- Email: [email protected]
RESULTS OF THE ADNI-DEPRESSION STUDY
AAGP Annual Meeting 2019 high rate of poverty, untreated depression and medical comorbidities. In this pilot study, PATH is delivered in English and Spanish, both in the home or office, in order to provide a patient centered psychosocial intervention that acknowledges the complexity of coping with depression for older adults with high medical illness burden and cognitive impairment. Supervision for the PATH therapist is provided by an interdisciplinary team including a psychologist, geriatric psychiatrist and licensed clinical social worker with training in family therapy. The adaptation of PATH to fit the needs of high risk older adults with cognitive impairment has yielded important lessons beyond treatment efficacy that have implications for future clinical trials and mental health care delivery in this population. During this session, presenters will describe how PATH has been tailored to meet the varying needs of high risk older adults. Presenters will describe the PATH-SP trial for recently discharged patients. Presenters involved in implementation and supervision of PATH at MMC will discuss chart review findings and clinical case examples which illustrate themes and helpful strategies in the treatment of depression in older adults with high medical illness burden and cognitive impairment. Finally presenters will describe how PATH aligns with systemic family therapy theories through clinical case examples. Presenters will discuss how findings will inform the evolution of PATH and future clinical trials of psychosocial interventions to cognitive impaired older adults. Faculty Disclosures Dimitris Kiosses NIMH Grant - Other Financial or Material Support Gary Kennedy Guilford Press - Other Financial or Material Support Janice Korenblatt Nothing to disclose Mirnova Ce€ıde Nothing to disclose
PUBLIC POLICY SESSION 5: ASLEEP AT THE SWITCH: HOW GERIATRIC PSYCHIATRY, IMPLEMENTATION SCIENCE, AND HEALTH POLICY CAN HELP TO REVERSE THE NATION’S GREATEST HEALTH DISPARITY Session 322 Stephen Bartels, MD, MS
Massachusetts General Hospital Abstract: People with serious mental illness have a reduced life expectancy between 11-30 years compared to the general population, accounting for one of the nation’s greatest, but least recognized health disparities. The primary cause of early mortality is cardiovascular disease, cancer, and related risk factors including obesity, tobacco dependence, high blood pressure, and diabetes. The purpose of this presentation is to provide an update on research addressing this challenge, including research on aging and mental health combined with implementation science can help to promote access to care models and technology to address this health disparity, along with the health care reforms needed to get the job done. Faculty Disclosures Stephen Bartels Nothing to disclose
RESULTS OF THE ADNI-DEPRESSION STUDY Session 3231 2 3
Scott Mackin ; Duygu Tosun ; James Craig Nelson ; Ruth Morin4 1
UCSF Department of Psychiatry; Mental Health Service San Francisco VA Medical Center UCSF 3 UCSF 4 San Francisco VA Medical Center 2
S36
Am J Geriatr Psychiatry 27:3S, March 2019
AAGP Annual Meeting 2019 Abstract: Results Of The ADNI-Depression Study. Overview: Late life depression (LLD) is one of the most common mental health disorders with which older patients are afflicted. LLD is complicated by the common co-occurrence of cognitive impairment (CI). Estimates suggest as many as 50-60% of older depressed patients may have mild cognitive deficits however the mechanisms contributing to CI are unclear. The ADNI-Depression (ADNI-D) Study is a 5-year two-site (University of California San Francisco and the University of Pittsburgh) NIMH sponsored study of late life depression. The study aims to characterize cognitive functioning patients with LLD and clarify neurobiological mechanisms contributing to cognitive impairment and accelerated cognitive decline in this patient population. The ADNI -D study partners with the Alzheimer’s Disease Network Initiative (ADNI) and utilizes its core labs for data management, brain imaging, and biomarker assessments. The ADNI D study has been designed to focus on evaluating the impact of reduced cerebral blood flow, cortical atrophy, white matter disease, and amyloid deposition on cognitive impairment in LLD. The study is longitudinal; after an initial assessment subject are followed for 2 1/2 years. ADNI-D is committed to rapid data sharing of the ADNI-D data. This session will present initial data from the ADNI-Depression Study baseline evaluation and will be organized into 4 topic areas. ADNI-D Methodology and Sample Characteristics (Nelson) The ADNI D sample is a well characterized sample of older adults with depression. The ADNI D methodology facilitates comparisons of this cohort of LLD participants with the larger ADNI study of non-depressed older adults with normal cognition, Mild Cognitive Impairment (MCI), and dementia in order to clarify neurobiological mechanisms contributing to cognitive impairment and accelerated cognitive decline. This session will be focused on describing the ADNI-D methodology for participant enrollment and data collection and to report ADNI D sample (n=121) characteristics for depression severity, lifetime history of depression and depression treatment, and functional impairment. Specifically, participant enrollment criteria and methods for the assessment of depression severity and lifetime history of depression and depression treatments will be summarized. Additionally, standardized methodology for collection of neuroimaging data, biomarkers, and data management will be presented. Cognitive Functioning in the ADNI Depression cohort (Morin). The clarification of types and severity of cognitive dysfunction in LLD remains a significant area of research. This session will focus on identifying the cognitive impairment rates of participants with LLD in the ADNI-D study at baseline, highlighting methodological considerations for matching subjects to ADNI participants on basis of cognitive functioning for biomarker analyses, and to assess the relationship of subjective cognitive complaints and ApoE status with objective measures cognitive performance. Association of Cortical Atrophy, White Matter Lesions, and Amyloid Accumulation with Cognition in Late Life Depression (Mackin) Cognitive impairment (CI) in LLD is often characterized by deficits of executive functioning (EF), memory, and language and LLD has been strongly linked to accelerated rates of cognitive decline in older adults. However, the causes of CI in LLD are not clear, in part due to limitations of previous work which have lacked comparisons to well characterized non-depressed older adults with CI caused by neurodegenerative diseases that are often concurrent with LLD, such as the early stages of Alzheimer’s disease (AD) and cerebrovascular disease (CVD). The ADNI-D study will facilitate clarification of neurobiological mechanisms contributing to CI in LLD. This session will be focused on evaluating the impact of reduced cerebral blood flow (hypoperfusion), cortical atrophy, and amyloid deposition on CI in LLD in the context of previously documented relationships between CI and subcortical white matter abnormalities and genetic risk factors. Functional Network Level Pathophysiologic Abnormalities Associated with Late Life Depression (Tosun) Cognitive impairment, particularly in the domains of information processing speed, executive functioning, and memory, in LLD is consistent with neurobiological conceptualizations of LLD as being heavily mediated by extended neural networks comprised of the orbitofrontal, medial prefrontal, and cingulate cortices, and anatomical connections with the temporal and parietal lobes, and basal ganglia. By disturbing the normal function and dynamics of different brain networks, the pathophysiological mechanisms of LLD may generate different specific clinical symptoms. Therefore we examine the extent to which multimodal neuroimaging techniques can identify biomarkers reflecting key pathophysiologic processes in LLD and whether such biomarkers may act as predictors, moderators, and mediators of depressive symptoms. This might facilitate development of personalized treatments based on a better understanding of the pathophysiological mechanisms of late life depression. Faculty Disclosures Scott Mackin Johnson& Johnson - Research Grant Site Principal Investigator Spouse employed by Genetech − Employee AVID - Research Grant Site Principal Investigator Janssen Pharmaceuticals - Research Grant Site Principal Investigator Duygu Tosun-Turgut Nothing to disclose J. Craig Nelson Eisai − Consultant Janssen − Consultant
Am J Geriatr Psychiatry 27:3S, March 2019
S37
AAGP Annual Meeting 2019 Assurex - Scientific/Medical Advisory Board Member Avid - Other Financial or Material Support UpToDate - Other Financial or Material Support Ruth Morin Nothing to disclose
2018 HIGHLIGHTED PAPERS FOR THE GERIATRIC MENTAL HEALTH CLINICAL PROVIDER Session 400 1 2 3 4 Juan Young ; Laurel Bessey ; Melanie Scharrer ; Silpa Balachandran 1
Case Western Reserve University MetroHealth Psychiatry University of Wisconsin School of Medicine and Public Health, Madison, WI 3 University of Wisconsin School of Medicine and Public Health, Madison, WI 4 Metrohealth Medical Center 2
Abstract: Geriatric psychiatrists and other geriatric mental health providers face several competing demands for their attention and time. Numerous scientific advances in this growing field are published each year. Providers are expected to engage in lifelong learning and to practice evidence-based medicine. This session will provide busy geriatric psychiatrists and mental health providers a highlighted overview of several of the most relevant updates pertaining to the clinical practice of geriatric psychiatry that have been published from the year 2018. We hope that after attending this session, the audience will find the information presented useful for their clinical practice and can disseminate these updates to their colleagues. This will promote efficient learning, application of acquired knowledge to clinical practice, and help busy providers who also serve as experts in geriatric psychiatry to disseminate knowledge about up-to-date advances to their colleagues back home. Faculty Disclosures Juan Young Nothing to disclose Laurel Bessey Nothing to disclose Melanie Scharrer Nothing to disclose Silpa Balachandran Nothing to disclose
DECONSTRUCTING DELIRIUM: RETHINKING THE ROLE OF BIOMARKERS AND DIAGNOSTIC ANOMALIES Session 401 1 2 3 4 5 6 Babar A. Khan ; Carol Chan ; Heidi Lindroth ; Jeffrey Browndyke ; Jo Ellen Wilson ; Sophia Wang 1
Indiana University School of Medicine Johns Hopkins Hospital, Baltimore, MD 3 Indiana University School of Medicine 4 Duke University Medical Center 5 Vanderbilt University Medical Center, Nolensville, TN 6 Indiana University School of Medicine 2
Abstract: The DSM-5 definition for delirium relies solely on clinical criteria. Recent developments in the National Institute on Aging-Alzheimer’s Association (NIA-AA) research framework have challenged clinicians to reflect on their approach for major and mild neurocognitive disorders, particularly with regards to biomarkers and preclinical Alzheimer’s disease. The implications of the NIA-AA research framework for delirium have not been fully explored. Given the overlap between delirium and dementia
S38
Am J Geriatr Psychiatry 27:3S, March 2019
PUBLIC POLICY SESSION 5: ASLEEP AT THE SWITCH: HOW GERIATRIC PSYCHIATRY, IMPLEMENTATION SCIENCE, AND HEALTH POLICY CAN HELP TO REVERSE THE NATION’S GREATEST HEALTH DISPARITY Session 322 Stephen Bartels, MD, MS
Massachusetts General Hospital Abstract: People with serious mental illness have a reduced life expectancy between 11-30 years compared to the general population, accounting for one of the nation’s greatest, but least recognized health disparities. The primary cause of early mortality is cardiovascular disease, cancer, and related risk factors including obesity, tobacco dependence, high blood pressure, and diabetes. The purpose of this presentation is to provide an update on research addressing this challenge, including research on aging and mental health combined with implementation science can help to promote access to care models and technology to address this health disparity, along with the health care reforms needed to get the job done. Faculty Disclosures Stephen Bartels Nothing to disclose
RESULTS OF THE ADNI-DEPRESSION STUDY Session 3231 2 3
Scott Mackin ; Duygu Tosun ; James Craig Nelson ; Ruth Morin4 1
UCSF Department of Psychiatry; Mental Health Service San Francisco VA Medical Center UCSF 3 UCSF 4 San Francisco VA Medical Center 2
S36
Am J Geriatr Psychiatry 27:3S, March 2019
AAGP Annual Meeting 2019 Abstract: Results Of The ADNI-Depression Study. Overview: Late life depression (LLD) is one of the most common mental health disorders with which older patients are afflicted. LLD is complicated by the common co-occurrence of cognitive impairment (CI). Estimates suggest as many as 50-60% of older depressed patients may have mild cognitive deficits however the mechanisms contributing to CI are unclear. The ADNI-Depression (ADNI-D) Study is a 5-year two-site (University of California San Francisco and the University of Pittsburgh) NIMH sponsored study of late life depression. The study aims to characterize cognitive functioning patients with LLD and clarify neurobiological mechanisms contributing to cognitive impairment and accelerated cognitive decline in this patient population. The ADNI -D study partners with the Alzheimer’s Disease Network Initiative (ADNI) and utilizes its core labs for data management, brain imaging, and biomarker assessments. The ADNI D study has been designed to focus on evaluating the impact of reduced cerebral blood flow, cortical atrophy, white matter disease, and amyloid deposition on cognitive impairment in LLD. The study is longitudinal; after an initial assessment subject are followed for 2 1/2 years. ADNI-D is committed to rapid data sharing of the ADNI-D data. This session will present initial data from the ADNI-Depression Study baseline evaluation and will be organized into 4 topic areas. ADNI-D Methodology and Sample Characteristics (Nelson) The ADNI D sample is a well characterized sample of older adults with depression. The ADNI D methodology facilitates comparisons of this cohort of LLD participants with the larger ADNI study of non-depressed older adults with normal cognition, Mild Cognitive Impairment (MCI), and dementia in order to clarify neurobiological mechanisms contributing to cognitive impairment and accelerated cognitive decline. This session will be focused on describing the ADNI-D methodology for participant enrollment and data collection and to report ADNI D sample (n=121) characteristics for depression severity, lifetime history of depression and depression treatment, and functional impairment. Specifically, participant enrollment criteria and methods for the assessment of depression severity and lifetime history of depression and depression treatments will be summarized. Additionally, standardized methodology for collection of neuroimaging data, biomarkers, and data management will be presented. Cognitive Functioning in the ADNI Depression cohort (Morin). The clarification of types and severity of cognitive dysfunction in LLD remains a significant area of research. This session will focus on identifying the cognitive impairment rates of participants with LLD in the ADNI-D study at baseline, highlighting methodological considerations for matching subjects to ADNI participants on basis of cognitive functioning for biomarker analyses, and to assess the relationship of subjective cognitive complaints and ApoE status with objective measures cognitive performance. Association of Cortical Atrophy, White Matter Lesions, and Amyloid Accumulation with Cognition in Late Life Depression (Mackin) Cognitive impairment (CI) in LLD is often characterized by deficits of executive functioning (EF), memory, and language and LLD has been strongly linked to accelerated rates of cognitive decline in older adults. However, the causes of CI in LLD are not clear, in part due to limitations of previous work which have lacked comparisons to well characterized non-depressed older adults with CI caused by neurodegenerative diseases that are often concurrent with LLD, such as the early stages of Alzheimer’s disease (AD) and cerebrovascular disease (CVD). The ADNI-D study will facilitate clarification of neurobiological mechanisms contributing to CI in LLD. This session will be focused on evaluating the impact of reduced cerebral blood flow (hypoperfusion), cortical atrophy, and amyloid deposition on CI in LLD in the context of previously documented relationships between CI and subcortical white matter abnormalities and genetic risk factors. Functional Network Level Pathophysiologic Abnormalities Associated with Late Life Depression (Tosun) Cognitive impairment, particularly in the domains of information processing speed, executive functioning, and memory, in LLD is consistent with neurobiological conceptualizations of LLD as being heavily mediated by extended neural networks comprised of the orbitofrontal, medial prefrontal, and cingulate cortices, and anatomical connections with the temporal and parietal lobes, and basal ganglia. By disturbing the normal function and dynamics of different brain networks, the pathophysiological mechanisms of LLD may generate different specific clinical symptoms. Therefore we examine the extent to which multimodal neuroimaging techniques can identify biomarkers reflecting key pathophysiologic processes in LLD and whether such biomarkers may act as predictors, moderators, and mediators of depressive symptoms. This might facilitate development of personalized treatments based on a better understanding of the pathophysiological mechanisms of late life depression. Faculty Disclosures Scott Mackin Johnson& Johnson - Research Grant Site Principal Investigator Spouse employed by Genetech − Employee AVID - Research Grant Site Principal Investigator Janssen Pharmaceuticals - Research Grant Site Principal Investigator Duygu Tosun-Turgut Nothing to disclose J. Craig Nelson Eisai − Consultant Janssen − Consultant
Am J Geriatr Psychiatry 27:3S, March 2019
S37
AAGP Annual Meeting 2019 Assurex - Scientific/Medical Advisory Board Member Avid - Other Financial or Material Support UpToDate - Other Financial or Material Support Ruth Morin Nothing to disclose
2018 HIGHLIGHTED PAPERS FOR THE GERIATRIC MENTAL HEALTH CLINICAL PROVIDER Session 400 1 2 3 4 Juan Young ; Laurel Bessey ; Melanie Scharrer ; Silpa Balachandran 1
Case Western Reserve University MetroHealth Psychiatry University of Wisconsin School of Medicine and Public Health, Madison, WI 3 University of Wisconsin School of Medicine and Public Health, Madison, WI 4 Metrohealth Medical Center 2
Abstract: Geriatric psychiatrists and other geriatric mental health providers face several competing demands for their attention and time. Numerous scientific advances in this growing field are published each year. Providers are expected to engage in lifelong learning and to practice evidence-based medicine. This session will provide busy geriatric psychiatrists and mental health providers a highlighted overview of several of the most relevant updates pertaining to the clinical practice of geriatric psychiatry that have been published from the year 2018. We hope that after attending this session, the audience will find the information presented useful for their clinical practice and can disseminate these updates to their colleagues. This will promote efficient learning, application of acquired knowledge to clinical practice, and help busy providers who also serve as experts in geriatric psychiatry to disseminate knowledge about up-to-date advances to their colleagues back home. Faculty Disclosures Juan Young Nothing to disclose Laurel Bessey Nothing to disclose Melanie Scharrer Nothing to disclose Silpa Balachandran Nothing to disclose
DECONSTRUCTING DELIRIUM: RETHINKING THE ROLE OF BIOMARKERS AND DIAGNOSTIC ANOMALIES Session 401 1 2 3 4 5 6 Babar A. Khan ; Carol Chan ; Heidi Lindroth ; Jeffrey Browndyke ; Jo Ellen Wilson ; Sophia Wang 1
Indiana University School of Medicine Johns Hopkins Hospital, Baltimore, MD 3 Indiana University School of Medicine 4 Duke University Medical Center 5 Vanderbilt University Medical Center, Nolensville, TN 6 Indiana University School of Medicine 2
Abstract: The DSM-5 definition for delirium relies solely on clinical criteria. Recent developments in the National Institute on Aging-Alzheimer’s Association (NIA-AA) research framework have challenged clinicians to reflect on their approach for major and mild neurocognitive disorders, particularly with regards to biomarkers and preclinical Alzheimer’s disease. The implications of the NIA-AA research framework for delirium have not been fully explored. Given the overlap between delirium and dementia
S38
Am J Geriatr Psychiatry 27:3S, March 2019