Worsening Memory, Slowing Gait Associated With Increased Risk of Dementia

Older adults who experience worsening memory and slowed walking may be at greater risk of dementia than those experiencing one or none of these changes, suggests a report published today in JAMA Network Open.

“Our findings provide further evidence for the importance of adding serial gait speed measures to dementia risk screening assessments, providing the opportunity for further comprehensive assessment and early preventative treatments,” wrote Taya A. Collyer, Ph.D., of Monash University in Victoria, Australia, and colleagues.

The researchers analyzed data collected during the ASPirin in Reducing Events in the Elderly (ASPREE) trial—a randomized, controlled trial of more than 19,000 community-dwelling older adults in Australia and the United States that took place between 2010 and 2017. The trial included adults aged 70 years or older (or aged 65 or older for U.S. participants belonging to a minority group) who did not have cardiovascular disease, dementia, or physical disability at the time of enrollment.

As part of the ASPREE trial, researchers measured the gait speed (in meters/second) of the participants at the beginning of the trial; years 2, 4, and 6; and at the end of the trial in 2017. The researchers also administered a series of cognitive tests at the beginning of the trial; years 1, 3, and 5; and in 2017. The cognitive tests included the Modified Mini-Mental State examination for global cognition, Hopkins Verbal Learning Test-Revised for memory, Symbol Digit Modalities for processing speed, and Controlled Oral Word Association Test for verbal fluency. Participants with cognitive concerns over the course of the trial were flagged for additional cognitive testing, and an expert committee determined whether participants met the criteria for dementia (according to DSM-IV).

Participants whose gait slowed 0.05 meters/second or more per year were considered to have gait decline. Participants who scored in the lowest third of the annual change on the cognitive tests were considered to have cognitive decline.

Compared with the adults who did not experience any declines, adults who had gait decline along with either memory decline or global cognition decline were more than 20 times likely to develop dementia, Collyer and colleagues found. Those experiencing slowing gait along with processing speed or verbal fluency decline were about 4 to 5 times more likely to develop dementia, although this risk was about the same as for adults experiencing gait decline alone.

“These results highlight the importance of gait in dementia risk assessment and suggest that dual decline in gait speed and a memory measure may be the best combination associated with accurate assessment of future dementia risk,” the researchers wrote.

“Despite the established predictive validity of gait assessments for geriatric syndromes, an implementation barrier for routine gait assessment in clinics exists that needs to be addressed to improve care of older patients,” wrote Joe Verghese, M.D., of Albert Einstein College of Medicine in an accompanying editorial. “Routine annual assessments of gait speed and cognition will need to be established in clinical settings to identify dual decliners.”

For related information, see the Psychiatric News article “Dual-Task Gait Testing Identifies MCI Patients Likely to Develop Dementia.”

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Deadline for Mental Health Services Conference Abstracts Is Thursday

The Mental Health Services Conference will empower all mental health service providers with practical tools and innovations to shape the future of community collaboration. Held in person in Washington, D.C., at the Capital Hilton Hotel on October 13-14, the conference will provide up to 18 continuing education credits for physicians, psychologists, social workers, and nurses. The deadline for abstracts is Thursday, June 2, at 5 p.m. ET.

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Lurasidone Benefits Youth With Bipolar Depression Without Major Side Effects

Lurasidone appears to be well tolerated and effective at reducing depressive symptoms in children and adolescents with bipolar I depression, reports a study published Friday in Journal of the American Academy of Child and Adolescent Psychiatry. 

After six weeks, youth with bipolar depression assigned to daily lurasidone showed significant improvements in their Children’s Depression Rating Scale–Revised (CDRS-R) scores compared with those assigned to placebo. Youth taking lurasidone also demonstrated improvements in anxiety, quality of life, and global functioning.

“In addition to significantly higher responder rates in patients treated with lurasidone versus placebo, the clinical relevance of improvement in the lurasidone group is underscored by the observed change in mean [global functioning] score from <50 at baseline (‘moderate-to-severe impairment in functioning’) to >60 at study endpoint (‘generally functioning pretty well’),” wrote Melissa DelBello, M.D., of the University of Cincinnati College of Medicine and colleagues. “The consistency of improvement across primary, key secondary, and all other secondary efficacy measures further substantiates the overall effectiveness of lurasidone in this pediatric population with bipolar depression.”

This study included 347 pediatric patients aged 10 to 17 with bipolar I disorder and CDRS-R scores of at least 45. The participants were randomly assigned to either lurasidone (20-80 mg daily) or placebo. At the study endpoint, CDRS-R total scores dropped 21 points in the lurasidone group compared with 15.3 points in the placebo group. Overall response rates (≥50% reduction from baseline to week 6 in CDRS-R total score) were 59.5% and 36.5% for the lurasidone and placebo groups, respectively.

DelBello and colleagues noted the improvements seen in the current study were comparable to those seen in a clinical trial of olanzapine/fluoxetine combination (OFC) therapy, but lurasidone had a better tolerability profile. 

The dropout rates among patients due to adverse events were low and similar for both groups in the lurasidone study (1.7% compared with 14.1% in the aforementioned OFC study). The two most common adverse events among patients taking lurasidone were nausea and somnolence. There were no significant differences in weight gain between lurasidone and placebo groups.

For related information, see the FOCUS article “Management of Bipolar Disorder in Children and Adolescents,” by DelBello and colleagues.

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Recovery-Oriented Cognitive Therapy Benefits Patients With Schizophrenia

Recovery-oriented cognitive therapy (CT-R)—a therapeutic approach that emphasizes a patient’s personal treatment goals—can lead to enduring improvements in low-functioning individuals with schizophrenia, reports a study published today in Psychiatric Services in Advance.

Paul M. Grant, Ph.D., of the University of Pennsylvania and colleagues randomly assigned 60 adults with schizophrenia or schizoaffective disorder to 18 months of CT-R plus standard treatment or standard treatment alone. Standard treatment consisted minimally of antipsychotic medication, but most in this group received some additional services from the local community mental health center. Researchers who were blind to the treatment groups evaluated the study participants at the start of the trial and again 6, 12, 18, and 24 months later.

The researchers found that even though CT-R ended at 18 months, global functioning in the CT-R group remained superior to that in the standard treatment group at 24 months. The CT-R group also showed lower scores for negative symptoms (avolition and apathy) and for positive symptoms compared with participants receiving standard treatment.

“The findings presented here show that these improvements over baseline were maintained across the follow-up period when therapy was withdrawn, supporting the notion that CT-R produces an enduring change in beliefs and skills that enables individuals to continue to maintain gains without their therapist,” Grant and colleagues wrote.

Those with less chronic illness began to show improvement sooner, some as early as six months, with the most prominent benefits evident at the end of active treatment at 18 months. “[T]hose with greater chronicity showed reliable improvements, but they did so later (at 24 months), suggesting that clinicians should not give up on these individuals when it seems that they are not improving as quickly as hoped,” the authors added. “More intensive treatment might quicken their recovery response.”

The CT-R treatment consisted of engaging and establishing a connection with the patient, for example, through music, singing, dancing, or taking a walk, and then working collaboratively with the patient to identify personal, meaningful, and valued goals for the future, such as finding a job, reconnecting with family, developing relationships, and pursuing independent living in the community. Therapists used the cognitive model to help participants overcome obstacles, such as low energy, hallucinations, and disorganization, within a goal-directed framework with personalized treatment targets. Later sessions focused on consolidating gains and preventing relapse.

For related information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis.”

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