Update on Cognitive Enhancers Among the Older Adult Population: A Clinical Review.

PURPOSE OF REVIEW: The purpose of this review is to identify key classes of medications that are used for the treatment of older adults with neurocognitive disorders. RECENT FINDINGS: Clinical factors play a critical role in the prescribing of these medication classes for the treatment of dementia. The variation in prescribing trends is determined by the presence of medical and psychiatric comorbidities commonly occurring in older adults and is based on the consideration of potential interactions between pharmacotherapies for the comorbidities and for the dementia. Six medication classes currently exist to address the neurocognitive aspect of dementia, with varying pharmacokinetic and pharmacodynamic profiles. We review these six classes in this report and provide a provision of clinical insights regarding the use of these agents. While literature exists on the safety and efficacy of individual medication options for the treatment of dementia in the older adult population, further research is needed to provide clearer guidance regarding the specific use of these agents in clinical practice.

A Clinician's Roadmap to the Research and Data Acquisition Process Within the Veterans Health System.

Objective Identify and address potential obstacles to initiation of older population-related research within the NF/SG VHS through the provision of a concise flowchart. Setting North Florida/South Georgia Veterans Health System (NF/SG VHS). Practice Description The Department of Veterans Affairs (VA) Research Service with connection to the University of Florida facilitates research that contributes to improving the delivery of inpatient/outpatient care to veterans and their families. Practice Innovation A compendium of a senior care pharmacist's experiences will be compiled and reviewed by other specialists within the field while attempting to submit research protocols for publication within the VHS through the use of data platforms such as VINCI (VA Informatics and Computing Infrastructure) and the Corporate Data Warehouse. Main Outcome Measurements Impact of navigating research websites affiliated with and directly pertaining to the NF/SG VHS upon clinicians attempting to begin research processes within the institution. Results It was determined that for the most expeditious publication experience to result the following six steps had to be pursued sequentially: VA Institutional Review Board (IRB) Net documentation/ submission, local myIRB submission, Data Access Request Tracker/VINCI access request, setup of VINCI workspace, drafting of VINCI cohort specification, data analysis and tracking, statistical methods, abstract, and manuscript production. Conclusion This study outlines a consistent/clear method from first-hand experiences on how to navigate, more efficiently, complex research processes to produce successful future impacts on patient care.

Mood Disorders.

PURPOSE OF REVIEW: This comprehensive review of mood disorders brings together the past and current literature on the diagnosis, evaluation, and treatment of the depressive and bipolar disorders. It highlights the primary mood disorders and secondary neurologic causes of mood disorders that are commonly encountered in a clinical setting. As the literature and our understanding evolve, recent additions to the current literature are important to bring forth to the readers. RECENT FINDINGS: Advancements in clinical medicine have strengthened our understanding of the associations of neurologic and psychiatric diseases. This article highlights the medications frequently used with newly identified mood disorders and the common side effects of these medications. A paradigm shift has moved toward newer treatment modalities, such as the use of ketamine, repetitive transcranial magnetic stimulation, and complementary and alternative medicine. The risks and benefits of such therapies, along with medications, are reviewed in this article. SUMMARY: Mood disorders are extraordinarily complex disorders with significant association with many neurologic disorders. Early identification of these mood disorders can prevent significant morbidity and mortality associated with them. With further expansion of pharmacologic options, more targeted therapy is possible in improving quality of life for patients.

American Association for Geriatric Psychiatry-Strategic Thinking.

Never has there been a more pressing time for the American Association for Geriatric Psychiatry (AAGP) to articulate a unified strategy to meet the challenges of our aging world. To this end, this report summarizes an AAGP leadership meeting that reviewed the results from a recent membership survey and launched a strategic planning process on behalf of AAGP members and stakeholders. This meeting was the first step in drafting a blueprint for the future that may serve as our guide in the context of finite resources to meet the infinitely complex and growing need for education, research, public advocacy, and clinical practice support. The following report serves to invite our valued colleagues to provide feedback and actively participate in defining our mission. Among the outcomes of the planning session, the following aspirations were identified by the participants 1) assert the AAGP as the "go to" organization for all things related to geriatric mental health, 2) prioritize activities that enhance the inclusivity/diversity of membership, and 3) collaborate across disciplines focused on geriatric mental health. From this initial framework, the group developed four general themes to guide AAGP's strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, 4) high purpose. Inclusivity was further defined as encompassing growth, return on investment, and workforce development. Higher purpose was further defined as encompassing engagement, purpose, branding, communication, and expertise. The AAGP affirmed its commitment to serving the needs of its members and widening its scope of impact in view of staggering demands for better access to geriatric mental healthcare.

The Road Ahead in Education: Milestones for Geriatric Psychiatry Subspecialty Training.

OBJECTIVE: The Accreditation Council of Graduate Medical Education (ACGME) Milestone Project is the next step in a series of changes revamping the system of graduate medical education. In 2013 the ACGME completed the general psychiatry milestones. The ACGME then pursued creation of milestones for accredited psychiatric subspecialty fellowships. This article documents the work of the geriatric psychiatry subspecialty milestones work group. It reports the history and rationale supporting the milestones, the milestone development process, and the implications for geriatric psychiatry fellowship training. METHODS: In consultation with the American Association for Geriatric Psychiatry, the American Board of Psychiatry and Neurology, and the ACGME Psychiatry Residency Review Committee, the ACGME appointed a working group to create the geriatric psychiatry milestones using the general psychiatry milestones as a guide. CONCLUSION: The geriatric psychiatry milestones are the result of an iterative process resulting in the definition of the characteristics vital to a fellowship-trained geriatric psychiatrist. It is premature to assess their effect on psychiatric training. The true impact of the milestones will be determined as each training director uses the milestones to re-evaluate their program curriculum and the educational and clinical learning environment. The ACGME is currently collecting the information about the milestone performance of residents and fellows to further refine and determine how the milestones can best be used to assist programs in improving training.

National survey of geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center.

OBJECTIVE: : To document the development of geriatric psychiatry (GP) fellowship training in the United States through 2008. METHODS: : A cross-sectional survey of the 56 U.S. GP fellowship programs was conducted in summer 2007. Longitudinal data from the American Medical Association and the Association of American Medical Colleges' National Graduate Medical Education Census and data from the Accreditation Council for Graduate Medical Education were also analyzed. RESULTS: : Thirty-seven (66%) of 56 program directors responded. The number of fellowship programs has decreased over the past 7 years. During 2006/07, 72 fellows were in training, as compared with 94 fellows in 2001/02. Application rates declined significantly with a mean of 4.3 applications per program in 2006/07 as compared with the mean of 10 applications per program in 2001/02. The fill rate for first-year GP fellowship positions dropped from 61% in 2001/02 to 48% in 2006/07. During 2006/07, 67% of programs reported having two or fewer first-year fellows and 16% had no first-year fellows. Seventeen programs reported having no United States medical school graduates as first-year fellows. CONCLUSION: : The number of GP fellows in training has declined by 23% from 2001/02 to 2006/07. This decline has occurred at the same time when the number of older adults continues to expand rapidly. It is critical that an adequate number of geriatric psychiatrists be trained to support and educate general psychiatrists in the care of the elderly. Specific strategies need to be developed urgently to stimulate interest in careers in clinical and academic GP.

Lewy body dementia and creativity: case report.

BACKGROUND: We studied a visual artist with Lewy body dementia (LBD) to learn how this disease influenced his paintings during the course of the disease. METHODS: Study 1 evaluated two paintings of the same subject matter, one that the patient painted before his illness and the other after the onset of this disease. Study 2 evaluated a collection of his paintings from the time before he was ill (1994) until the time he stopped painting when he was suffering with LBD (2002). To learn how the onset and progression of LBD affected his paintings we had judges score the following qualities: aesthetic-beauty, closure completeness, evocative impact, novelty, technique and representational quality. RESULTS: In Study 1 we found that the representational ratings for the picture he painted when he had LBD was significantly lower than the picture he painted before he developed LBD. In Study 2, we found that all the artistic qualities measures temporally declined except novelty. We also found that the paintings that were judges as having the highest quality representations were significantly more novel than those that had poorer representations. In addition, we conducted a forward stepwise regression analysis using quality measures as predictor of year. This analysis revealed that only representational quality significantly predicted painting year. CONCLUSIONS: Our results suggest that as LBD progresses, except for novelty there is a gradual degradation of the ability to visually express artistic subject matter. It possible that the preserved ability to paint novel picture is related to relative preservation of frontal lobe function, but the degradation of other artistic qualities might be related to deterioration of the parietal lobes which either impairs the brain's iconic representations or the knowledge needed to portray these representations.

Differences in the indicators of depressive symptoms among a community sample of African-American and Caucasian older adults.

Depression among older adults is a major public health concern in the U.S. Yet, time and again this condition goes undiagnosed, or attributed to other causes. Despite being treatable, few individuals older than age 65 are treated for this disorder. Using a community sample of 404 African-American and Caucasian older adults, the aim of this study was to identify the sources of racial group variance in self-reports of depressive symptoms. Descriptive and multivariate analyses reveal no racial/ethnic differences in the mean level of depressive symptoms, but differences in the correlates of self-reported depression, as well as differences in the distribution of individual indicators of depressive symptoms.