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Maye JE, Depp CA, Lee EE, Keller AV, Kim HC, Jeste DV, Twamley EW. Cognition and Functional Capacity: An Initial Comparison of Veteran and Non-Veteran Older Adults. Mil Med 2024:usae225. [PMID: 38739491 DOI: 10.1093/milmed/usae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The U.S. Military Veterans aged 65 and older comprise an estimated 43% of the 22 million living Veterans in the United States. Veterans have high rates of physical, psychiatric, and social challenges, but it is not known whether Veteran status confers additional risk for cognitive or functional impairments in later life. Thus, this investigation specifically compared older Veterans with their non-Veteran peers in cognitive functioning and performance-based functional capacity. MATERIALS AND METHODS Participants (N = 110; 29 Veterans and 81 non-Veterans) were part of a larger longitudinal study on biopsychosocial functioning in independently living older adult residents of a Continuing Care Senior Housing Community. The University of California San Diego Institutional Review Board approved the study and all participants provided written informed consent. Participants provided demographic and mental health information and were administered a comprehensive neuropsychological battery. Functional capacity was assessed using the UCSD Performance-Based Skills Assessment-Brief (UPSA-B), which uses financial and communication role-plays to assess everyday functioning skills. Neuropsychological scores were appropriately normed prior to analysis. Multivariate Analyses of Variances with post hoc t-tests and an Analysis of Covariance were used to examine neuropsychological and functional capacity differences, respectively, between Veterans and non-Veterans. RESULTS Veterans did not differ from non-Veterans in educational attainment (16.4 years versus 15.5 years, P = 0.110), but they were significantly older (mean age 86.9 years ± 5.7, versus 81.74 years ± 6.53; P < 0.001) and were more likely to be male (X2 [1, N = 110] = 62.39, P < 0.001). Thus, though neuropsychological norms already accounted for demographic differences in our participants, age and sex were controlled in the Analysis of Covariance predicting UPSA-B score from Veteran status. Results suggested that, compared to non-Veterans, Veterans had significantly worse performance in the list learning portion of a test of verbal memory (Hopkins Verbal Learning Test-Revised, Total Recall; t = 2.56, P = 0.012, d = 0.56). Veterans and non-Veterans did not significantly differ in performance on the delayed recall portion of the verbal learning test and did not differ on a cognitive screening test (Montreal Cognitive Assessment) or on measures of premorbid intellectual functioning (Wide Range Achievement Test-4 Reading), language (Boston Naming Test, Verbal Fluency), visual memory (Brief Visuospatial Memory Test-Revised), attention/working memory (WAIS-IV Digit Span), processing speed (WAIS-IV Digit Symbol Coding), executive function (Delis-Kaplan Executive Function System Trails and Color-Word Test), or functional capacity (UPSA-B). Because our examination of multiple outcomes might have inflated Type I error, we performed a post hoc adjustment of P values using Benjamini-Hochberg procedures and the group difference in verbal learning remained significant. CONCLUSIONS Despite largely similar function in most domains, Veterans performed significantly more poorly in verbal list learning than their non-Veteran peers. Additional attention should be given to the understanding, assessment, and possible treatment of learning and memory differences in older Veterans, as this may be an area in which Veteran status confers additional risk or vulnerability to decline. This is the first study to compare objective neuropsychological and functional performance between older (age 65+) US Veterans and non-Veterans.
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Affiliation(s)
- Jacqueline E Maye
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
| | - Ellen E Lee
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
| | - Amber V Keller
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92182, USA
| | - Ho-Cheol Kim
- Academic Research Programs, IBM Research-Almaden, San Jose, CA 95120, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
| | - Elizabeth W Twamley
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
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Baran B, Lee EE. Age-Related Changes in Sleep and Its Implications for Cognitive Decline in Aging Persons With Schizophrenia: A Critical Review. Schizophr Bull 2024:sbae059. [PMID: 38713085 DOI: 10.1093/schbul/sbae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive impairment is a core feature of schizophrenia that worsens with aging and interferes with quality of life. Recent work identifies sleep as an actionable target to alleviate cognitive deficits. Cardinal non-rapid eye movement (NREM) sleep oscillations such as sleep spindles and slow oscillations are critical for cognition. People living with schizophrenia (PLWS) and their first-degree relatives have a specific reduction in sleep spindles and an abnormality in their temporal coordination with slow oscillations that predict impaired memory consolidation. While NREM oscillatory activity is reduced in typical aging, it is not known how further disruption in these oscillations contributes to cognitive decline in older PLWS. Another understudied risk factor for cognitive deficits among older PLWS is obstructive sleep apnea (OSA) which may contribute to cognitive decline. STUDY DESIGN We conducted a narrative review to examine the published literature on aging, OSA, and NREM sleep oscillations in PLWS. STUDY RESULTS Spindles are propagated via thalamocortical feedback loops, and this circuitry shows abnormal hyperconnectivity in schizophrenia as revealed by structural and functional MRI studies. While the risk and severity of OSA increase with age, older PLWS are particularly vulnerable to OSA-related cognitive deficits because OSA is often underdiagnosed and undertreated, and OSA adds further damage to the circuitry that generates NREM sleep oscillations. CONCLUSIONS We highlight the critical need to study NREM sleep in older PWLS and propose that identifying and treating OSA in older PLWS will provide an avenue to potentially mitigate and prevent cognitive decline.
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Affiliation(s)
- Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Oughli HA, Lee EE. Lonely for Life? Differences Between Chronic and Transient Loneliness and Their Impact on Depression in Older Adults. Am J Geriatr Psychiatry 2024; 32:424-426. [PMID: 38176966 PMCID: PMC10964992 DOI: 10.1016/j.jagp.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Hanadi Ajam Oughli
- Department of Psychiatry and Biobehavioral Sciences (HAO), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ellen E Lee
- Department of Psychiatry (EEL), University of California San Diego, La Jolla, CA; Desert-Pacific Mental Illness Research Education and Clinical Center (EEL), Veterans Affairs San Diego Healthcare System, San Diego, CA.
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Kwak PP, Ibarra C, Hernandez A, Carrasco J, Sears DD, Jeste D, Marquine MJ, Lee EE. Differences in metabolic biomarkers in people with schizophrenia who are of Mexican descent compared to non-Hispanic whites. Psychiatry Res 2024; 334:115788. [PMID: 38401486 DOI: 10.1016/j.psychres.2024.115788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
Metabolic dysfunction is highly prevalent and contributes to premature mortality among people with schizophrenia (PwS), especially in Hispanic/Latino/a/x/e PwS, compared to non-Hispanic White (NHW) PwS. This study evaluated the relative contributions of Mexican descent and schizophrenia diagnosis to metabolic biomarker levels. This cross-sectional study included 115 PwS and 102 non-psychiatric comparison (NC) participants - English-speakers aged 26-66 years, 27% Mexican descent, and 52% women across both groups. Assessments included evaluations of BMI, psychopathology, and fasting metabolic biomarkers. We used ANOVA analyses to compare metabolic outcomes between diagnostic and ethnic subgroups, linear regression models to examine associations between Mexican descent and metabolic outcomes, and Spearman's correlations to examine relationships between metabolic outcomes and illness-related variables in PwS. Mexican PwS had higher hemoglobin A1c levels, insulin resistance, and body mass index than NHW PwS. Mexican descent was associated with higher hemoglobin A1c levels, insulin resistance, body mass index, and leptin levels, controlling for age, sex, depression, education, and smoking. Among Mexican PwS, worse negative symptoms were associated with greater insulin resistance. These findings support the possibility of ethnicity-based differences in metabolic dysregulation, though further investigation is warranted to create targeted health interventions for Hispanic PwS.
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Affiliation(s)
- Paulyn P Kwak
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Cynthia Ibarra
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Alexa Hernandez
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Jessica Carrasco
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - Dorothy D Sears
- Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Department of Family Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; College of Health Solutions, Arizona State University, 550N 3rd St, Phoenix, AZ 85004, USA
| | - Dilip Jeste
- Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - María J Marquine
- Department of Medicine Geriatrics Division, Duke Center for the Study of Aging and Human Development, Duke University, 201 Trent Dr, Durham, NC 27710, USA; Department of Psychiatry and Behavioral Sciences, Duke Center for the Study of Aging and Human Development, Duke University, 201 Trent Dr, Durham, NC 27710, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
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Lee EE. A New Window to the Brain: Exosomes as a Promising Approach to Understand Mechanisms of Cognitive Deficits Associated With Obstructive Sleep Apnea. Am J Geriatr Psychiatry 2024:S1064-7481(24)00293-8. [PMID: 38584034 DOI: 10.1016/j.jagp.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Ellen E Lee
- Department of Psychiatry (EEL), University of California San Diego, La Jolla, CA; Desert-Pacific Mental Illness Research Education and Clinical Center (EEL), Veterans Affairs San Diego Healthcare System, San Diego, CA.
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Adamowicz DH, Wu TC, Daly R, Irwin MR, Jeste DV, Tu XM, Eyler LT, Lee EE. Executive functioning trajectories and their prospective association with inflammatory biomarkers in schizophrenia and non-psychiatric comparison participants. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110866. [PMID: 37742747 PMCID: PMC10829566 DOI: 10.1016/j.pnpbp.2023.110866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive change in people with schizophrenia (PwS) is challenging to assess, but important to understand. Previous studies with limited age ranges and follow-up were subject to practice effects. Controlling for practice effects in a well-established cohort, we examined executive functioning trajectories and their association with inflammatory biomarkers, hypothesizing that PwS will have worsening executive functioning over time compared to non-psychiatric comparison participants (NCs), predicted by higher baseline inflammation with a stronger relationship in PwS than NCs. STUDY DESIGN Executive functioning was assessed in 350 participants (n = 186 PwS, 164 NCs) at 12-16-month intervals (0 to 7 follow-up visits). Inflammatory biomarkers at baseline included high sensitivity C-Reactive Protein (hs-CRP), Interferon-gamma, Tumor Necrosis Factor (TNF)-alpha, and Interleukin(IL)-6, -8, and - 10. Executive functioning trajectories across diagnostic groups were estimated using a linear mixed-effects model controlling for age, sex, race/ethnicity, and education level, with additional models to assess prediction by baseline inflammation. STUDY RESULTS Over 4.4 years average follow-up, improvements in executive functioning were attenuated in PwS and older participants. Controlling for practice effects negated improvements, revealing declines among highly educated participants regardless of diagnosis. Higher baseline hs-CRP predicted worse executive functioning only among NCs, while TNF-alpha was predictive of change in all participants only after controlling for practice effects. Only the main effect of hs-CRP on executive function was significant after adjusting for multiple comparisons. None of the other inflammatory biomarkers predicted executive functioning or trajectories of performance among study participants. CONCLUSIONS Systemic inflammation as reflected by baseline inflammatory biomarker levels did not predict longitudinal declines in executive functioning. Additional studies examining the temporal dynamics of inflammation and cognition in PwS will help further clarify their relationship and associated mechanisms.
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Affiliation(s)
- David H Adamowicz
- Mass General Brigham, Department of Psychiatry, Division of Geriatric Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.
| | - Tsung-Chin Wu
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA.
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, University of California, Los Angeles, CA, USA.
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
| | - Xin M Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA.
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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Jeon JM, Ma J, Kwak P, Dang B, Buleje I, Ancoli-Israel S, Malhotra A, Lee EE. Developing a novel mobile application for cognitive behavioral therapy for insomnia for people with schizophrenia: integration of wearable and environmental sleep sensors. Sleep Breath 2024:10.1007/s11325-023-02980-4. [PMID: 38177830 DOI: 10.1007/s11325-023-02980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND People with serious mental illnesses (SMIs) have three-fold higher rates of comorbid insomnia than the general population, which has downstream effects on cognitive, mental, and physical health. Cognitive Behavioral Therapy for Insomnia (CBT-i) is a safe and effective first-line treatment for insomnia, though the therapy's effectiveness relies on completing nightly sleep diaries which can be challenging for some people with SMI and comorbid cognitive deficits. Supportive technologies such as mobile applications and sleep sensors may aid with completing sleep diaries. However, commercially available CBT-i apps are not designed for individuals with cognitive deficits. To aid with this challenge, we have developed an integrated mobile application, named "Sleep Catcher," that will automatically incorporate data from a wearable fitness tracker and a bed sensor to track nightly sleep duration, overnight awakenings, bed-times, and wake-times to generate nightly sleep diaries for CBT-i. METHODS The application development process will be described-writing algorithms to generating useful data, creating a clinician web portal to oversee patients and the mobile application, and integrating sleep data from device platforms and user input. RESULTS The mobile and web applications were developed using Flutter, IBM Code Engine, and IBM Cloudant database. The mobile application was developed with a user-centered approach and incremental changes informed by a series of beta tests. Special user-interface features were considered to address the challenges of developing a simple and effective mobile application targeting people with SMI. CONCLUSION There is strong potential for synergy between engineering and mental health expertise to develop technologies for specific clinical populations. Digital health technologies allow for the development of multi-disciplinary solutions to existing health disparities in vulnerable populations, particularly in people with SMI.
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Affiliation(s)
- Jae Min Jeon
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr #0664, La Jolla, CA, 92093-0664, USA
| | - Junhua Ma
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr #0664, La Jolla, CA, 92093-0664, USA
| | - Paulyn Kwak
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr #0664, La Jolla, CA, 92093-0664, USA
| | - Bing Dang
- Digital Health, IBM T.J. Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY, 10598, USA
| | - Italo Buleje
- Digital Health, IBM T.J. Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY, 10598, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr #0664, La Jolla, CA, 92093-0664, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, 4520 Executive Dr Suite P2, San Diego, CA, 92121, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr #0664, La Jolla, CA, 92093-0664, USA.
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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Bhatia R, Mai A, George J, Cao Y, Siu C, Lee EE, Redmond KJ, Jackson C, Lim M, Bettegowda C, Kleinberg LR. Outcomes of Brain Metastases with Suspicious Imaging Undergoing Resection to Evaluate for Radionecrosis vs. Tumor Progression. Int J Radiat Oncol Biol Phys 2023; 117:e88. [PMID: 37786204 DOI: 10.1016/j.ijrobp.2023.06.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In patients treated with stereotactic radiosurgery (SRS) for brain metastases, radiographic changes on surveillance imaging may result from treatment effect/radionecrosis (RN) or tumor progression. Distinguishing between these processes is critical to appropriate management. We report long-term outcomes for a cohort of patients who demonstrated radiographic progression on serial imaging after initial radiation and ultimately underwent resection to inform further management. MATERIALS/METHODS A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022 that were initially treated with SRS, then demonstrated suspicious imaging changes developing through at least two scan time points that led to pathologic confirmation of either tumor or RN. We report clinical outcomes and details of further treatments. RESULTS Of the 82 lesions, 55 (67.1%) were found to be pathologically-confirmed viable tumor and were treated with repeat radiation and 27 (32.9%) were found to be strictly RN and conservatively managed. Over half of the lesions (14/27) ultimately found to be radionecrotic required use of steroids pre-operatively due to neurologic symptoms. Among the 27 that were found to be RN, the most common histology was melanoma (33.3%, n = 9). The most common dose fractionation regimen was 20 Gy in 1 fx (n = 11, 40.7%; range: 16-20 Gy x 1Fx), and the median BED (10) was 50.4 Gy (IQR 41.6 - 50 Gy). None of these lesions required further intervention with median post-surgery follow up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of pathologically-confirmed recurrent/progressive tumor who were consequently treated with repeat radiation with either Cs-131 brachytherapy (12 (21.8%)) or SRS (43 (78.2%)). The most common histology was NSCLC (37.2%, n = 19). The most common fractionation for repeat irradiation with SRS was 8 Gy x 3 fx (n = 15, 27.3%), followed by 5 Gy x 5 fx (n = 10, 18.2%), and 4 Gy x 5 fx (n = 8, 14.6%). Four individuals each had two lesions that were re-irradiated for local recurrence. Among patients treated with re-irradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). Radionecrosis was confirmed on pathology in 4/55 (7.2%) of lesions. The median follow-up from date of SRS2 to local failure was 14.1 months (95% CI 7.6-24.3 months). The 2-yr local control rate was 74.8% (95% CI 61.7-90.7%). CONCLUSION We recommend cautious monitoring of possible progression after radiosurgery, with consideration of resection for continuous progression, as a significant proportion of radiographic progression are ultimately pure RN. Management determined by pathology (observation for RN; additional radiation for confirmed tumor) leads to excellent control.
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Affiliation(s)
- R Bhatia
- Johns Hopkins University, Baltimore, MD
| | - A Mai
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J George
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA
| | - Y Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Siu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K J Redmond
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Jackson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Lim
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - C Bettegowda
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Lee EE, Dairo O, Oliveira L, Nourmohammadi Abadchi S, Lotan TL, Song D. Immunohistochemistry-Based Biomarkers and Impact on Outcomes Following Salvage Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e403-e404. [PMID: 37785344 DOI: 10.1016/j.ijrobp.2023.06.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Salvage radiation therapy (SRT) is a mainstay of treatment for prostate cancer patients who experience biochemical relapse following radical prostatectomy. We sought to characterize the prognostic impact of previously identified deleterious molecular phenotypes-loss of PTEN, ERG expression, and p53 mutation- upon survival in patients undergoing SRT. MATERIALS/METHODS We analyzed an institutional database of 320 patients treated with SRT for whom prostatectomy tissue was available; tissue microarrays (TMAs) were constructed and used for genetically validated immunohistochemistry assays for PTEN, ERG, and p53. Chi-squared and Mann-Whitney's tests were used to assess association between molecular expression and clinical risk factors for adverse survival. Uni- and multivariate Cox-proportional hazards models were constructed to determine effects on biochemical (bRFS) and metastasis-free survival (MFS), calculated from end of SRT to event. RESULTS Loss of PTEN (n = 123, 50%) and ERG expression (n = 118, 39.1%) were common, while p53 overexpression (signifying TP53 missense mutation) was less common (n = 21, 6.6%). On univariate Cox regression, loss of PTEN portended worse bRFS [HR 1.86; 95% CI 1.36-2.57] and MFS [HR 1.89; 1.21-2.94], with homogeneous loss associated with particularly worse MFS [HR 2.47; 1.54-3.95]. Similarly, p53 overexpression predicted worse bRFS [HR 1.95; 1.14-3.32] and MFS [HR 2.79; 1.50-5.19]. ERG expression was associated with only worse MFS [HR 1.6; 1.03-2.48]. On multivariate analysis adjusting for known prognostic features (grade, nodal involvement, pathologic stage, androgen deprivation therapy (ADT), and PSA velocity), homogeneous PTEN loss remained predictive of adverse bRFS [HR 1.73; 1.06-2.82] and MFS [HR 2.35; 1.04-5.34]. CONCLUSION PTEN loss identified by immunohistochemistry is an independent adverse prognostic factor for both biochemical and metastasis-free survival in prostate cancer patients treated with SRT. Although clinically validated RNA expression assays also exist which are prognostic for outcomes following SRT, stromal contamination in bulk RNA could mask "loss" signals specific to tumor cells, such as PTEN. Further work is necessary to determine the optimal approach to treating patients with poor molecular prognostic features in a salvage setting.
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Affiliation(s)
- E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - O Dairo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L Oliveira
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - T L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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English KK, Singh T, McNutt TR, Lee EE, Bae HJ, Yenokyan G, DeWeese TL, Song D. Sexual Function and Dosimetric Relationships to Erectile Structures among Patients Treated Definitively with Pd-103 LDR Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2023; 117:e228-e229. [PMID: 37784920 DOI: 10.1016/j.ijrobp.2023.06.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Sexual potency and erectile function are important quality of life metrics for many men and is a significant consideration when planning and treating prostate cancer. There are limited long-term data correlating post-implant dosimetry with patient-reported sexual toxicity outcomes following LDR prostate brachytherapy using Pd-103, specifically as it pertains to genital substructures. Our aim was to correlate dosimetric patterns with quality-of-life outcomes to determine if dose to the pudendal arteries and neurovascular bundles is a significant consideration when planning prostate LDR brachytherapy. MATERIALS/METHODS We analyzed a prospectively collected IRB-approved database of men receiving LDR prostate brachytherapy between 11/2014-04/2019 at our institution. Patients received either LDR brachytherapy only, or combined with intensity-modulated radiation therapy (IMRT) to the prostate with or without pelvic lymph node coverage. Patients were given quality of life questionnaires at consultation and at subsequent follow up visits. Outcomes data related to sexual toxicity were evaluated based on the Sexual Health Inventory (SHIM) Questionnaire. The right/left pudendal arteries, and right/left neurovascular bundles (NVB) were contoured retrospectively on CT-MRI fusion sequences. Dosimetric data for each of the erectile substructures was analyzed. Statistical analyses included generalized linear mixed effects models with random intercept for patient to explore the association between dose and SHIM confidence. RESULTS A total of 50 patients met criteria for inclusion in the analysis. 5 patients received combined IMRT to 45 Gy with Pd-103 (90-100 Gy) and 45 patients received Pd-103 monotherapy (125 Gy). Median follow-up was 18 months for 50 patients; 40 (80%) patients had follow-up greater than 2 years, and 15 (30%) greater than 5 years. There were 344 individual questionnaires completed. 28% of records reported low or very low confidence level (Question #1 of SHIM questionnaire). Likelihood of moderate-very high confidence increased up to 2 years after beginning of treatment (p = 0.052) and then subsequently decreased between 2- and 5 years post treatment (p = 0.042). NVB doses were not associated with SHIM confidence level. D100 greater than 150 cGy to either pudendal artery was associated with worse SHIM confidence score after treatment (p = 0.003). CONCLUSION Sexual function is variable in the post treatment setting following definitive prostate radiation with Pd-103 LDR-brachytherapy. Avoiding pudendal artery dose may improve sexual outcomes and should be considered when planning prostate brachytherapy. Further investigation with a larger prospective, cohort may be warranted.
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Affiliation(s)
| | - T Singh
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - T R McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H J Bae
- University of Maryland, Baltimore, MD
| | - G Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - T L DeWeese
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - D Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Thomas ML, Palmer BW, Lee EE, Liu J, Daly R, Tu XM, Jeste DV. Abbreviated San Diego Wisdom Scale (SD-WISE-7) and Jeste-Thomas Wisdom Index (JTWI) - CORRIGENDUM. Int Psychogeriatr 2023; 35:587. [PMID: 35319427 PMCID: PMC10938455 DOI: 10.1017/s1041610222000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yamada Y, Shinkawa K, Shimmei K, Kim HC, Daly R, Depp C, Jeste DV, Lee EE. Latent subgroups with distinct patterns of factors associated with self-rated successful aging among 1,510 community-dwelling Americans: potential role of wisdom as an implicit promoter. Aging Ment Health 2023; 27:1127-1134. [PMID: 35735096 PMCID: PMC9780403 DOI: 10.1080/13607863.2022.2087207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/28/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate whether latent subgroups with distinct patterns of factors associated with self-rated successful aging can be identified in community-dwelling adults, and how such patterns obtained from analysis of quantitative data are associated with lay perspectives on successful aging obtained from qualitative responses. METHODS Cross-sectional data were collected from 1,510 community-dwelling Americans aged 21-99 years. Latent class regression was used to identify subgroups that explained the associations of self-rated successful aging with measures of physical, cognitive, and mental health as well as psychological measures related to resilience and wisdom. Natural language processing was used to extract important themes from qualitative responses to open-ended questions, including the participants' definitions of successful aging. RESULTS Two latent subgroups were identified, and their main difference was that the wisdom scale was positively associated with self-rated successful aging in only one subgroup. This subgroup had significantly lower self-rated successful aging and worse scores for all health and psychological measures. In the subgroup's qualitative responses, the theme of wisdom was only mentioned by 10.6%; this proportion was not statistically different from the other subgroup, for which the wisdom scale was not statistically associated with the self-rated successful aging. CONCLUSION Our results showed heterogeneous patterns in the factors underpinning successful aging even in community-dwelling adults. We found the existence of a latent subgroup with lower self-rated successful aging as well as worse health and psychological scores, and we suggest a potential role of wisdom in promoting successful aging for this subgroup, even though individuals may not explicitly recognize wisdom as important for successful aging.
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Affiliation(s)
| | | | | | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden, San Jose, US
| | - Rebecca Daly
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, US
- Department of Psychiatry, University of California San Diego, La Jolla, US
| | - Colin Depp
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, US
- Department of Psychiatry, University of California San Diego, La Jolla, US
| | - Dilip V. Jeste
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, US
- Department of Psychiatry, University of California San Diego, La Jolla, US
- Department of Neurosciences, University of California San Diego, La Jolla, US
| | - Ellen E. Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, US
- Department of Psychiatry, University of California San Diego, La Jolla, US
- VA San Diego Healthcare System, San Diego, US
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13
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Ramsey A, Govind T, Lam JA, Palmer BW, Jeste DV, Lee EE. Self-compassion, but not compassion toward others, is associated with better physical health: A cross-sectional study. Schizophr Res 2023; 255:17-23. [PMID: 36940620 PMCID: PMC10881115 DOI: 10.1016/j.schres.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/20/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Compassion is a modifiable construct that is associated with better physical health outcomes but, to our knowledge, has seldom been studied in people with schizophrenia (PwS) despite its applicability to counteract widespread depression in this community that might prevent positive health behaviors. We hypothesized that, compared to non-psychiatric comparison subjects (NCs), PwS would have lower compassion toward self (CTS), lower compassion toward others (CTO), and a positive association between compassion and health outcomes, such as physical wellbeing, comorbidities, and plasma hs-CRP. This cross-sectional study examined differences in physical health, CTS, and CTO in 189 PwS and 166 NCs. We used general linear models to analyze the relationship between compassion and health. As hypothesized, PwS had lower levels of CTS and CTO, worse physical well-being, more comorbidities, and higher levels of plasma hs-CRP than NCs. In the combined sample, higher CTS was significantly associated with better physical well-being and fewer comorbidities, while higher CTO was significantly associated with more comorbidities. In PwS alone, higher CTS was significantly associated with better physical well-being and lower levels of hs-CRP. CTS seemed to have a larger positive association with physical health than CTO, with depression acting as a potential mediator for CTS. Exploring effects of CTS interventions on physical health and health behaviors could be a promising next step.
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Affiliation(s)
- Arren Ramsey
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Tushara Govind
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Jeffrey A Lam
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barton W Palmer
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System MIRECC, San Diego, CA, USA
| | - Dilip V Jeste
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Ellen E Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA.
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14
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Lee EE, Adamowicz DH, Frangou S. An NIMH Workshop on Non-Affective Psychosis in Midlife and Beyond: Research Agenda on Phenomenology, Clinical Trajectories, Underlying Mechanisms, and Intervention Targets. Am J Geriatr Psychiatry 2023; 31:353-365. [PMID: 36858928 PMCID: PMC10990076 DOI: 10.1016/j.jagp.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
We present a review of the state of the research in the phenomenology, clinical trajectories, biological mechanisms, aging biomarkers, and treatments for middle-aged and older people with schizophrenia (PwS) discussed at the NIMH sponsored workshop "Non-affective Psychosis in Midlife and Beyond." The growing population of PwS has specific clinical needs that require tailored and mechanistically derived interventions. Differentiating between the effects of aging and disease progression is a key challenge of studying older PwS. This review of the workshop highlights the recent findings in this understudied clinical population and the critical gaps in knowledge and consensus for research priorities. This review showcases the major challenges and opportunities for research to advance clinical care for this growing and understudied population.
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Affiliation(s)
- Ellen E Lee
- Department of Psychiatry (EEL, DA), University of California San Diego, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging (EEL, DA), University of California San Diego, La Jolla, CA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System (EEL), San Diego, CA.
| | - David H Adamowicz
- Department of Psychiatry (EEL, DA), University of California San Diego, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging (EEL, DA), University of California San Diego, La Jolla, CA
| | - Sophia Frangou
- Department of Psychiatry (SF), University of British Columbia, Vancouver, British Columbia, Canada; Icahn School of Medicine at Mount Sinai (SF), New York, NY
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15
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Adamowicz DH, Lee EE. Dementia among older people with schizophrenia: an update on recent studies. Curr Opin Psychiatry 2023; 36:150-155. [PMID: 36794983 PMCID: PMC10079629 DOI: 10.1097/yco.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE OF REVIEW This narrative review examines recently published research that examines the prevalence, underlying causes, and treatments for dementia among people with schizophrenia. RECENT FINDINGS People with schizophrenia have high rates of dementia, compared with the general population, and cognitive decline has been observed 14 years prior to onset of psychosis with accelerated decline in middle age. Underlying mechanisms of cognitive decline in schizophrenia include low cognitive reserve, accelerated cognitive aging, cerebrovascular disease and medication exposure. Although pharmacologic, psychosocial and lifestyle interventions show early promise for preventing and mitigating cognitive decline, few studies have been conducted in older people with schizophrenia. SUMMARY Recent evidence supports accelerated cognitive decline and brain changes in middle-aged and older people with schizophrenia, relative to the general population. More research in older people with schizophrenia is needed to tailor existing cognitive interventions and develop novel approaches for this vulnerable and high-risk group.
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Affiliation(s)
| | - Ellen E Lee
- Department of Psychiatry
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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16
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Lee EE. Relationships of Purpose in Life with Mental Health Among Older Adults: Links to Health and Social Behaviors. Am J Geriatr Psychiatry 2023; 31:94-96. [PMID: 36347724 PMCID: PMC9907059 DOI: 10.1016/j.jagp.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA.
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17
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Jeste DV, Glorioso DK, Depp CA, Lee EE, Daly RE, Jester DJ, Palmer BW, Mausbach BT. Remotely Administered Resilience- and Wisdom-Focused Intervention to Reduce Perceived Stress and Loneliness: Pilot Controlled Clinical Trial in Older Adults. Am J Geriatr Psychiatry 2023; 31:58-64. [PMID: 35965169 PMCID: PMC9847241 DOI: 10.1016/j.jagp.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Older adults are vulnerable to perceived stress and loneliness, exacerbated by the COVID-19 pandemic. We previously reported inverse relationships between loneliness/perceived stress and wisdom/resilience. There are few evidence-based tele-health interventions for older adults. We tested a new remotely-administered manualized resilience- and wisdom-focused behavioral intervention to reduce perceived stress and loneliness in older adults. METHODS This pilot controlled clinical trial used a multiple-phase-change single-case experimental design, with three successive 6-week phases: control, intervention, and follow-up periods. The intervention included six once-a-week one-hour sessions. Participants were 20 adults >65 years, without dementia. RESULTS All 20 participants completed every session. The study indicated feasibility and acceptability of the intervention. While the sample was too small for demonstrating efficacy, there was a reduction (small-to-medium effect size) in perceived stress and loneliness, and increase in resilience, happiness, and components of wisdom and positive perceptions of aging. CONCLUSION These preliminary data support feasibility, acceptability, and possible efficacy of a remotely-administered resilience- and wisdom-focused intervention in older adults to reduce stress and loneliness.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Danielle K Glorioso
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Colin A Depp
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Ellen E Lee
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Rebecca E Daly
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Dylan J Jester
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Barton W Palmer
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA
| | - Brent T Mausbach
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego CA.
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18
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Campbell LM, Kohli M, Lee EE, Kaufmann CN, Higgins M, Delgadillo JD, Heaton RK, Cherner M, Ellis RJ, Moore DJ, Moore RC. Objective and subjective sleep measures are associated with neurocognition in aging adults with and without HIV. Clin Neuropsychol 2022; 36:1352-1371. [PMID: 32993422 PMCID: PMC8007669 DOI: 10.1080/13854046.2020.1824280] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 02/01/2023]
Abstract
Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n = 52, HIV-negative n = 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p's > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p = 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p = 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p = 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p = 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p = 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive disorders as well as neurodegenerative disorders associated with aging. Future studies should evaluate if behavioral sleep interventions can improve neurocognition.
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Affiliation(s)
- Laura M. Campbell
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Maulika Kohli
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Ellen E. Lee
- Department of Psychiatry, University of California San
Diego, San Diego, CA
- VA San Diego Healthcare System, San Diego, California,
U.S.A
- Sam and Rose Stein Institute for Research on Aging,
University of California San Diego, La Jolla, California, U.S.A
| | - Christopher N. Kaufmann
- VA San Diego Healthcare System, San Diego, California,
U.S.A
- Division of Geriatrics and Gerontology, Department of
Medicine, University of California San Diego, La Jolla, California, U.S.A
| | - Michael Higgins
- Department of Family Medicine and Public Health, University
of California San Diego, San Diego, CA
| | - Jeremy D. Delgadillo
- Advancing Diversity in Aging Research (ADAR) Program, San
Diego State University, San Diego, CA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San
Diego, San Diego, CA
- Department of Neurosciences, University of California San
Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San
Diego, San Diego, CA
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Abstract
OBJECTIVES Wisdom is a personality trait comprising seven components: self-reflection, pro-social behaviors, emotional regulation, acceptance of diverse perspectives, decisiveness, social advising, and spirituality. Wisdom, a potentially modifiable trait, is strongly associated with well-being. We have published a validated 28-item San Diego Wisdom Scale, the SD-WISE-28. Brief scales are necessary for use in large population-based studies and in clinical practice. The present study aimed to create an abbreviated 7-item version of the SD-WISE. METHOD Participants included 2093 people, aged 20-82 years, recruited and surveyed through the online crowdsourcing platform Amazon Mechanical Turk. The participants' mean age was 46 years, with 55% women. Participants completed the SD-WISE-28 as well as validation scales for various positive and negative constructs. Psychometric analyses (factor analysis and item response theory) were used to select one item from each of the seven SD-WISE-28 subscales. RESULTS We selected a combination of items that produced acceptable unidimensional model fit and good reliability (ω = 0.74). Item statistics suggested that all seven items were strong indicators of wisdom, although the association was weakest for spirituality. Analyses indicated that the 28-item and 7-item SD-WISE are both very highly correlated (r = 0.92) and produce a nearly identical pattern of correlations with demographic and validity variables. CONCLUSION The SD-WISE-7, and its derived Jeste-Thomas Wisdom Index (JTWI) score, balances reliability and brevity for research applications.
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Affiliation(s)
- Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
- VA San Diego Healthcare System, San Diego, California, U.S.A
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, U.S.A
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
- VA San Diego Healthcare System, San Diego, California, U.S.A
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, U.S.A
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, U.S.A
- Department of Mathematics, University of California San Diego, La Jolla, California, U.S.A
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, U.S.A
| | - Xin M. Tu
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
- VA San Diego Healthcare System, San Diego, California, U.S.A
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, U.S.A
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, U.S.A
- Department of Neurosciences, University of California San Diego, La Jolla, California, U.S.A
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Artin H, Bentley S, Mehaffey E, Liu FX, Sojourner K, Bismark AW, Printz D, Lee EE, Martis B, De Peralta S, Baker DG, Mishra J, Ramanathan D. Effects of intranasal ( S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series. EClinicalMedicine 2022; 48:101439. [PMID: 35706484 PMCID: PMC9092498 DOI: 10.1016/j.eclinm.2022.101439] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND (S)-ketamine is a glutamatergic drug with potent and rapid acting effects for the treatment of depression. Little is known about the effectiveness of intranasal (S)-ketamine for treating patients with comorbid depression and post-traumatic stress disorder (PTSD). METHODS We performed a retrospective case series analysis of clinical outcomes in 35 Veterans with co-morbid depression and PTSD who were treated with intranasal (S)-ketamine treatments at the VA San Diego Neuromodulation Clinic between Jan 2020 and March 2021. Veterans were not randomized or blinded to treatment. The primary outcome measured was a change in patient health questionnaire-9 (PHQ-9) and PTSD Checklist for DSM-5 (PCL-5) scores across the first 8 treatments (induction period) using a repeated measures analysis of variance (ANOVA). In a smaller sub-group (n = 19) of Veterans who received at least 8 additional treatments, we analyzed whether intranasal (S)-ketamine continued to show treatment effects. Finally, we performed a sub-group and correlation analyses to understand how changes in PHQ-9 and PCL-5 scores were related across treatments. FINDINGS During the induction phase of treatment there was an absolute reduction of 5.1 (SEM 0.7) on the patient health questionnaire-9 (PHQ-9) rating scale for depression, from 19.8 (SEM 0.7) at treatment 1 to 14.7 (SEM 0.8) at treatment 8 (week 4) (F(7238) = 8.3, p = 1e-6, partial η2 = 0.2). Five Veterans (14%) showed a clinically meaningful response (50% reduction in PHQ-9 score) at treatment 8. There was an absolute reduction of 15.5 +/- 2.4 on the patient checklist 5 (PCL-5) rating scale for PTSD, from 54.8 (SEM 2) at treatment 1 down to 39.3 (SEM 2.5) at treatment 8 (F(7238) = 15.5, p = 2e-7, partial η2 = 0.31). Sixteen Veterans (46%) showed a clinically meaningful response (reduction in PCL-5 of > 30%) in PTSD. Change in PHQ-9 correlated with change in PCL-5 at treatment 8 (r = 0.47, p = 0.005), but a decrease in PTSD symptoms were observable in some individuals with minimal anti-depressant response. INTERPRETATIONS While this is an open-label retrospective analysis, our results indicate that both depression and PTSD symptoms in Veterans with dual-diagnoses may improve with repeated intranasal (S)-ketamine treatment. The effects of (S)-ketamine on PTSD symptoms were temporally and individually distinct from those on depression, suggesting potentially different modes of action on the two disorders. This work may warrant formal randomized controlled studies on the effects of intranasal (S)-ketamine for individuals with co-morbid MDD and PTSD. FUNDING VA Center of Excellence in Stress and Mental Health, VA ORD (Career Development Award to DSR), Burroughs-Wellcome Fund Award (DSR), NIMH (EL).
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Affiliation(s)
- Hewa Artin
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Sean Bentley
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Eamonn Mehaffey
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Fred X. Liu
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Kevin Sojourner
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
| | - Andrew W. Bismark
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - David Printz
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Ellen E. Lee
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Brian Martis
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Sharon De Peralta
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Dewleen G. Baker
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Jyoti Mishra
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Dhakshin Ramanathan
- Mental Health Service, VA San Diego Healthcare System (VASDHS), San Diego, CA 92161, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161, USA
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
- Corresponding author at: Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA.
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21
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Davidson EJ, Taylor CT, Ayers CR, Quach NE, Tu XM, Lee EE. The Relationship Between Loneliness and Positive Affect in Older Adults. Am J Geriatr Psychiatry 2022; 30:678-685. [PMID: 34887211 PMCID: PMC9095765 DOI: 10.1016/j.jagp.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To establish whether positive affect (PA) is uniquely associated with loneliness and other social functioning variables beyond negative affect (NA) among older adults. METHODS Four hundred and twenty-eight participants (aged 60+ years old, 82% White, and 48% female) were recruited using random digit-dialing and completed scales for loneliness (UCLA Loneliness Scale), companionship (PROMIS scale), satisfaction with discretionary social activities (PROMIS scale), PA (Center for Epidemiologic Studies [CES] Happiness Scale), and NA (CES-Depression scale and Brief Symptom Inventory-Anxiety Subscale). RESULTS Multiple linear regression models found PA to be a significant predictor of lower loneliness where the effect of PA on loneliness is dependent on the level of NA; a large effect size at the mean level of NA, which becomes attenuated when NA increases. Although the direction of effect of PA on loneliness will change for NA > 5.10, which is 5 standard deviations away from 0, based on the model estimates, the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with lower loneliness, however this effect is attenuated for larger NA. Similarly, multiple linear regression models found that companionship was associated with PA and NA where the effect of PA is dependent on the level of NA; a medium effect size at the mean level of NA, which becomes attenuated when NA increases. As in the case of loneliness, the direction of effect of PA on companionship will change for NA > 3.52, which is 3.5 standard deviation away from 0, based on the model estimates, but the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with increased companionship, aand this effect is attenuated with greater NA. Satisfaction with social activities was associated with PA only (medium effect size). CONCLUSION Results suggest PA appears to be uniquely associated with social functioning among older adults. These findings support the potential for treatments that target PA to decrease loneliness among older adults, or vice versa.
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Affiliation(s)
- Eliza J. Davidson
- Research Service, VA San Diego Healthcare System,San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Charles T. Taylor
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology,Department of Psychiatry, University of California, San Diego School of Medicine
| | - Catherine R. Ayers
- Mental Healthcare Line, VA San Diego Healthcare System,Department of Psychiatry, University of California, San Diego School of Medicine
| | - Natalie E. Quach
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Xin M. Tu
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Ellen E. Lee
- Mental Healthcare Line, VA San Diego Healthcare System,Department of Psychiatry, University of California, San Diego School of Medicine,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA
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22
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Yamada Y, Shinkawa K, Kobayashi M, Badal VD, Glorioso D, Lee EE, Daly R, Nebeker C, Twamley EW, Depp C, Nemoto M, Nemoto K, Kim HC, Arai T, Jeste DV. Automated Analysis of Drawing Process to Estimate Global Cognition in Older Adults: Preliminary International Validation on the US and Japan Data Sets. JMIR Form Res 2022; 6:e37014. [PMID: 35511253 PMCID: PMC9121219 DOI: 10.2196/37014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations. OBJECTIVE The aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations. METHODS We collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning-based regression analyses. RESULTS We found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen's horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P<.001). CONCLUSIONS This study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment.
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Affiliation(s)
| | | | | | - Varsha D Badal
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Camille Nebeker
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Colin Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Miyuki Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Almaden Research Center, San Jose, CA, United States
| | - Tetsuaki Arai
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
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23
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Sommerfeld DH, Brunner AM, Glorioso D, Lee EE, Ibarra C, Zunshine E, Daly RE, Zoumas C, Jeste DV. Improving Healthy Living in Residential Care Facilities: Feasibility, Acceptability, and Appropriateness of Implementing a Multicomponent Intervention for Diabetes Risk Reduction in Adults with Serious Mental Illnesses. Adm Policy Ment Health 2022; 49:646-657. [PMID: 35113264 PMCID: PMC8820366 DOI: 10.1007/s10488-022-01189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Persons with serious mental illnesses experience high rates of medical comorbidity, especially diabetes. This study examined initial implementation feasibility, acceptability, and appropriateness of a new 6-month Multicomponent Intervention for Diabetes risk reduction in Adults with Serious mental illnesses (MIDAS) among persons in residential care facilities (RCFs). We conducted a mixed-methods study using four types of quantitative and qualitative data sources (administrative data; structured facility-level observations; resident assessments including blood-based biomarkers, 24-h dietary recalls, and self-report physical activity; and focus groups/interviews with staff and participants), to assess evidence of and factors affecting intervention feasibility, acceptability, and appropriateness. It was feasible to provide a high percentage of MIDAS class sessions (mean 50 of 52 intended sessions delivered) and make nutrition-related RCF changes (substitutions for healthier food items and reduced portion sizes). Class attendance rates and positive feedback from residents and staff provided evidence of MIDAS acceptability and appropriateness for addressing identified health needs. The residents who attended ≥ 85% of the sessions had greater improvement in several desired outcomes compared to others. Implementing a fully integrated MIDAS model with more extensive changes to facilities and more fundamental health changes among residents was more challenging. While the study found evidence to support feasibility, acceptability, and appropriateness of individual MIDAS components, some challenges for full implementation and success in obtaining immediate health benefits were also apparent. The study results highlight the need for improving health among RCF populations and will inform MIDAS adaptations designed to improve intervention fit and effectiveness outcomes.
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Affiliation(s)
- David H Sommerfeld
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Amy M Brunner
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.,VA San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Cynthia Ibarra
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Elizabeth Zunshine
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Christine Zoumas
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. .,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA. .,Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA.
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24
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Badal VD, Lee EE, Daly R, Parrish EM, Kim HC, Jeste DV, Depp CA. Dynamics of Loneliness Among Older Adults During the COVID-19 Pandemic: Pilot Study of Ecological Momentary Assessment With Network Analysis. Front Digit Health 2022; 4:814179. [PMID: 35199099 PMCID: PMC8859335 DOI: 10.3389/fdgth.2022.814179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had potentially severe psychological implications for older adults, including those in retirement communities, due to restricted social interactions, but the day-to-day experience of loneliness has received limited study. We sought to investigate sequential association, if any, between loneliness, activity, and affect. METHODS We used ecological momentary assessment (EMA) with dynamic network analysis to investigate the affective and behavioral concomitants of loneliness in 22 residents of an independent living sector of a continuing care retirement community (mean age 80.2; range 68-93 years). RESULTS Participants completed mean 83.9% of EMA surveys (SD = 16.1%). EMA ratings of loneliness were moderately correlated with UCLA loneliness scale scores. Network models showed that loneliness was contemporaneously associated with negative affect (worried, anxious, restless, irritable). Negative (but not happy or positive) mood tended to be followed by loneliness and then by exercise or outdoor physical activity. Negative affect had significant and high inertia (stability). CONCLUSIONS The data suggest that EMA is feasible and acceptable to older adults. EMA-assessed loneliness was moderately associated with scale-assessed loneliness. Network models in these independent living older adults indicated strong links between negative affect and loneliness, but feelings of loneliness were followed by outdoor activity, suggesting adaptive behavior among relatively healthy adults.
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Affiliation(s)
- Varsha D Badal
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Rebecca Daly
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Emma M Parrish
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Ho-Cheol Kim
- AI and Cognitive Software, International Business Machines (IBM) Research-Almaden, San Jose, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA, United States
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25
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Karim HT, Vahia IV, Iaboni A, Lee EE. Editorial: Artificial Intelligence in Geriatric Mental Health Research and Clinical Care. Front Psychiatry 2022; 13:859175. [PMID: 35299825 PMCID: PMC8921095 DOI: 10.3389/fpsyt.2022.859175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ipsit V Vahia
- Division of Geriatrics, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Andrea Iaboni
- Knowledge, Innovation, Talent, Everywhere (KITE), Toronto Rehab Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ellen E Lee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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26
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Ramsey M, Lee EE. Digital Dementia Care for the Future: Opportunities and Challenges. Am J Geriatr Psychiatry 2022; 30:12-14. [PMID: 34134922 PMCID: PMC8752056 DOI: 10.1016/j.jagp.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Marina Ramsey
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California
| | - Ellen E. Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California,Department of Psychiatry, University of California San Diego, San Diego, California,VA San Diego Healthcare System, La Jolla, California
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27
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Jeste DV, Di Somma S, Lee EE, Nguyen TT, Scalcione M, Biaggi A, Daly R, Liu J, Tu X, Ziedonis D, Glorioso D, Antonini P, Brenner D. Study of loneliness and wisdom in 482 middle-aged and oldest-old adults: a comparison between people in Cilento, Italy and San Diego, USA. Aging Ment Health 2021; 25:2149-2159. [PMID: 33000647 PMCID: PMC8012404 DOI: 10.1080/13607863.2020.1821170] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES There has been growing research interest in loneliness and wisdom in recent decades, but no cross-cultural comparisons of these constructs using standardized rating measures in older adults, especially the oldest-old. This was a cross-sectional study of loneliness and wisdom comparing middle-aged and oldest-old adults in Cilento, Italy and San Diego, United States. METHOD We examined loneliness and wisdom, using the UCLA Loneliness Scale Version 3 (UCLA-3) and San Diego Wisdom Scale (SD-WISE), respectively, in four subject groups: adults aged 50-65 and those ≥90 years from Cilento, Italy (N = 212 and 47, respectively) and San Diego, California, USA (N = 138 and 85, respectively). RESULTS After controlling for education, there were no significant group differences in levels of loneliness, while on SD-WISE the Cilento ≥90 group had lower scores compared to the other three groups. There was a strong inverse correlation between loneliness and wisdom in each of the four subject groups. Loneliness was negatively associated while wisdom was positively associated with general health, sleep quality, and happiness in most groups, with varying levels of significance. CONCLUSION These results largely support cross-cultural validity of the constructs of loneliness and wisdom, and extend previous findings of strong inverse correlations between these two entities. Loneliness has become a growing public health problem, and the results of our study suggest that wisdom could be a protective factor against loneliness, although alternative explanations are also possible. Research on interventions to reduce loneliness by enhancing wisdom in older adults is needed.
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Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA,Department of Neurosciences, University of California San Diego, USA
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, University of Rome La Sapienza, Rome, Italy,Great Network, Italy
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA,VA San Diego Healthcare System, San Diego, CA, USA
| | - Tanya T. Nguyen
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA
| | - Mara Scalcione
- Great Network, Italy,University of Rome La Sapienza School of Medicine, Rome, Italy
| | - Alice Biaggi
- Great Network, Italy,University of Rome La Sapienza School of Medicine, Rome, Italy
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA
| | - Jinyuan Liu
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA,Department of Family Medicine and Public Health, University of California San Diego, USA
| | - Xin Tu
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA,Department of Family Medicine and Public Health, University of California San Diego, USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of California San Diego, USA,School of Medicine, University of California San Diego, USA
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, USA
| | | | - David Brenner
- School of Medicine, University of California San Diego, USA
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28
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Lam JA, Murray ER, Yu KE, Ramsey M, Nguyen TT, Mishra J, Martis B, Thomas ML, Lee EE. Neurobiology of loneliness: a systematic review. Neuropsychopharmacology 2021; 46:1873-1887. [PMID: 34230607 PMCID: PMC8258736 DOI: 10.1038/s41386-021-01058-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023]
Abstract
Loneliness is associated with increased morbidity and mortality. Deeper understanding of neurobiological mechanisms underlying loneliness is needed to identify potential intervention targets. We did not find any systematic review of neurobiology of loneliness. Using MEDLINE and PsycINFO online databases, we conducted a search for peer-reviewed publications examining loneliness and neurobiology. We identified 41 studies (n = 16,771 participants) that had employed various methods including computer tomography (CT), structural magnetic resonance imaging (MRI), functional MRI (fMRI), electroencephalography (EEG), diffusion tensor imaging (DTI), single-photon emission computed tomography (SPECT), positron emission tomography (PET), and post-mortem brain tissue RNA analysis or pathological analysis. Our synthesis of the published findings shows abnormal structure (gray matter volume or white matter integrity) and/or activity (response to pleasant versus stressful images in social versus nonsocial contexts) in the prefrontal cortex (especially medial and dorsolateral), insula (particularly anterior), amygdala, hippocampus, and posterior superior temporal cortex. The findings related to ventral striatum and cerebellum were mixed. fMRI studies reported links between loneliness and differential activation of attentional networks, visual networks, and default mode network. Loneliness was also related to biological markers associated with Alzheimer's disease (e.g., amyloid and tau burden). Although the published investigations have limitations, this review suggests relationships of loneliness with altered structure and function in specific brain regions and networks. We found a notable overlap in the regions involved in loneliness and compassion, the two personality traits that are inversely correlated in previous studies. We have offered recommendations for future research studies of neurobiology of loneliness.
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Affiliation(s)
- Jeffrey A. Lam
- grid.40263.330000 0004 1936 9094Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Emily R. Murray
- grid.266100.30000 0001 2107 4242Division of Biological Sciences, University of California San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
| | - Kasey E. Yu
- grid.266100.30000 0001 2107 4242Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
| | - Marina Ramsey
- grid.266100.30000 0001 2107 4242Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
| | - Tanya T. Nguyen
- grid.266100.30000 0001 2107 4242Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708Veterans Affairs San Diego Healthcare System, San Diego, CA USA
| | - Jyoti Mishra
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Brian Martis
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708Veterans Affairs San Diego Healthcare System, San Diego, CA USA
| | - Michael L. Thomas
- grid.47894.360000 0004 1936 8083Department of Psychology, Colorado State University, Fort Collins, CO USA
| | - Ellen E. Lee
- grid.266100.30000 0001 2107 4242Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708Veterans Affairs San Diego Healthcare System, San Diego, CA USA
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Kaufmann CN, Lee EE, Wing D, Sutherland AN, Christensen C, Ancoli-Israel S, Depp CA, Yoon HK, Soontornniyomkij B, Eyler LT. Correlates of poor sleep based upon wrist actigraphy data in bipolar disorder. J Psychiatr Res 2021; 141:385-389. [PMID: 34329990 PMCID: PMC8722119 DOI: 10.1016/j.jpsychires.2021.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Wrist-worn actigraphy can objectively measure sleep, and has advantages over self-report, particularly for people with Bipolar Disorder (BD) for whom self-reports might be influenced by affect. Clinically useful data reduction approaches are needed to explore these complex data. METHODS We created a composite score of sleep metrics in BD based on 51 BD and 80 healthy comparison (HC) participants. Subjects wore an actigraph for up to 14 consecutive 24-h periods, and we assessed total sleep time (TST), wake after sleep onset (WASO), percent sleep (PS), and number of awakenings (NA). We focused on participants who had at least 5 nights of actigraphy data. We computed z-scores for within-person means of sleep measures for BD subjects versus HCs, which were averaged to create a composite measure. We correlated this composite with participant characteristics, and used LASSO regression to identify sleep measures best explaining variability in identified correlates. RESULTS Sleep measures and the composite did not differ between BDs and HCs; however, there was considerable variability in z-scores among those with BD. In BDs, the composite score was higher in women (t(49) = 2.28, p = 0.027) and those who were employed (t(34) = 2.34, p = 0.025), and positively correlated with medication load (r = 0.41, p = 0.003) while negatively correlated with Young Mania Rating Scale (YMRS; r = -0.35, p = 0.030). In LASSO regression, TST and NA best explained medication load while PS best explained employment and YMRS. CONCLUSION While a composite score of sleep metrics may provide useful information about sleep quality globally, our findings suggest that selection of theory-driven sleep measures may be more clinically meaningful.
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Affiliation(s)
- Christopher N. Kaufmann
- Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL,Corresponding Author: Christopher N. Kaufmann, PhD, MHS, Assistant Professor, Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL 32603, P: 323-528-2786,
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA,San Diego VA Healthcare System, La Jolla, CA, USA
| | - David Wing
- Center for Wireless and Population Health Systems, University of California San Diego, La Jolla, CA, USA
| | | | | | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA,San Diego VA Healthcare System, La Jolla, CA, USA
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | | | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
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Van Patten R, Nguyen TT, Mahmood Z, Lee EE, Daly RE, Palmer BW, Wu TC, Tu X, Jeste DV, Twamley EW. Physical and Mental Health Characteristics of 2,962 Adults With Subjective Cognitive Complaints. Int J Aging Hum Dev 2021; 94:459-477. [PMID: 34192887 DOI: 10.1177/00914150211026548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We investigated subjective cognitive complaints (SCCs), as well as physical and mental health factors, in adults and older adults. U.S. residents (N = 2,962) were recruited via the Amazon Mechanical Turk platform and completed a 90-item survey. Overall, 493/1930 (25.5%) of younger adults and 278/1032 (26.9%) of older adults endorsed SCCs. Analyses revealed worse physical and mental health characteristics in the SCC+ compared to the SCC- group, with primarily medium (Cohen's d = 0.50) to large (0.80) effect sizes. Age did not moderate relationships between SCCs and physical/mental health. Results suggest that SCCs are associated with a diverse set of negative health characteristics such as poor sleep and high body mass index, and lower levels of positive factors, including happiness and wisdom. Effect sizes of psychological correlates were at least as large as those of physical correlates, indicating that mental health is critical to consider when evaluating SCCs.
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Affiliation(s)
- Ryan Van Patten
- 1811 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Tanya T Nguyen
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
| | - Zanjbeel Mahmood
- Veterans Affairs San Diego Healthcare System, CA, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, CA, USA
| | - Ellen E Lee
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
| | - Rebecca E Daly
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
| | - Barton W Palmer
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
| | - Tsung-Chin Wu
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
| | - Xin Tu
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
| | - Dilip V Jeste
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA.,Department of Neurosciences, University of California San Diego, CA, USA
| | - Elizabeth W Twamley
- 8784 Department of Psychiatry, University of California San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, USA
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Grennan G, Balasubramani PP, Alim F, Zafar-Khan M, Lee EE, Jeste DV, Mishra J. Cognitive and Neural Correlates of Loneliness and Wisdom during Emotional Bias. Cereb Cortex 2021; 31:3311-3322. [PMID: 33687437 PMCID: PMC8196261 DOI: 10.1093/cercor/bhab012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
Loneliness and wisdom have opposing impacts on health and well-being, yet their neuro-cognitive bases have never been simultaneously investigated. In this study of 147 healthy human subjects sampled across the adult lifespan, we simultaneously studied the cognitive and neural correlates of loneliness and wisdom in the context of an emotion bias task. Aligned with the social threat framework of loneliness, we found that loneliness was associated with reduced speed of processing when angry emotional stimuli were presented to bias cognition. In contrast, we found that wisdom was associated with greater speed of processing when happy emotions biased cognition. Source models of electroencephalographic data showed that loneliness was specifically associated with enhanced angry stimulus-driven theta activity in the left transverse temporal region of interest, which is located in the area of the temporoparietal junction (TPJ), while wisdom was specifically related to increased TPJ theta activity during happy stimulus processing. Additionally, enhanced attentiveness to threatening stimuli for lonelier individuals was observed as greater beta activity in left superior parietal cortex, while wisdom significantly related to enhanced happy stimulus-evoked alpha activity in the left insula. Our results demonstrate emotion-context driven modulations in cognitive neural circuits by loneliness versus wisdom.
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Affiliation(s)
- Gillian Grennan
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, 92037 CA, USA
| | - Pragathi Priyadharsini Balasubramani
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, 92037 CA, USA
| | - Fahad Alim
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, 92037 CA, USA
| | - Mariam Zafar-Khan
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, 92037 CA, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, 92037 CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, 92161 CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, 92037 CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, 92037 CA, USA
| | - Jyoti Mishra
- Department of Psychiatry, University of California, San Diego, La Jolla, 92037 CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, 92037 CA, USA
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Jeste DV, Patel S, Lee EE, Daly R, Govind T, Parekh R, Levin S. American Psychiatric Association's Leadership Fellowship Program: Short-term and Longer-term Outcomes. Acad Psychiatry 2021; 45:142-149. [PMID: 33078331 PMCID: PMC8049497 DOI: 10.1007/s40596-020-01339-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/05/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This study assessed the impact of a Leadership Fellowship, sponsored by the American Psychiatric Association (APA) and APA Foundation, on the careers of psychiatry residents and examined the influence of gender and year of Fellowship completion. This 2-year program for residents offered multiple opportunities to interact with professional leaders at various levels. METHODS A retrospective online survey of alumni of the APA Leadership Fellowship, who had completed this Fellowship between 2003 and 2019, was conducted. RESULTS Out of the 93 psychiatrists who were sent the survey, 59 alumni responded (60.8% response rate). Most respondents had remained involved with organized psychiatry groups and 80% held leadership positions. Respondents reported high levels of satisfaction with the APA Fellowship experience, noting the importance of peer networking. Overall, male and female respondents were similar in their subsequent leadership positions and satisfaction with the survey. Similarly, Fellows who completed the Fellowship in 2003-2015 had responses about the experience that were largely similar to those in the 2016-2019 cohort that had not yet completed their residency. CONCLUSION A vast majority of alumni of the APA Leadership Fellowship had become leaders in their workplace or organized psychiatry groups. The leadership-focused career development programs for psychiatry trainees are important avenues to develop a diverse cohort of future leaders in psychiatry.
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Affiliation(s)
- Dilip V Jeste
- University of California San Diego, La Jolla, CA, USA.
| | - Sejal Patel
- American Psychiatric Association, Washington, DC, USA
| | - Ellen E Lee
- University of California San Diego, La Jolla, CA, USA
| | - Rebecca Daly
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Saul Levin
- American Psychiatric Association, Washington, DC, USA
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Daly JR, Depp C, Graham SA, Jeste DV, Kim HC, Lee EE, Nebeker C. Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study. JMIR Aging 2021; 4:e25779. [PMID: 33690146 PMCID: PMC8081194 DOI: 10.2196/25779] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. OBJECTIVE This study aimed to assess the impact of the COVID-19 pandemic and the resulting "Stay-at-Home" order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. METHODS This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the "stay-at-home" mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. RESULTS Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. CONCLUSIONS Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research.
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Affiliation(s)
- Jessica R Daly
- Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Colin Depp
- Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Sarah A Graham
- Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden, San Jose, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Camille Nebeker
- Research Center for Optimal Digital Ethics in Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
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Morlett Paredes A, Lee EE, Chik L, Gupta S, Palmer BW, Palinkas LA, Kim HC, Jeste DV. Qualitative study of loneliness in a senior housing community: the importance of wisdom and other coping strategies. Aging Ment Health 2021; 25:559-566. [PMID: 31918561 PMCID: PMC7347442 DOI: 10.1080/13607863.2019.1699022] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Older adults are at a high risk for loneliness, which impacts their health, well-being, and longevity. While related to social isolation, loneliness is a distinct, internally experienced, distressing feeling. The present qualitative study sought to identify characteristics of loneliness in older adults living independently within a senior housing community, which is typically designed to reduce social isolation. METHOD Semi-structured qualitative interviews regarding the experience of loneliness, risk factors, and ways to combat it were conducted with 30 older adults, ages 65-92 years. The interviews were audiotaped, transcribed, and coded using a grounded theory analytic approach based on coding, consensus, co-occurrence, and comparison. RESULTS Three main themes with multiple subthemes are described: (A) Risk and Protective factors for loneliness: age-associated losses, lack of social skills or abilities, and protective personality traits; (B) Experience of loneliness: Sadness and lack of meaning as well as Lack of motivation; and (C) Coping strategies to prevent or overcome loneliness: acceptance of aging, compassion, seeking companionship, and environment enables socialization. DISCUSSION Despite living within a communal setting designed to reduce social isolation, many older adults described feeling lonely in stark negative terms, attributing it to aging-associated losses or lack of social skills and abilities. However, interviewees also reported positive personal qualities and actions to prevent or cope with loneliness, several of which mirrored specific components of wisdom. The results support the reported inverse relationship between loneliness and wisdom and suggest a potential role for wisdom-enhancing interventions to reduce and prevent loneliness in older populations.
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Affiliation(s)
- Alejandra Morlett Paredes
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Lisa Chik
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Saumya Gupta
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Lawrence A. Palinkas
- Department of Family Medicine and Public Health, University of California San Diego
| | - Ho-Cheol Kim
- Scalable Knowledge Intelligence, IBM Research-Almaden, San Jose, CA, US
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Neurosciences, University of California San Diego, La Jolla, CA
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Lee EE, Torous J, De Choudhury M, Depp CA, Graham SA, Kim HC, Paulus MP, Krystal JH, Jeste DV. Artificial Intelligence for Mental Health Care: Clinical Applications, Barriers, Facilitators, and Artificial Wisdom. Biol Psychiatry Cogn Neurosci Neuroimaging 2021; 6:856-864. [PMID: 33571718 DOI: 10.1016/j.bpsc.2021.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022]
Abstract
Artificial intelligence (AI) is increasingly employed in health care fields such as oncology, radiology, and dermatology. However, the use of AI in mental health care and neurobiological research has been modest. Given the high morbidity and mortality in people with psychiatric disorders, coupled with a worsening shortage of mental health care providers, there is an urgent need for AI to help identify high-risk individuals and provide interventions to prevent and treat mental illnesses. While published research on AI in neuropsychiatry is rather limited, there is a growing number of successful examples of AI's use with electronic health records, brain imaging, sensor-based monitoring systems, and social media platforms to predict, classify, or subgroup mental illnesses as well as problems such as suicidality. This article is the product of a study group held at the American College of Neuropsychopharmacology conference in 2019. It provides an overview of AI approaches in mental health care, seeking to help with clinical diagnosis, prognosis, and treatment, as well as clinical and technological challenges, focusing on multiple illustrative publications. Although AI could help redefine mental illnesses more objectively, identify them at a prodromal stage, personalize treatments, and empower patients in their own care, it must address issues of bias, privacy, transparency, and other ethical concerns. These aspirations reflect human wisdom, which is more strongly associated than intelligence with individual and societal well-being. Thus, the future AI or artificial wisdom could provide technology that enables more compassionate and ethically sound care to diverse groups of people.
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Affiliation(s)
- Ellen E Lee
- Department of Psychiatry, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard University, Boston, Massachusetts
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Sarah A Graham
- Department of Psychiatry, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden, San Jose, California
| | | | - John H Krystal
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, San Diego, California; Department of Neurosciences, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California.
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36
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Treichler EBH, Palmer BW, Wu TC, Thomas ML, Tu XM, Daly R, Lee EE, Jeste DV. Women and Men Differ in Relative Strengths in Wisdom Profiles: A Study of 659 Adults Across the Lifespan. Front Psychol 2021; 12:769294. [PMID: 35185678 PMCID: PMC8850272 DOI: 10.3389/fpsyg.2021.769294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023] Open
Abstract
Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27-103 years completed surveys including the 3-Dimensional Wisdom Scale (3D-WS) and the San Diego Wisdom Scale (SD-WISE). Analyses assessed gender differences in wisdom and gender's moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step.
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Affiliation(s)
- Emily B H Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Barton W Palmer
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Tsung-Chin Wu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Xin M Tu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Rebecca Daly
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Ellen E Lee
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Dilip V Jeste
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
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Badal VD, Nebeker C, Shinkawa K, Yamada Y, Rentscher KE, Kim HC, Lee EE. Do Words Matter? Detecting Social Isolation and Loneliness in Older Adults Using Natural Language Processing. Front Psychiatry 2021; 12:728732. [PMID: 34867518 PMCID: PMC8635064 DOI: 10.3389/fpsyt.2021.728732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/08/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: Social isolation and loneliness (SI/L) are growing problems with serious health implications for older adults, especially in light of the COVID-19 pandemic. We examined transcripts from semi-structured interviews with 97 older adults (mean age 83 years) to identify linguistic features of SI/L. Methods: Natural Language Processing (NLP) methods were used to identify relevant interview segments (responses to specific questions), extract the type and number of social contacts and linguistic features such as sentiment, parts-of-speech, and syntactic complexity. We examined: (1) associations of NLP-derived assessments of social relationships and linguistic features with validated self-report assessments of social support and loneliness; and (2) important linguistic features for detecting individuals with higher level of SI/L by using machine learning (ML) models. Results: NLP-derived assessments of social relationships were associated with self-reported assessments of social support and loneliness, though these associations were stronger in women than in men. Usage of first-person plural pronouns was negatively associated with loneliness in women and positively associated with emotional support in men. ML analysis using leave-one-out methodology showed good performance (F1 = 0.73, AUC = 0.75, specificity = 0.76, and sensitivity = 0.69) of the binary classification models in detecting individuals with higher level of SI/L. Comparable performance were also observed when classifying social and emotional support measures. Using ML models, we identified several linguistic features (including use of first-person plural pronouns, sentiment, sentence complexity, and sentence similarity) that most strongly predicted scores on scales for loneliness and social support. Discussion: Linguistic data can provide unique insights into SI/L among older adults beyond scale-based assessments, though there are consistent gender differences. Future research studies that incorporate diverse linguistic features as well as other behavioral data-streams may be better able to capture the complexity of social functioning in older adults and identification of target subpopulations for future interventions. Given the novelty, use of NLP should include prospective consideration of bias, fairness, accountability, and related ethical and social implications.
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Affiliation(s)
- Varsha D Badal
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Camille Nebeker
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, United States
| | | | | | - Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden, San Jose, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,VA San Diego Healthcare System, La Jolla, CA, United States
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Jeste DV, Thomas ML, Liu J, Daly RE, Tu XM, Treichler EBH, Palmer BW, Lee EE. Is spirituality a component of wisdom? Study of 1,786 adults using expanded San Diego Wisdom Scale (Jeste-Thomas Wisdom Index). J Psychiatr Res 2021; 132:174-181. [PMID: 33126011 PMCID: PMC7736537 DOI: 10.1016/j.jpsychires.2020.09.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Wisdom has gained increasing interest among researchers as a personality trait relevant to well-being and mental health. We previously reported development of a new 24-item San Diego Wisdom Scale (SD-WISE), with good to excellent psychometric properties, comprised of six subscales: pro-social behaviors, emotional regulation, self-reflection (insight), tolerance for divergent values (acceptance of uncertainty), decisiveness, and social advising. There is controversy about whether spirituality is a marker of wisdom. The present cross-sectional study sought to address that question by developing a new SD-WISE subscale of spirituality and examining its associations with various relevant measures. METHODS Data were collected from a national-level sample of 1,786 community-dwelling adults age 20-82 years, as part of an Amazon M-Turk cohort. Participants completed the 24-item SD-WISE along with several subscales of a commonly used Brief Multidimensional Measure of Religiousness/Spirituality, along with validated scales for well-being, resilience, happiness, depression, anxiety, loneliness, and social network. RESULTS Using latent variable models, we developed a Spirituality subscale, which demonstrated acceptable psychometric properties including a unidimensional factor structure and good reliability. Spirituality correlated positively with age and was higher in women than in men. The expanded 28-item, 7-subscale SD-WISE total score (called the Jeste-Thomas Wisdom Index or JTWI) demonstrated acceptable psychometric properties. The Spirituality subscale was positively correlated with good mental health and well-being, and negatively correlated with poor mental health. However, compared to other components of wisdom, the Spirituality factor showed weaker (i.e., small-to-medium vs. medium-to-large) association with the SD-WISE higher-order Wisdom factor (JTWI). CONCLUSION Similar to other components as well as overall wisdom, spirituality is significantly associated with better mental health and well-being, and may add to the predictive utility of the total wisdom score. Spirituality is, however, a weaker contributor to overall wisdom than components like pro-social behaviors and emotional regulation. Longitudinal studies of larger and more diverse samples are needed to explore mediation effects of these constructs on well-being and health.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA
| | - Xin M Tu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Emily B H Treichler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry (DVJ, EEL), University of California San Diego, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego (DVJ, EEL), La Jolla, CA; Department of Neurosciences (DVJ), University of California San Diego, La Jolla, CA.
| | - Ellen E Lee
- Department of Psychiatry (DVJ, EEL), University of California San Diego, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego (DVJ, EEL), La Jolla, CA; VA San Diego Healthcare System (EEL), San Diego, CA
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40
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Kidambi N, Lee EE. Insight into Potential Mechanisms Linking Loneliness and Cognitive Decline: Commentary on "Health Factors as Potential Mediator the Longitudinal Effect of Loneliness on General Cognitive Ability". Am J Geriatr Psychiatry 2020; 28:1284-1286. [PMID: 32950365 PMCID: PMC7452903 DOI: 10.1016/j.jagp.2020.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Neha Kidambi
- Department of Psychiatry, University of California San Diego, San Diego, CA (NK, EL)
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, San Diego, CA (NK, EL); Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA ( EEL); VA San Diego Healthcare System, La Jolla, CA (EEL).
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Vásquez E, Lee EE, Zhang W, Tu X, Moore DJ, Marquine MJ, Jeste DV. HIV and three dimensions of Wisdom: Association with cognitive function and physical and mental well-being: For: Psychiatry Research. Psychiatry Res 2020; 294:113510. [PMID: 33096437 PMCID: PMC7942181 DOI: 10.1016/j.psychres.2020.113510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
Wisdom is a unique human personality trait with cognitive, affective or compassionate, and reflective dimensions. We evaluated relationships of three specific dimensions of wisdom with cognitive function and physical and mental well-being in people with HIV (PWH) and HIV-negative (HIV-) participants. Subjects included 138 adults (61 PWH, 77 HIV-) from the San Diego community. Validated measures were used to assess wisdom and well-being. Cognitive function was assessed via the Montreal Cognitive Assessment. We conducted multivariate linear regressions to evaluate the associations of wisdom dimensions with cognitive function and physical and mental well-being. Compared to the HIV- group, PWH had lower mean scores on cognitive function, and physical and mental well-being, and cognitive and reflective dimensions of wisdom, but similar scores on affective or compassionate wisdom. Among PWH, higher total wisdom scores were associated with older age, lower likelihood of substance dependence, greater mental well-being, better cognitive function, higher resilience, social support, and optimism scores, as well as lower levels of perceived stress and nadir CD4 count. Our findings of an association of different dimensions of wisdom with physical and/or mental well-being in PWH would point to a possibility that enhancing these dimensions of wisdom might improve health outcomes in PWH.
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Affiliation(s)
- Elizabeth Vásquez
- School of Public Health, University at Albany State University of New York, New York, NY, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Weihui Zhang
- School of Public Health, University at Albany State University of New York, New York, NY, United States
| | - Xin Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Neurosciences, University of California San Diego, La Jolla, CA, United States.
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Nguyen TT, Lee EE, Daly RE, Wu TC, Tang Y, Tu X, Van Patten R, Jeste DV, Palmer BW. Predictors of Loneliness by Age Decade: Study of Psychological and Environmental Factors in 2,843 Community-Dwelling Americans Aged 20-69 Years. J Clin Psychiatry 2020; 81:20m13378. [PMID: 33176072 PMCID: PMC7953851 DOI: 10.4088/jcp.20m13378] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Loneliness is a prevalent and serious public health problem due to its effects on health, well-being, and longevity. Understanding correlates of loneliness is critical for guiding efforts toward the development of evidence-based strategies for prevention and intervention. Considering that patterns of association between age and loneliness vary, the present study sought to examine age-related differences in risk and protective factors for loneliness. METHODS Correlates of loneliness were examined through a large web-based survey of 2,843 participants (aged 20-69 years) from across the United States from April 10, 2019, through May 10, 2019. Participants completed the 4-item UCLA Loneliness Scale, San Diego Wisdom Scale (with the following subscales measuring components of wisdom: Prosocial Behaviors, Emotional Regulation, Self-Reflection, Acceptance of Divergent Values, Decisiveness, and Social Advising), and other scales measuring psychosocial variables. Multivariate regression analyses were conducted to identify the best model of loneliness and examine potential age-related differences. RESULTS Age demonstrated a nonlinear quadratic relationship with loneliness (Wald statistic = 5.48, P = .019); levels were highest in the 20s and lowest in the 60s with another peak in the mid-40s. Across all decades, loneliness was associated with not having a spouse or partner (P < .001), sleep disturbance (P < .02), lower prosocial behaviors (P < .001), and smaller social network (P < .001). Lower social self-efficacy (P < .001) and higher anxiety (P < .005) were associated with worse loneliness in all age decades, except the 60s. Loneliness was uniquely associated with decisiveness in the 50s (P = .012) and with education (P = .046) and memory complaints (P = .013) in the 60s. CONCLUSIONS Our findings identify several potentially modifiable targets related to loneliness, including several aspects of wisdom and social self-efficacy. Differential predictors at different decades suggest a need for a personalized and nuanced prioritizing of prevention and intervention targets.
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Affiliation(s)
- Tanya T Nguyen
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Ellen E Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Rebecca E Daly
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Tsung-Chin Wu
- Department of Mathematics, University of California San Diego, La Jolla, California, USA
| | - Yi Tang
- Newcomb-Tulane College, Tulane University, New Orleans, Louisiana, USA
| | - Xin Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Ryan Van Patten
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Dilip V Jeste
- University of California San Diego, 9500 Gilman Drive #0664, La Jolla, CA 92023-0664.
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Barton W Palmer
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Badal VD, Graham SA, Depp CA, Shinkawa K, Yamada Y, Palinkas LA, Kim HC, Jeste DV, Lee EE. Prediction of Loneliness in Older Adults Using Natural Language Processing: Exploring Sex Differences in Speech. Am J Geriatr Psychiatry 2020; 29:853-866. [PMID: 33039266 PMCID: PMC7486862 DOI: 10.1016/j.jagp.2020.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The growing pandemic of loneliness has great relevance to aging populations, though assessments are limited by self-report approaches. This paper explores the use of artificial intelligence (AI) technology to evaluate interviews on loneliness, notably, employing natural language processing (NLP) to quantify sentiment and features that indicate loneliness in transcribed speech text of older adults. DESIGN Participants completed semi-structured qualitative interviews regarding the experience of loneliness and a quantitative self-report scale (University of California Los Angeles or UCLA Loneliness scale) to assess loneliness. Lonely and non-lonely participants (based on qualitative and quantitative assessments) were compared. SETTING Independent living sector of a senior housing community in San Diego County. PARTICIPANTS Eighty English-speaking older adults with age range 66-94 (mean 83 years). MEASUREMENTS Interviews were audiotaped and manually transcribed. Transcripts were examined using NLP approaches to quantify sentiment and expressed emotions. RESULTS Lonely individuals (by qualitative assessments) had longer responses with greater expression of sadness to direct questions about loneliness. Women were more likely to endorse feeling lonely during the qualitative interview. Men used more fearful and joyful words in their responses. Using linguistic features, machine learning models could predict qualitative loneliness with 94% precision (sensitivity = 0.90, specificity = 1.00) and quantitative loneliness with 76% precision (sensitivity = 0.57, specificity = 0.89). CONCLUSIONS AI (e.g., NLP and machine learning approaches) can provide unique insights into how linguistic features of transcribed speech data may reflect loneliness. Eventually linguistic features could be used to assess loneliness of individuals, despite limitations of commercially developed natural language understanding programs.
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Affiliation(s)
- Varsha D Badal
- Department of Psychiatry (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; Sam and Rose Stein Institute for Research on Aging (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA
| | - Sarah A Graham
- Department of Psychiatry (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; Sam and Rose Stein Institute for Research on Aging (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA
| | - Colin A Depp
- Department of Psychiatry (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; Sam and Rose Stein Institute for Research on Aging (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; VA San Diego Healthcare System (CAD, EEL), La Jolla, CA
| | - Kaoru Shinkawa
- Accessibility and Aging, IBM Research-Tokyo (KS, YY), Tokyo, Japan
| | - Yasunori Yamada
- Accessibility and Aging, IBM Research-Tokyo (KS, YY), Tokyo, Japan
| | - Lawrence A Palinkas
- Suzanne Dworak Peck School of Social Work (LAP), University of Southern California, Los Angeles, CA
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden (HCK), San Jose, CA
| | - Dilip V Jeste
- Department of Psychiatry (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; Sam and Rose Stein Institute for Research on Aging (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; Department of Neurosciences (DVJ), University of California San Diego, La Jolla, CA
| | - Ellen E Lee
- Department of Psychiatry (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; Sam and Rose Stein Institute for Research on Aging (VDB, SAG, CAD, DVJ, EEL), University of California San Diego, San Diego, CA; VA San Diego Healthcare System (CAD, EEL), La Jolla, CA.
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Lee EE, Bangen KJ, Avanzino JA, Hou B, Ramsey M, Eglit G, Liu J, Tu XM, Paulus M, Jeste DV. Outcomes of Randomized Clinical Trials of Interventions to Enhance Social, Emotional, and Spiritual Components of Wisdom: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:925-935. [PMID: 32401284 PMCID: PMC7221873 DOI: 10.1001/jamapsychiatry.2020.0821] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/01/2020] [Indexed: 11/14/2022]
Abstract
Importance Wisdom is a neurobiological personality trait made up of specific components, including prosocial behaviors, emotional regulation, and spirituality. It is associated with greater well-being and happiness. Objective To evaluate the effectiveness of interventions to enhance individual components of wisdom. Data Sources MEDLINE and PsycINFO databases were searched for articles published through December 31, 2018. Study Eligibility Criteria Randomized clinical trials that sought to enhance a component of wisdom, used published measures to assess that component, were published in English, had a minimum sample size of 40 participants, and presented data that enabled computation of effect sizes were included in this meta-analysis. Data Extraction and Synthesis Random-effect models were used to calculate pooled standardized mean differences (SMDs) for each wisdom component and random-effects meta-regression to assess heterogeneity of studies. Main Outcomes and Measures Improvement in wisdom component using published measures. Results Fifty-seven studies (N = 7096 participants) met review criteria: 29 for prosocial behaviors, 13 for emotional regulation, and 15 for spirituality. Study samples included people with psychiatric or physical illnesses and from the community. Of the studies, 27 (47%) reported significant improvement with medium to large effect sizes. Meta-analysis revealed significant pooled SMDs for prosocial behaviors (23 studies; pooled SMD, 0.43 [95% CI, 0.22-0.3]; P = .02), emotional regulation (12 studies; pooled SMD, 0.67 [95% CI, 0.21-1.12]; P = .004), and spirituality (12 studies; pooled SMD, 1.00 [95% CI, 0.41-1.60]; P = .001). Heterogeneity of studies was considerable for all wisdom components. Publication bias was present for prosocial behavior and emotional regulation studies; after adjusting for it, the pooled SMD for prosocial behavior remained significant (SMD, 0.4 [95% CI, 0.16-0.78]; P = .003). Meta-regression analysis found that effect sizes did not vary by wisdom component, although for trials on prosocial behaviors, large effect sizes were associated with older mean participant age (β, 0.08 [SE, 0.04]), and the reverse was true for spirituality trials (β, -0.13 [SE, 0.04]). For spirituality interventions, higher-quality trials had larger effect sizes (β, 4.17 [SE, 1.07]), although the reverse was true for prosocial behavior trials (β, -0.91 [SE 0.44]). Conclusions and Relevance Interventions to enhance spirituality, emotional regulation, and prosocial behaviors are effective in a proportion of people with mental or physical illnesses and from the community. The modern behavioral epidemics of loneliness, suicide, and opioid abuse point to a growing need for wisdom-enhancing interventions to promote individual and societal well-being.
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Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Katherine J. Bangen
- Department of Psychiatry, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Julie A. Avanzino
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - BaiChun Hou
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Marina Ramsey
- Department of Psychiatry, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Graham Eglit
- Department of Psychiatry, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Xin M. Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Martin Paulus
- Department of Psychiatry, University of California San Diego, La Jolla
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Neurosciences, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
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Abstract
BACKGROUND The ultimate goal of artificial intelligence (AI) is to develop technologies that are best able to serve humanity. This will require advancements that go beyond the basic components of general intelligence. The term "intelligence" does not best represent the technological needs of advancing society, because it is "wisdom", rather than intelligence, that is associated with greater well-being, happiness, health, and perhaps even longevity of the individual and the society. Thus, the future need in technology is for artificial wisdom (AW). METHODS We examine the constructs of human intelligence and human wisdom in terms of their basic components, neurobiology, and relationship to aging, based on published empirical literature. We review the development of AI as inspired and driven by the model of human intelligence, and consider possible governing principles for AW that would enable humans to develop computers which can operationally utilize wise principles and result in wise acts. We review relevant examples of current efforts to develop such wise technologies. RESULTS AW systems will be based on developmental models of the neurobiology of human wisdom. These AW systems need to be able to a) learn from experience and self-correct; b) exhibit compassionate, unbiased, and ethical behaviors; and c) discern human emotions and help the human users to regulate their emotions and make wise decisions. CONCLUSIONS A close collaboration among computer scientists, neuroscientists, mental health experts, and ethicists is necessary for developing AW technologies, which will emulate the qualities of wise humans and thus serve the greatest benefit to humanity. Just as human intelligence and AI have helped further the understanding and usefulness of each other, human wisdom and AW can aid in promoting each other's growth.
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Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, US
- Sam and Rose Stein Institute for Research on Aging, University of California La Jolla, San Diego, CA, US
- Department of Neurosciences, University of California La Jolla, San Diego, CA, US
| | - Sarah A. Graham
- Department of Psychiatry, University of California San Diego, La Jolla, CA, US
- Sam and Rose Stein Institute for Research on Aging, University of California La Jolla, San Diego, CA, US
| | - Tanya T. Nguyen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, US
- Sam and Rose Stein Institute for Research on Aging, University of California La Jolla, San Diego, CA, US
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, US
- Sam and Rose Stein Institute for Research on Aging, University of California La Jolla, San Diego, CA, US
- VA San Diego Healthcare System
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, US
- Sam and Rose Stein Institute for Research on Aging, University of California La Jolla, San Diego, CA, US
- VA San Diego Healthcare System
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden, San Jose, CA, US
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Jeste DV, Lee EE, Palmer BW, Treichler EBH. Moving from Humanities to Sciences: A New Model of Wisdom Fortified by Sciences of Neurobiology, Medicine, and Evolution. Psychol Inq 2020; 31:134-143. [PMID: 33731980 PMCID: PMC7963217 DOI: 10.1080/1047840x.2020.1757984] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, San Diego, CA, USA
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, San Diego, CA, United States
| | - Emily B. H. Treichler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, San Diego, CA, United States
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, San Diego
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego
| | - Ellen E Lee
- Department of Psychiatry, University of California, San Diego, San Diego
- Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Stephanie Cacioppo
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
- Brain Dynamics Laboratory, University of Chicago, Chicago, Illinois
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Postolache TT, Akram F, Lee EE, Lowry CA, Stiller JW, Brenner LA, Streeten EA, Turecki G, Dwivedi Y. Increased brain vitamin D receptor expression and decreased expression of cathelicidin antimicrobial peptide in individuals who died by suicide. J Psychiatr Res 2020; 125:75-84. [PMID: 32213352 DOI: 10.1016/j.jpsychires.2020.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/01/2020] [Accepted: 02/24/2020] [Indexed: 01/22/2023]
Abstract
Vitamin D deficiency is associated with immune dysregulation, increased vulnerability to infections, depression, and suicidal behavior. One mediator of vitamin D-dependent immune regulation and antimicrobial defense is the cathelicidin antimicrobial peptide (LL-37), encoded by the cathelicidin-related antimicrobial peptide (CRAMP) gene. We compared the mRNA expression of the CRAMP gene, the vitamin D receptor (VDR) gene, as well as the CYP27B1 and CYP24A1 genes (involved in vitamin D metabolism) in the dorsolateral prefrontal cortex (dlPFC) and anterior cingulate cortex (ACC) between depressed individuals who died by suicide (n = 15) and matched (age, gender, and post-mortem interval) non-psychiatric controls (n = 15). Gene expression was measured through qRT-PCR with TaqMan® primers and probes, with GAPDH and β-actin genes as endogenous controls. Statistical analyses included t-tests and Pearson correlations. CRAMP mRNA expression was downregulated and VDR mRNA expression was upregulated in both dlPFC and ACC in suicides relative to controls, with no significant differences in expression of CYP24A1 and CYP27B1. To our knowledge, this is the first study on brain cathelicidin expression in the human brain in relationship to suicide. Increased VDR and decreased CRAMP expression are consistent with previously reported associations between vitamin D deficiency, immune dysregulation, and suicidal behavior, and should lead to future studies uncovering novel interactive targets for suicide prevention.
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Affiliation(s)
- Teodor T Postolache
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA; Veterans Health Administration, Capitol MIRECC, Baltimore VA Medical Center, Baltimore MD, USA.
| | - Faisal Akram
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Christopher A Lowry
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA; Department of Integrative Physiology, Center for Neuroscience, And Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John W Stiller
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, USA; Maryland State Athletic Commission, Baltimore, MD, USA
| | - Lisa A Brenner
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth A Streeten
- Program for Personalized and Genomic Medicine, Department of Medicine, Endocrinology, Diabetes & Metabolism, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Graham SA, Lee EE, Jeste DV, Van Patten R, Twamley EW, Nebeker C, Yamada Y, Kim HC, Depp CA. Artificial intelligence approaches to predicting and detecting cognitive decline in older adults: A conceptual review. Psychiatry Res 2020; 284:112732. [PMID: 31978628 PMCID: PMC7081667 DOI: 10.1016/j.psychres.2019.112732] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 12/13/2022]
Abstract
Preserving cognition and mental capacity is critical to aging with autonomy. Early detection of pathological cognitive decline facilitates the greatest impact of restorative or preventative treatments. Artificial Intelligence (AI) in healthcare is the use of computational algorithms that mimic human cognitive functions to analyze complex medical data. AI technologies like machine learning (ML) support the integration of biological, psychological, and social factors when approaching diagnosis, prognosis, and treatment of disease. This paper serves to acquaint clinicians and other stakeholders with the use, benefits, and limitations of AI for predicting, diagnosing, and classifying mild and major neurocognitive impairments, by providing a conceptual overview of this topic with emphasis on the features explored and AI techniques employed. We present studies that fell into six categories of features used for these purposes: (1) sociodemographics; (2) clinical and psychometric assessments; (3) neuroimaging and neurophysiology; (4) electronic health records and claims; (5) novel assessments (e.g., sensors for digital data); and (6) genomics/other omics. For each category we provide examples of AI approaches, including supervised and unsupervised ML, deep learning, and natural language processing. AI technology, still nascent in healthcare, has great potential to transform the way we diagnose and treat patients with neurocognitive disorders.
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Affiliation(s)
- Sarah A Graham
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States; Department of Neurosciences, University of California San Diego, La Jolla, CA, United States.
| | - Ryan Van Patten
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Camille Nebeker
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | | | - Ho-Cheol Kim
- IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States; Scalable Knowledge Intelligence, IBM Research-Almaden, San Jose, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; IBM-UCSD Artificial Intelligence for Healthy Living Program, La Jolla, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
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50
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Lee EE, Winston-Gray C, Barlow JW, Rissman RA, Jeste DV. Plasma Levels of Neuron- and Astrocyte-Derived Exosomal Amyloid Beta1-42, Amyloid Beta1-40, and Phosphorylated Tau Levels in Schizophrenia Patients and Non-psychiatric Comparison Subjects: Relationships With Cognitive Functioning and Psychopathology. Front Psychiatry 2020; 11:532624. [PMID: 33762974 PMCID: PMC7982803 DOI: 10.3389/fpsyt.2020.532624] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction: Cognitive deficits in people with schizophrenia (PWS) are a major predictor of disability and functioning, yet the underlying pathophysiology remains unclear. A possible role of amyloid and tau biomarkers (hallmarks of Alzheimer's disease) is still speculative in schizophrenia. Exosomes or extracellular vesicles, involved with cell-to-cell communication and waste removal, can be used to assay brain-based proteins from peripheral blood. To our knowledge, this is the first study of exosomal amyloid and tau protein levels in PWS. Methods: This cross-sectional study included 60 PWS and 60 age- and sex-comparable non-psychiatric comparison subjects (NCs), age range 26-65 years. Assessments of global cognitive screening, executive functioning, psychopathology, and physical measures were conducted. Exosomes were extracted and precipitated from fasting plasma and identified as neuron-derived exosomes (NDEs) or astrocyte-derived exosomes (ADEs). Human-specific ELISAs were used to assay levels of amyloid-beta 1-42 (Aβ42), amyloid-beta 1-40 (Aβ40), and phosphorylated T181 tau (P-T181-tau). Plasma assays for aging biomarkers (C-reactive protein and F2-isoprostanes) were also performed. Results: ADE-Aβ42 levels were higher in PWS compared to NCs, though the other exosomal markers were similar between the two groups. Higher ADE-P-T181-tau levels were associated with worse executive functioning. Among PWS, higher ADE-P-T181-tau levels were associated with less severe negative symptoms and increased F2-isoprostane levels. Astrocyte-derived Aβ marker levels were sensitive and specific in differentiating between diagnostic groups. Among PWS, Aβ40 levels differed most by exosomal origin. Discussion: Exosomal markers may provide novel insights into brain-based processes (e.g., aging, oxidative stress) from peripheral blood samples.
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Affiliation(s)
- Ellen E Lee
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, United States
| | - Charisse Winston-Gray
- Department of Neuroscience, University of California San Diego, San Diego, CA, United States
| | - James W Barlow
- Department of Neuroscience, University of California San Diego, San Diego, CA, United States
| | - Robert A Rissman
- Department of Neuroscience, University of California San Diego, San Diego, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry and Neurosciences, University of California San Diego, San Diego, CA, United States
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