Older People Using the Revised Cambridge Cognitive Examination]]></title>
      <description><![CDATA[Objectives: The Revised Cambridge Cognitive Examination (CAMCOG-R) is a cognitive screen that has been used to discriminate individuals with dementia from cognitively intact older people. It consists of items assessing various cognitive domains, but the construct validity of the cognitive subscores has not been established yet. The authors examine the subscores Memory and Executive Function in relation to extensive neuropsychological testing in a group of older adults with or without cognitive decline.
Design: Observational study.
Setting: Memory clinic at the department of geriatrics of a university medical center.
Participants: A convenience sample of 36 outpatients diagnosed with cognitive decline and 24 older healthy participants.
Measurements: Sensitivity and specificity of the CAMCOG-R Memory subscore and Executive Function subscore were established using extensive neuropsychological assessment of memory (using the Rey-Auditory Verbal Learning Test, Location Learning Test, Visual Association Test, and Story Recall) and executive function (using the Brixton Spatial Anticipation Test, Trail Making Test, and Key Search test) as the gold standard.
Results: For the CAMCOG-R Executive Function subscore, a cutoff point of 16.5 had a good sensitivity (0.82) and adequate specificity (0.73) for discriminating people with and without executive dysfunction. However, the Total Score and Language subscore also differentiated between people with and without executive dysfunction. The CAMCOG-R Memory subscore could not validly distinguish between people with and without memory impairment.
Conclusion: The CAMCOG-R subscores Memory and Executive Function have limited validity, and clinicians should be cautious in interpreting these in the absence of other neuropsychological measures or clinical information.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200909000-00010</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2006/03000/Efficacy_and_Adverse_Effects_of_Atypical.4.aspx</link>
      <author>Schneider, Lon S.; Dagerman, Karen; Insel, Philip S.</author>
      <category>Special Article</category>
      <title><![CDATA[Efficacy and Adverse Effects of Atypical Antipsychotics for Dementia: Meta-analysis of Randomized, Placebo-Controlled Trials]]></title>
      <description><![CDATA[Objective: Atypical antipsychotic medications are widely used to treat delusions, aggression, and agitation in people with Alzheimer disease (AD) and other dementia. Several clinical trials have not shown efficacy, and there have been concerns about adverse events. The objective of this study was to assess the evidence for efficacy and adverse events of atypicals for people with dementia
Methods: MEDLINE, the Cochrane Register of Controlled Trials, meetings, presentations, and information obtained from sponsors were used in this study. Published and unpublished randomized, placebo-controlled, double-blind, parallel-group trials in patients with AD or dementia of atypical antipsychotics marketed in the United States were studied. Clinical and trials characteristics, outcomes, and adverse events were extracted. Data were checked by a second reviewer. Fifteen trials including 16 contrasts of atypical antipsychotics with placebo met selection criteria: aripiprazole (k = 3), olanzapine (k = 5), quetiapine (k = 3), and risperidone (k = 5). A total of 3,353 patients were randomized to drug and 1,757 to placebo. Standard meta-analysis methods were used to summarize outcomes.
Results: Quality of the reporting of trials varied. Efficacy on rating scales was observed by meta-analysis for aripiprazole and risperidone, but not for olanzapine. Response rates were frequently not reported. There were smaller effects for less severe dementia, outpatients, and patients selected for psychosis. Approximately one-third dropped out without overall differences between drug and placebo. Adverse events were mainly somnolence and urinary tract infection or incontinence across drugs, and extrapyramidal symptoms or abnormal gait with risperidone or olanzapine. Cognitive test scores worsened with drugs. There was no evidence for increased injury, falls, or syncope. There was a significant risk for cerebrovascular events, especially with risperidone; increased risk for death overall was reported elsewhere.
Conclusions: Small statistical effect sizes on symptom rating scales support the evidence for the efficacy of aripiprazole and risperidone. Incomplete reporting restricts estimates of response rates and clinical significance. Dropouts and adverse events further limit effectiveness. Atypicals should be considered within the context of medical need and the efficacy and safety of alternatives. Individual patient meta-analyses are needed to better assess clinical significance and effectiveness.
Copyright (C) 2006 American Association for Geriatric Psychiatry]]></description>
      <pubDate>3/1/2006 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200603000-00004</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/01000/The_Montgomery_Asberg_Depression_Rating_Scale_and.7.aspx</link>
      <author>Leontjevas, Ruslan; van Hooren, Susan; Mulders, Ans</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[The Montgomery-Asberg Depression Rating Scale and the Cornell Scale for Depression in Dementia: A Validation Study With Patients Exhibiting Early-Onset Dementia]]></title>
      <description><![CDATA[Objective: To investigate some validity measures of Montgomery-Asberg Depression Rating Scale (MADRS) and Cornell Scale for Depression in Dementia (CSDD) in patients with early-onset dementia (EOD).
Design: Cross-sectional design.
Setting: Nursing home.
Participants: A sample of 63 inpatients with EOD.
Measurements: Participants were assessed for the presence of clinical depression using the Provisional Diagnostic Criteria for Depression in Alzheimer Disease. Caregivers were administered the MADRS and CSDD, and two subscales from the Neuropsychiatric Inventory (NPI).
Results: Depressed patients had higher scores on 6 of the 10 MADRS items and on 3 of the 19 CSDD items than nondepressed patients. Receiver operating characteristic curve analysis revealed a larger area under the curve for MADRS (0.87) than for CSDD (0.76), the difference was significant (p = 0.044). A CSDD optimal cutoff score of "5/6" yielded a sensitivity of 0.833 and a specificity of 0.567. A MADRS cutoff score of "19/20" yielded the highest sum of sensitivity (0.750) and specificity (0.843). A MADRS score of "14/15" with almost the same sum of sensitivity and specificity had a higher sum of sensitivity and a negative predictive value than "19/20." Both scales correlated with the NPI subscales depression/dysphoria (MADRS: rs = 0.70; CSDD: rs = 0.62) and apathy/indifference (MADRS: rs = 0.59; CSDD: rs = 0.50).
Conclusion: The MADRS and CSDD performed well in distinguishing depressed from nondepressed EOD patients and showed good congruent validity. The scales may be used to assess depressive symptoms in EOD. The MADRS intensity grades may be used for development or refinement of depression scales in (early onset) dementia.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>1/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200901000-00007</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Knowledge,_Detection,_and_Reporting_of_Abuse_by.3.aspx</link>
      <author>Cooper, Claudia; Selwood, Amber; Livingston, Gill</author>
      <category>Clinical Review Article</category>
      <title><![CDATA[Knowledge, Detection, and Reporting of Abuse by Health and Social Care Professionals: A Systematic Review]]></title>
      <description><![CDATA[The authors systematically reviewed the 32 articles fitting predetermined criteria that investigated health and social care professionals' knowledge, detection, and reporting of elder abuse. These included 21 surveys (of 5,325 professionals), nine analyses of elder abuse reports to statutory bodies, and two intervention studies. Compatible results were pooled in a meta-analysis. Professionals consistently underestimated the prevalence of elder abuse. Only a quarter of U.S. physicians were aware of American Medical Association elder abuse guidelines. The authors found that 33.7% (95% confidence interval: 27.5-40.1) of health care professionals had detected a case of older adult abuse in the last year. This was slightly higher when only studies judged to be most representative, which all surveyed physicians, were included (39.9% [23.4-57.7]). About half of the detected abuse cases were reported. Professionals who recalled receiving any training on abuse were no more likely to detect abuse than those who stated they had not had training, although they were more likely to report the abuse if they detected it. Interventions that taught professionals about the management of abuse by face-to-face training were effective in increasing knowledge, whereas giving written information was not. No intervention studies have investigated whether detection and reporting of abuse can also be increased through education. Current evidence would support the development and testing of interventions to increase professionals' detection and reporting of abuse. These would encourage them to ask older people about abuse, and address professionals' concerns about the impact of reporting on therapeutic relationships, victims; and legal consequences for the reporter.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00003</guid>
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      <link>http://pdfs.journals.lww.com/ajgponline/9000/00000/Attempted_Suicide_in_the_Elderly__Characteristics.99905.pdf</link>
      <author>Wiktorsson, Stefan; Runeson, Bo; Skoog, Ingmar; Östling, Svante; Waern, Margda</author>
      <category>Regular Research Articles:  PDF Only</category>
      <title><![CDATA[Attempted Suicide in the Elderly: Characteristics of Suicide Attempters 70 Years and Older and a General Population Comparison Group]]></title>
      <description><![CDATA[Objective: To identify factors associated with attempted suicide in the elderly.
Design: Social, psychological, and psychiatric characteristics were compared in suicide attempters (70 years and older) and a representative population sample.
Settings: Emergency departments at five hospitals in western Sweden and a representative sample of the elderly population.
Participants: Persons with Mini Mental State Examination (MMSE) score <15 were excluded. One hundred forty persons who sought hospital treatment after a suicide attempt were eligible and 103 participated (57 women, 46 men, and mean age 80 years). Comparison subjects matched for gender and age group (N = 408) were randomly selected among participants in our general population studies.
Measurements: Symptoms were rated with identical instruments in cases and comparison subjects. The examination included the MMSE and tests of short- and long-term memory, abstract thinking, aphasia, apraxia, and agnosia. Depressive symptomatology was measured using the Montgomery-Asberg Depression Rating Scale, and major and minor depressions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, using symptom algorithms.
Results: Factors associated with attempted suicide included being unmarried, living alone, low education level, history of psychiatric treatment, and previous suicide attempt. There was no association with dementia. Odds ratios were increased for both major (odds ratio [OR]: 47.4, 95% confidence interval [CI]: 19.1-117.7) and minor (OR: 2.6, 95% CI: 1.5-4.7) depressions. An association was observed between perceived loneliness and attempted suicide; this relationship was independent of depression (OR: 2.8, 95% CI: 1.3-6.1).
Conclusions: Observed associations mirrored those previously shown for completed suicide. Results may help to inform clinical decisions regarding suicide risk evaluation in this vulnerable and growing age group.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/17/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-900000000-99905</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Serotonergic_System_Genes_in_Psychosis_of.4.aspx</link>
      <author>Ramanathan, Seethalakshmi; Glatt, Stephen J.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Serotonergic System Genes in Psychosis of Alzheimer Dementia: Meta-Analysis]]></title>
      <description><![CDATA[Objective: The authors attempted to understand the role of two serotonin system genes, HTR2A and SLC6A4, on psychosis associated with Alzheimer dementia (AD).
Method: Relevant published studies were assessed, and their data were meta-analyzed to determine pooled odds ratios (ORs) that were assessed for heterogeneity. Additional robustness checks were performed to assess for publication bias and any undue influence from a single study. Finally, the number of studies required to invalidate positive findings was determined.
Results: The C allele of HTR2A emerged as a significant risk factor for psychosis, with an allelic OR of 2.191 that increased to 5.143 for the homozygous CC genotype. The SLC6A4 polymorphism was not reliably associated with either psychosis or delusions.
Conclusions: The strong and robust positive association that was noted between the C allele of HTR2A and psychosis suggests that the HTR2A T102C polymorphism is a significant risk factor for psychosis of AD.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00004</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2008/10000/Preferences_of_Older_and_Younger_Adults_With.6.aspx</link>
      <author>O'Neal, Erica L.; Adams, Jared R.; McHugo, Gregory J.; Van Citters, Aricca D.; Drake, Robert E.; Bartels, Stephen J.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Preferences of Older and Younger Adults With Serious Mental Illness for Involvement in Decision-Making in Medical and Psychiatric Settings]]></title>
      <description><![CDATA[Objectives: There is a growing call for greater consumer participation in health care encounters. Prior research suggests that older age is associated with a greater preference for a more passive role in clinical decision-making, yet little is known about preferences for persons with mental illness. This pilot study compared preferences for involvement in decision-making between older and younger adults with serious mental illness.
Design: Cross-sectional observational survey.
Participants: The authors surveyed 33 older adults (>=50 years) and 32 younger adults (<50 years) with serious mental illness from two mental health center clinics and one residential facility for their preferences on decision-making with their psychiatrists and primary care providers.
Measurements: Measures included the Control Preferences Scale, the Autonomy Preference Index, and the Decision Self-Efficacy Scale.
Results: Contrary to our primary hypothesis, older adults reported a stronger desire for involvement in decision-making compared with younger adults. However, both age groups were similar in their desire for information to aid in decision-making. The majority in both age groups also preferred a collaborative role with a psychiatrist for medication decisions, an autonomous role for decisions related to psychosocial interventions, and a passive role with their primary care provider. Older and younger adults expressed similar decision self-efficacy.
Conclusion: Our study suggests that older persons with serious mental illness have a stronger desire for involvement in decision-making than younger consumers. Additionally, role preference for involvement in decision-making varies across different clinical decisions and for psychopharmacological versus psychosocial interventions.
Copyright (C) 2008 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2008 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200810000-00006</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/06000/Age_at_Onset_of_Generalized_Anxiety_Disorder_in.4.aspx</link>
      <author>Chou, Kee-Lee</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Age at Onset of Generalized Anxiety Disorder in Older Adults]]></title>
      <description><![CDATA[Objectives: To investigate the distribution of age at onset of generalized anxiety disorder (GAD) as well as the possible differences in demographic and psychosocial risk factors, the comorbidities of other psychiatric disorders, health status, and healthcare utilization in respondents suffering from early onset GAD (<50 years) and late-onset GAD ([greater than over equal to]50 years) in adults aged 55 or above.
Design: Cross-sectional observational study.
Setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (2001-2002), a national representative survey of the noninstitutionalized U.S. household population.
Participants: The 439 respondents aged 55 or above who participated in the NESARC and were found to have lifetime GAD.
Measurements: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version was used to assess psychiatric disorders, and the Medical Outcomes study 12-item Short Form questionnaire was included.
Results: The distribution of age at onset appeared normally distributed for respondents with current or lifetime GAD. Among respondents with lifetime GAD, early-onset cases tended to be younger with a higher education level and to have a significantly higher prevalence of panic disorder (current and lifetime), lifetime social phobia, current bipolar I disorder, lifetime alcohol abuse or dependence, or lifetime nicotine dependence than late-onset cases. In addition, respondents presenting with late-onset GAD were more likely to report hypertension and poor health-related quality of life than those with early-onset GAD.
Conclusion: About half of the older adult respondents with GAD reported a late onset and, among those with lifetime GAD, late-onset GAD was distinguished from early-onset GAD by a more frequent association with the presence of hypertension and a poorer health-related quality of life.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>6/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200906000-00004</guid>
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      <link>http://pdfs.journals.lww.com/ajgponline/2009/03001/2009_AAGP_Annual_Meeting_Abstracts.1.pdf</link>
      <category>2009 AAGP Annual Meeting Abstracts:  PDF Only</category>
      <title><![CDATA[2009 AAGP Annual Meeting Abstracts]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>3/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200903001-00001</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Influence_of_the_MTHFR_C677T_Polymorphism_on.5.aspx</link>
      <author>Hong, Edmund D.; Taylor, Warren D.; McQuoid, Douglas R.; Potter, Guy G.; Payne, Martha E.; Ashley-Koch, Allison; Steffens, David C.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Influence of the MTHFR C677T Polymorphism on Magnetic Resonance Imaging Hyperintensity Volume and Cognition in Geriatric Depression]]></title>
      <description><![CDATA[Objective: The 5,10-methylenetetrahydrofolate reductase gene (MTHFR) has been linked to unipolar major depressive disorder (MDD) and magnetic resonance imaging (MRI) hyperintensities. The authors examined the relationship between the MTHFR C677T polymorphism (C677T) and a) geriatric depression, b) MRI hyperintense lesion volume, and c) neurocognitive test performance.
Design: Cross-sectional.
Setting: Duke University Medical Center.
Participants: Depressed (N = 178) and comparison (N = 85) elderly subjects.
Measurements: Subjects had blood drawn to assess MTHFR genotype, were imaged by MRI to determine their white matter hyperintense lesion (WML) and gray matter hyperintense lesion (GML) volume, and assessed using a comprehensive neurocognitive battery evaluating multiple domains of function. Linear regression models were fit to test the effect of genotype, a depression by genotype interaction, and an age by genotype interaction on both hyperintense lesion volume measures and neurocognitive task performance.
Results: The MTHFR C677T genotype by age interaction term was significantly associated with MRI WML volume (p = 0.0175); however, this relationship was no longer statistically significant when WML volumes underwent a log transformation to produce a more normal distribution. The 677T allele was neither more frequent in depressed subjects nor associated with either gray matter hyperintensity volume or neurocognitive test performance.
Conclusions: MTHFR genotype affects the relationship between age and WML volume where individuals who carry the 677T allele exhibit greater WML volume by age, although this relationship should be verified given the failure to replicate the finding using transformed WML volumes. Genotype was not related to GML volume, cognitive function, or presence of depression, although demographic differences could account for this negative finding.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00005</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Genetic_Biomarkers_for_Dementia_Related_Processes_.2.aspx</link>
      <author>Swantek, Sandra S.; Csernansky, John G.</author>
      <category>Editorial</category>
      <title><![CDATA[Genetic Biomarkers for Dementia-Related Processes: How Close are the Authors?]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00002</guid>
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      <link>http://pdfs.journals.lww.com/ajgponline/9000/00000/Late_Life_Depression,_Mild_Cognitive_Impairment,.99926.pdf</link>
      <author>Panza, Francesco; Frisardi, Vincenza; Capurso, Cristiano; D'Introno, Alessia; Colacicco, Anna M.; Imbimbo, Bruno P.; Santamato, Andrea; Vendemiale, Gianluigi; Seripa, Davide; Pilotto, Alberto; Capurso, Antonio; Solfrizzi, Vincenzo</author>
      <category>Article:  PDF Only</category>
      <title><![CDATA[Late-Life Depression, Mild Cognitive Impairment, and Dementia: Possible Continuum?]]></title>
      <description><![CDATA[Clinical and epidemiologic research has focused on the identification of risk factors that may be modified in predementia syndromes, at a preclinical and early clinical stage of dementing disorders, with specific attention to the role of depression. Our goal was to provide an overview of these studies and more specifically to describe the prevalence and incidence of depression in individuals with mild cognitive impairment (MCI), the possible impact of depressive symptoms on incident MCI, or its progression to dementia and the possible mechanisms behind the observed associations. Prevalence and incidence of depressive symptoms or syndromes in MCI vary as a result of different diagnostic criteria and different sampling and assessment procedures. The prevalence of depression in individuals with MCI was higher in hospital-based studies (median: 44.3%, range: 9%-83%) than in population-based studies (median: 15.7%, range: 3%-63%), reflecting different referral patterns and selection criteria. Incidence of depressive symptoms varied from 11.7 to 26.6/100 person-years in hospital-based and population-based studies. For depressed normal subjects and depressed patients with MCI, the findings on increased risk of incident MCI or its progression to dementia were conflicting. These contrasting findings suggested that the length of the follow-up period, the study design, the sample population, and methodological differences may be central for detecting an association between baseline depression and subsequent development of MCI or its progression to dementia. Assuming that MCI may be the earliest identifiable clinical stage of dementia, depressive symptoms may be an early manifestation rather than a risk factor for dementia and Alzheimer disease, arguing that the underlying neuropathological condition that causes MCI or dementia also causes depressive symptoms. In this scenario, at least in certain subsets of elderly patients, late-life depression, MCI, and dementia could represent a possible clinical continuum.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/17/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-900000000-99926</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2001/05000/The_Association_of_Late_Life_Depression_and.4.aspx</link>
      <author>Lenze, Eric J.; Rogers, Joan C.; Martire, Lynn M.; Mulsant, Benoit H.; Rollman, Bruce L.; Dew, Mary Amanda; Schulz, Richard; Reynolds, Charles F. III</author>
      <category>Special Article</category>
      <title><![CDATA[The Association of Late-Life Depression and Anxiety With Physical Disability: A Review of the Literature and Prospectus for Future Research]]></title>
      <description><![CDATA[Depression and anxiety disorders are associated with excess disability. The authors searched the recent geriatric literature for studies associating late-life depression or anxiety with physical disability. Studies showed depression in old age to be an independent risk factor for disability; similarly, disability was found to be a risk factor for depression. Anxiety in late life was also found to be a risk factor for disability, although not necessarily independently of depression. Increased disability due to depression is only partly explained by differences in socioeconomic measures, medical conditions, and cognition. Physical disability improves with treatment for depression; comparable studies have not been done for anxiety. The authors discuss how these findings inform current concepts of physical disability and discuss the implications for future intervention studies of late-life depression and anxiety disorders.
Copyright (C) 2001 American Association for Geriatric Psychiatry]]></description>
      <pubDate>5/1/2001 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200105000-00004</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Distress_of_Caregivers_of_Older_Adults_Receiving.11.aspx</link>
      <author>Onder, Graziano; Finne-Soveri, Harriet; Soldato, Manuel; Liperoti, Rosa; Lattanzio, Fabrizia; Bernabei, Roberto; Landi, Francesco</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Distress of Caregivers of Older Adults Receiving Home Care in European Countries: Results From the AgeD in HOme Care Study]]></title>
      <description><![CDATA[Objective: To identify factors associated with distress of caregivers of home care patients in Europe and to assess whether caregivers response to distress varies among countries.
Design and Setting: Cross-sectional study among older adults receiving home care in 11 European countries.
Participants: A total of 3,449 older adults receiving home care in Europe.
Measurement: Caregiver distress was assessed by asking whether caregiver was distressed, angry, depressed, or in conflict because of caring for the participant.
Results: Mean age of study participants was 82.4 years, and distress was present in 7.5% of their caregivers. In all the country sample, number of depressive symptoms (OR 1.38, 95% CI: 1.27-1.49), cognitive performance scale score (OR 1.19, 95% CI: 1.10-1.30), number of impaired Activities of Daily Living (OR 1.36, 95% CI: 1.25-1.47), and number of behavioral symptoms (OR 1.28, 95% CI: 1.04-1.58) were significantly associated with caregivers distress. These associations were consistent among caregivers in all countries. Overall, 295 caregivers (8.6%) felt that participant would be better off in another living environment, and 1,444 (41.9%) caregivers were willing to increase help. Despite an elevated rate of distress, a low proportion of caregivers in Italy (3.0%), Germany (6.1%), and France (5.5%) felt that participants would be better off in another living environment. By contrast, in countries with lower rate of distress, as Iceland and the Netherlands, this rate was more elevated (15.5% and 20.6%, respectively).
Conclusion: Distress of caregivers is associated with patient cognitive and functional status, depressive, and behavioral symptoms, and there are national differences in the response to distress.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00011</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/11000/New_Research_on_Aging_Minority_Groups_is_Timely.2.aspx</link>
      <author>Cañive, José M.; Escobar, Javier I.</author>
      <category>Editorial</category>
      <title><![CDATA[New Research on Aging Minority Groups is Timely and Incorporates State of the Art Methodologies]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200911000-00002</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/11000/AAGP_Position_Statement__Disaster_Preparedness_for.3.aspx</link>
      <author>Sakauye, Kenneth M.; Streim, Joel E.; Kennedy, Gary J.; Kirwin, Paul D.; Llorente, Maria D.; Schultz, Susan K.; Srinivasan, Shilpa</author>
      <category>Special Article</category>
      <title><![CDATA[AAGP Position Statement: Disaster Preparedness for Older Americans: Critical Issues for the Preservation of Mental Health]]></title>
      <description><![CDATA[The Disaster Preparedness Task Force of the American Association for Geriatric Psychiatry was formed after Hurricane Katrina devastated New Orleans to identify and address needs of the elderly after the disaster that led to excess health disability and markedly increased rates of hopelessness, suicidality, serious mental illness (reported to exceed 60% from baseline levels), and cognitive impairment. Substance Abuse and Mental Health Services Administration (SAMHSA) outlines risk groups which fail to address later effects from chronic stress and loss and disruption of social support networks. Range of interventions recommended for Preparation, Early Response, and Late Response reviewed in the report were not applied to elderly for a variety of reasons. It was evident that addressing the needs of elderly will not be made without a stronger mandate to do so from major governmental agencies (Federal Emergency Management Agency [FEMA] and SAMHSA). The recommendation to designate frail elderly and dementia patients as a particularly high-risk group and a list of specific recommendations for research and service and clinical reference list are provided.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200911000-00003</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2006/05000/What_Is_the_Best_Dementia_Screening_Instrument_for.3.aspx</link>
      <author>Brodaty, Henry; Low, Lee-Fay; Gibson, Louisa; Burns, Kim</author>
      <category>Clinical Review</category>
      <title><![CDATA[What Is the Best Dementia Screening Instrument for General Practitioners to Use?]]></title>
      <description><![CDATA[Objective: The objective of this study was to review existing dementia screening tools with a view to informing and recommending suitable instruments to general practitioners (GPs) based on their performance and practicability for general practice.
Method: A systematic search of pre-MEDLINE, MEDLINE, PsycINFO, and the Cochrane Library Database was undertaken. Only available full-text articles about dementia screening instruments written in English or with an English version were included. Articles using a translation of an English language instrument were excluded unless validated in a general practice, community, or population sample.
Results: The General Practitioner Assessment of Cognition (GPCOG), Mini-Cog, and Memory Impairment Screen (MIS) were chosen as most suitable for routine dementia screening in general practice. The GPCOG, Mini-Cog, and MIS were all validated in community, population, or general practice samples, are easy to administer, and have administration times of 5 minutes or less. They also have negative predictive validity and misclassification rates, which do not differ significantly from those of the Mini-Mental Status Examination.
Conclusions: It is recommended that GPs consider using the GPCOG, Mini-Cog, or MIS when screening for cognitive impairment or for case detection.
Copyright (C) 2006 American Association for Geriatric Psychiatry]]></description>
      <pubDate>5/1/2006 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200605000-00003</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/07000/The_Personality_Domains_and_Styles_of_the.8.aspx</link>
      <author>Weiss, Alexander; Sutin, Angelina R.; Duberstein, Paul R.; Friedman, Bruce; Bagby, R Michael; Costa, Paul T. Jr</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[The Personality Domains and Styles of the Five-Factor Model are Related to Incident Depression in Medicare Recipients Aged 65 to 100]]></title>
      <description><![CDATA[Objectives: Few prospective studies have examined personality and depression in older adults. The authors investigated whether the Five-Factor Model of personality traits-Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness-and trait combinations (styles) are related to incident major or minor depression.
Participants/Setting: Prospective data were gathered on a community sample of 512 older adults with disability and a history of significant health care utilization who were enrolled in a Medicare Demonstration Project.
Measurements: Depression and personality traits and styles were assessed at baseline; depression was assessed again at approximately 12 and 22 months.
Design: Participants who developed incident major depression were compared with those free of depression at all three assessments. Similar analyses were done for minor depression.
Results: High Neuroticism and low Conscientiousness were risk factors for both major and minor depression. Combinations of high Neuroticism with low or high Extraversion or high Openness conferred risk for major depression. Other novel findings for major depression revealed new trait combinations of low Conscientiousness with low or high Extraversion, high Openness, or low Agreeableness. Three trait combinations, all involving low Conscientiousness, predicted risk for minor depression: high Neuroticism, high Agreeableness, and low Openness.
Conclusion: The present findings highlight the importance of examining combinations of personality traits or personality styles when identifying those who are most at-risk for geriatric depression. Since other personality domains may modify the risk related to high Neuroticism and low Conscientiousness, the prevention, diagnosis, and treatment of depression could be greatly improved by assessing older patients not only on all five domains of personality but in terms of their combinations.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200907000-00008</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/06000/The_Burden_of_Late_Life_Generalized_Anxiety.6.aspx</link>
      <author>Porensky, Emily K.; Dew, Mary Amanda; Karp, Jordan F.; Skidmore, Elizabeth; Rollman, Bruce L.; Shear, M Katherine; Lenze, Eric J.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[The Burden of Late-Life Generalized Anxiety Disorder: Effects on Disability, Health-Related Quality of Life, and Healthcare Utilization]]></title>
      <description><![CDATA[Objective: To describe the burden of Generalized Anxiety Disorder (GAD), a common anxiety disorder in older adults.
Design: Cross-sectional.
Setting: Late-life depression and anxiety research clinic in Pittsburgh, PA.
Participants: One hundred sixty-four older adults with GAD and 42 healthy comparison participants with no lifetime history of psychiatric disorder were recruited from primary care and mental health settings as well as advertisements.
Measurements: Participants were evaluated with the Late Life Function and Disability Index to assess disability, the MOS 36-Item Short Form Survey Instrument to assess health-related quality of life (HRQOL), and the Cornell Service Index to assess healthcare utilization.
Results: Older adults with GAD were more disabled, had worse HRQOL, and had greater healthcare utilization, than nonanxious comparison participants, even in the absence of psychiatric comorbidity. After controlling for medical burden and depressive symptoms, higher severity of anxiety symptoms was associated with greater disability and poorer HRQOL in several domains. The greatest decrements in HRQOL and function were observed in measures assessing role functioning, including social function.
Conclusion: This study, the largest ever of GAD in older adults, provides evidence of the significant burden of this disorder in late life. Given the high prevalence and chronicity of GAD in the elderly, these data provide a public health imperative for finding and implementing effective management strategies for this typically undiagnosed and untreated disorder.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>6/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200906000-00006</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Obesity_and_Metabolic_Syndrome_Increase_the_Risk.10.aspx</link>
      <author>Almeida, Osvaldo P.; Calver, Janine; Jamrozik, Konrad; Hankey, Graeme J.; Flicker, Leon</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Obesity and Metabolic Syndrome Increase the Risk of Incident Depression in Older Men: The Health in Men Study]]></title>
      <description><![CDATA[Background: Obesity has been associated with increased risk of prevalent depression among young and middle-aged adults, but the association between obesity (and its various measures, including the metabolic syndrome [MetS]) and incident depression has not been examined adequately in the elderly.
Objectives: This study evaluated the association between various measures of obesity and incident depression over a 10-year period in a large cohort of community-based older men.
Methods: The authors recruited 12,216 men aged 65-84 years living in Perth, Australia, between 1996 and 1998, and measured their height, weight, waist and hip circumference, and blood pressure. Participants also completed a questionnaire that included information about the clinical diagnosis and treatment for diabetes, hypertension, and high cholesterol or triglycerides. The authors then used the Western Australian Linked Data System to retrieve information about the following ICD-10 diagnoses between January 1, 1966, and December 31, 2006: depressive episode, recurrent depressive disorder, and dysthymia.
Results: The authors excluded 150 men from these analyses because of prior history of depression or missing data. The mean age of our 12,066 participants was 72 +/- 4 years at the time of recruitment, and they were followed up for an average of 8 +/- 2 years. There were 3,623 deaths during follow-up, and 481 men received the diagnosis of depression. The incidence of depression was 5 per 1,000 person-years. Adjusted Cox proportional hazard models showed that men with body mass index (BMI) >=30 had a 31% (95% confidence interval [CI] = 5%-64%) increase in the risk of depression compared with that of nonobese men (BMI <30). The association between depression and waist circumference >=102 cm and waist/hip >=1 did not reach statistical significance. Men with MetS at the time of recruitment had a 137% (95% CI = 60%-251%) increase in the adjusted risk of incident depression.
Conclusions: Our results indicate that obesity and MetS are associated with an increase in the risk of incident depression among older men. If this association is truly causal, reducing the prevalence of obesity and MetS could potentially lead to a decline in the prevalence and incidence of depression in later life.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00010</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2003/01000/Problem_Solving_Therapy_Versus_Supportive_Therapy.7.aspx</link>
      <author>Alexopoulos, George S.; Raue, Patrick; Areán, Patricia</author>
      <category>Regular Research Article</category>
      <title><![CDATA[Problem-Solving Therapy Versus Supportive Therapy in Geriatric Major Depression With Executive Dysfunction]]></title>
      <description><![CDATA[OBJECTIVE: The authors compared the efficacy of problem-solving therapy (PST) and supportive therapy (ST) in a group of elderly subjects with impairment in executive functions. This group was targeted because it has been shown to be at the risk for poor response to pharmacotherapy.
METHODS: A total of 25 elderly subjects with major depression and abnormal scores in initiation/perseveration and response inhibition tasks were randomly assigned to receive weekly sessions of PST or ST for 12 weeks. The subjects were systematically evaluated by raters blind to the study hypotheses.
RESULTS: PST was more effective than ST in leading to remission of depression, fewer post-treatment depressive symptoms, and less disability. A substantial part of the change in depression and disability was explained by the subjects' improvement of skills in generating alternatives and in decision-making.
CONCLUSION: This preliminary study suggests that PST is effective in reducing depressive symptoms and disability in elderly patients with major depression and executive dysfunction. If these findings are confirmed, PST may become an important therapeutic alternative for a patient population who may otherwise remain symptomatic and disabled.
Copyright (C) 2003 American Association for Geriatric Psychiatry]]></description>
      <pubDate>1/1/2003 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200301000-00007</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2002/03000/Provisional_Diagnostic_Criteria_for_Depression_of.4.aspx</link>
      <author>Olin, Jason T.; Katz, Ira R.; Meyers, Barnett S.; Schneider, Lon S.; Lebowitz, Barry D.</author>
      <category>Special Article</category>
      <title><![CDATA[Provisional Diagnostic Criteria for Depression of Alzheimer Disease: Rationale and Background]]></title>
      <description><![CDATA[This review provides the rationale and background for the development of diagnostic criteria for depression of Alzheimer disease (AD), including risk factors and neurobiological correlates, epidemiology, and clinical characteristics, along with course, assessment, treatment, economics, a description of the criteria, and future research directions. Overall, there is substantial research to suggest that the depression that may co-occur with AD is different from other depressive disorders. Further research is needed to better define core symptoms, clinical course, and efficacy of treatments.
Copyright (C) 2002 American Association for Geriatric Psychiatry]]></description>
      <pubDate>3/1/2002 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200203000-00004</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/10000/Executive_Function_in_Self_Neglecting_Adult.12.aspx</link>
      <author>Schillerstrom, Jason E.; Salazar, Ricardo; Regwan, Heather; Bonugli, Rebecca J.; Royall, Donald R.</author>
      <category>Brief Report</category>
      <title><![CDATA[Executive Function in Self-Neglecting Adult Protective Services Referrals Compared With Elder Psychiatric Outpatients]]></title>
      <description><![CDATA[Objective: Psychometric performance, with an emphasis on executive function, was compared between adult protective services (APS) clients referred for a decision-making capacity consultation and elders seen in an outpatient geriatric psychiatry clinic.
Methods: The authors performed a retrospective medical records review extracting general, executive, and visuospatial cognitive performance and depression symptom burden in APS referrals (N = 63) and geriatric psychiatry outpatients (N = 58).
Results: After adjusting for age and education, APS clients had worse mean executive performance as measured by the Executive Interview (24.3 [SD 6.4] versus 17.3 [SD 7.6], F[1, 87] 15.7, p <0.001) and CLOX1 (7.4 [SD 4.0] versus 9.3 [SD 4.2], F[1, 92] 4.79, p = 0.03). There were no differences in visuospatial or general cognitive abilities. The self-neglect subgroup had worse cognitive performance on each measure than other APS referrals.
Conclusions: Compared with routine geriatric psychiatry patients, APS referrals are more likely to be executively impaired but less depressed. General cognitive screens do not distinguish these two groups.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>10/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200910000-00012</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/06000/Insomnia_in_Older_Adults_With_Generalized_Anxiety.5.aspx</link>
      <author>Brenes, Gretchen A.; Miller, Michael E.; Stanley, Melinda A.; Williamson, Jeff D.; Knudson, Mark; McCall, W Vaughn</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Insomnia in Older Adults With Generalized Anxiety Disorder]]></title>
      <description><![CDATA[Objectives: The purposes of this study are to determine the frequency and severity of insomnia symptoms and related complaints experienced by older adults with Generalized Anxiety Disorder (GAD) and compare them with older adults without GAD; compare insomnia symptoms among older adults with GAD with and without comorbid depression; determine if there are age differences in insomnia severity among people with GAD; and determine if there are differences in insomnia severity between older adults with GAD and older adults diagnosed with insomnia.
Design: Cross-sectional.
Setting: Participants were recruited through primary care clinics, advertisements, and mass mailings.
Participants: One hundred ten older adults; 31 with GAD, 25 with GAD and depression, 33 worried well, and 21 with no psychiatric diagnosis.
Measurements: Psychiatric diagnosis, sleep disturbance, and health.
Results: Participants with GAD with and without comorbid depression reported significantly greater sleep disturbance severity than participants with no psychiatric diagnosis and the worried well. There were no differences in sleep disturbances between older adults with GAD only and older adults with comorbid GAD and depression. The severity of sleep disturbance reported by older participants with GAD was greater than reports by young and middle-aged participants with GAD, and comparable with reports by older adults with a diagnosis of insomnia.
Conclusions: Ninety percent of older adults with GAD report dissatisfaction with sleep and the majority report moderate to severe insomnia. These findings support the assessment of sleep disturbances within the context of late-life GAD.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>6/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200906000-00005</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/08000/Late_Life_Depression,_Cortisol,_and_the_Metabolic.12.aspx</link>
      <author>Vogelzangs, Nicole; Beekman, Aartjan T.F.; Dik, Miranda G.; Bremmer, Marijke A.; Comijs, Hannie C.; Hoogendijk, Witte J.G.; Deeg, Dorly J.H.; Penninx, Brenda W.J.H.</author>
      <category>Brief Report</category>
      <title><![CDATA[Late-Life Depression, Cortisol, and the Metabolic Syndrome]]></title>
      <description><![CDATA[Objectives: High-cortisol levels in depressed persons could possibly give rise to the metabolic syndrome. This study investigated cross-sectionally whether depression and high-cortisol levels increased the odds of metabolic syndrome in an older community-based sample.
Methods: In 1,212 participants, aged >=65 years, enrolled in the Longitudinal Aging Study Amsterdam, depression (major [1-month diagnosis] or subthreshold [no 1-month diagnosis, but symptoms]), metabolic syndrome (modified Adult Treatment Panel III criteria), and free cortisol index (total serum cortisol/cortisol binding globulin) were assessed.
Results: Major depression was not associated with the metabolic syndrome (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.54-2.49), but subthreshold depression was associated with a decreased odds (OR = 0.55, 95% CI = 0.37-0.82). Persons with higher levels of free cortisol index showed a higher odds of metabolic syndrome (OR per standard deviation increase = 1.21, 95% CI = 1.06-1.39).
Conclusions: As persons with high-cortisol levels more often had metabolic syndrome, hypercortisolemia within depressed persons may increase the risk of metabolic syndrome.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>8/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200908000-00012</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2003/03000/Agitation_and_Depression_in_Frail_Nursing_Home.14.aspx</link>
      <author>Bartels, Stephen J.; Horn, Susan D.; Smout, Randall J.; Dums, Aricca R.; Flaherty, Ellen; Jones, Judith K.; Monane, Mark; Taler, George A.; Voss, Anne C.</author>
      <category>Regular Research Article</category>
      <title><![CDATA[Agitation and Depression in Frail Nursing Home Elderly Patients With Dementia: Treatment Characteristics and Service Use]]></title>
      <description><![CDATA[OBJECTIVE: The authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia.
METHODS: Authors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression.
RESULTS: Compared with the other subgroups, frail elderly patients with dementia complicated by mixed agitation and depression have the highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications. Depression in dementia (either alone or mixed with agitation) was associated with greater prevalence of pain.
CONCLUSIONS: Dementia complicated by mixed agitation and depression accounts for over one-third of complicated dementia and is associated with multiple psychiatric and medical needs, intensive pharmacological treatment, and use of high-cost services. Research should target this complex, high-risk group to develop appropriate diagnostic criteria and effective treatment interventions.
Copyright (C) 2003 American Association for Geriatric Psychiatry]]></description>
      <pubDate>3/1/2003 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200303000-00014</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2009/01000/Brain_Lithium_Levels_and_Effects_on_Cognition_and.3.aspx</link>
      <author>Forester, Brent P.; Streeter, Chris C.; Berlow, Yosef A.; Tian, Hua; Wardrop, Megan; Finn, Chelsea T.; Harper, David; Renshaw, Perry F.; Moore, Constance M.</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Brain Lithium Levels and Effects on Cognition and Mood in Geriatric Bipolar Disorder: A Lithium-7 Magnetic Resonance Spectroscopy Study]]></title>
      <description><![CDATA[Objectives: The authors investigated the relationship between brain lithium, serum lithium and age in adult subjects treated with lithium. In addition, the authors investigated the association between brain lithium and serum lithium with frontal lobe functioning and mood in a subgroup of older subjects.
Design: Cross-sectional assessment.
Setting: McLean Hospital's Geriatric Psychiatry Research Program and Brain Imaging Center; The Division of Psychiatry, Boston University School of Medicine.
Participants: Twenty-six subjects, 20 to 85 years, with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-TR bipolar disorder (BD), currently treated with lithium.
Measurements: All subjects had measurements of mood (Hamilton Depression Rating Scale [HDRS] and Young Mania Rating Scale) and serum and brain lithium levels. Brain lithium levels were assessed using lithium Magnetic Resonance Spectroscopy. Ten subjects older than 50 years also had assessments of frontal lobe functioning (Stroop, Trails A and B, Wis. Card Sorting Task).
Results: Brain lithium levels correlated with serum lithium levels for the group as a whole. However, this relationship was not present for the group of subjects older than 50. For these older subjects elevations in brain (but not serum) lithium levels were associated with frontal lobe dysfunction and higher HDRS scores. The higher HDRS were associated with increased somatic symptoms.
Conclusion: Frontal lobe dysfunction and elevated depression symptoms correlating with higher brain lithium levels supports conservative dosing recommendations in bipolar older adults. The absence of a predictable relationship between serum and brain lithium makes specific individual predictions about the "ideal" lithium serum level in an older adult with BD difficult.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>1/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200901000-00003</guid>
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      <link>http://journals.lww.com/ajgponline/Fulltext/2005/05000/Prevalence_of_Depression_and_Its_Correlates_in.10.aspx</link>
      <author>Chi, Iris; Yip, Paul S.F.; Chiu, Helen F.K.; Chou, Kee Lee; Chan, Kin Sun; Kwan, Chi Wai; Conwell, Yeates; Caine, Eric</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Prevalence of Depression and Its Correlates in Hong Kong's Chinese Older Adults]]></title>
      <description><![CDATA[Objective: Because of the rapid aging of the population and inconsistent findings of previous epidemiological studies in Hong Kong, a prevalence study of depression among older adults was timely. The authors assessed the prevalence of depression among older adults and identified factors associated with it.
Methods: The authors interviewed a random representative sample of 917 community-dwelling Chinese adults age 60 and over. The 15-item Chinese Geriatric Depression Scale with a cutoff of >=8 was used to identify clinically significant depression in the older adults.
Results: The authors found that 11.0% and 14.5% of older Chinese men and women, respectively, scored above the cutoff, a prevalence rate similar to those found in other countries, including the United States, England, and Finland. Factors that were associated with an increased likelihood of depression among older adults included poor self-rated health, long-term pain, vision problems, higher level of impairment in activities of daily living, residing in Hong Kong less than 20 years, financial strain, and having less social support.
Conclusions: The prevalence rate of depression among older Chinese adults in Hong Kong is more or less similar to rates found in Western countries. The data suggest that older adults who receive less social support are more likely to be depressed.
Copyright (C) 2005 American Association for Geriatric Psychiatry]]></description>
      <pubDate>5/1/2005 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200505000-00010</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/1998/11000/Hoarding_Behavior_in_Dementia__A_Preliminary.3.aspx</link>
      <author>Hwang, Jen-Ping; Tsai, Shih-Jen; Yang, Chen-Hong; Liu, King-Ming; Lirng, Jiing-Feng</author>
      <category>Regular Article</category>
      <title><![CDATA[Hoarding Behavior in Dementia: A Preliminary Report]]></title>
      <description><![CDATA[Hoarding behavior has been reported in several mental disorders and is occasionally reported by the caregivers of dementia patients. Such behavior may have adverse effects on the patients and increase the burden of the caregivers. This study was conducted to investigate the prevalence of hoarding behavior in patients with dementia and identify the characteristics and psychiatric symptoms associated with it. The sample was 133 dementia patients admitted to a geropsychiatric ward. Of the 133 dementia patients, 30 (22.6%) showed hoarding. Hoarding was found in various types of dementia. Patients with hoarding had a higher prevalence of repetitive behaviors, hyperphagia, and pilfering. Results suggested that hoarding behavior is a common symptom in dementia patients and a complex phenomenon. Better understanding of the underlying pathogenesis may highlight specific pharmacological or behavioral methods for treatment of the behavior.
Copyright (C) 1998 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/1/1998 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-199811000-00003</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/09000/Brief_Psychosocial_Therapy_for_the_Treatment_of.3.aspx</link>
      <author>Ballard, Clive; Brown, Richard; Fossey, Jane; Douglas, Simon; Bradley, Paul; Hancock, Judith; James, Ian A.; Juszczak, Edmund; Bentham, Peter; Burns, Alistair; Lindesay, James; Jacoby, Robin; O'Brien, John; Bullock, Roger; Johnson, Tony; Holmes, Clive; Howard, Robert</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Brief Psychosocial Therapy for the Treatment of Agitation in Alzheimer Disease (The CALM-AD Trial)]]></title>
      <description><![CDATA[Background: Good practice guidelines state that a psychological intervention should usually precede pharmacotherapy, but there are no data evaluating the feasibility of psychological interventions used in this way.
Methods: At the first stage of a randomized blinded placebo-controlled trial, 318 patients with Alzheimer disease (AD) with clinically significant agitated behavior were treated in an open design with a psychological intervention (brief psychosocial therapy [BPST]) for 4 weeks, preceding randomization to pharmacotherapy. The therapy involved social interaction, personalized music, or removal of environmental triggers.
Results: Overall, 318 patients with AD completed BPST with an improvement of 5.6 points on the total Cohen-Mansfield Agitation Inventory (CMAI; mean [SD], 63.3 [16.0] to 57.7 [18.4], t = 4.8, df = 317, p < 0.0001). Therapy worksheets were completed in six of the eight centers, with the key elements of the intervention delivered according to the manual for >95% of patients. More detailed evaluation of outcome was completed for the 198 patients with AD from these centers, who experienced a mean improvement of 6.6 points on the total CMAI (mean [SD], 62.2 [14.3] to 55.6 [15.8], t = 6.5, df = 197, p < 0.0001). Overall, 43% of participants achieved a 30% improvement in their level of agitation.
Conclusion: The specific attributable benefits of BPST cannot be determined from an open trial. However, the BPST therapy was feasible and was successfully delivered according to an operationalized manual. The encouraging outcome indicates the need for a randomized controlled trial of BPST.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200909000-00003</guid>
    </item>
    <item>
      <link>http://journals.lww.com/ajgponline/Fulltext/2009/11000/Developing_a_Community_Academic_Partnership_to.7.aspx</link>
      <author>Dobransky-Fasiska, Deborah; Brown, Charlotte; Pincus, Harold A.; Nowalk, Mary P.; Wieland, Melissa; Parker, Lisa S.; Cruz, Mario; McMurray, Michelle L.; Mulsant, Benoit; Reynolds, Charles F. III; RNDC-Community Partners</author>
      <category>Regular Research Articles</category>
      <title><![CDATA[Developing a Community-Academic Partnership to Improve Recognition and Treatment of Depression in Underserved African American and White Elders]]></title>
      <description><![CDATA[Objective: Reducing mental health disparities among underserved populations, particularly African American elders, is an important public health priority. The authors describe the process and challenges of developing a community/academic research partnership to address these disparities.
Methods: The authors are using a Community-Based Participatory Research approach to gain access to underserved populations in need of depression treatment. The authors identify six stages: 1) Collaborating to Secure Funding; 2) Building a Communications Platform and Research Infrastructure; 3) Fostering Enduring Relationships; 4) Assessing Needs/Educating about Research Process; 5) Initiating Specific Collaborative Projects (meeting mutual needs/interests); and 6) Maintaining a Sustainable and Productive Partnership. Data from a needs assessment developed collaboratively by researchers and community agencies facilitated agreement on mutual research goals, while strengthening the partnership.
Results: A community/academic-based partnership with a solid research infrastructure has been established and maintained for 3 years. Using the results of a needs assessment, the working partnership prioritized and launched several projects. Through interviews and questionnaires, community partners identified best practices for researchers working in the community. Future research and interventional projects have been developed, including plans for sustainability that will eventually shift more responsibility from the academic institution to the community agencies.
Conclusions: To reach underserved populations by developing and implementing models of more effective mental health treatment, it is vital to engage community agencies offering services to this population. A successful partnership requires "cultural humility," collaborative efforts, and the development of flexible protocols to accommodate diverse communities.
Copyright (C) 2009 American Association for Geriatric Psychiatry]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00019442-200911000-00007</guid>
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