Highlights of 3 recent studies that focus on psychiatric disorders in older adults.
1. Karlamangla AS, Lachman ME, Han W, et al. Evidence for cognitive aging in midlife women: Study of Women’s Health Across the Nation. PLoS One. 2017;12:e0169008.
2. Moore TJ, Mattison DR. Adult utilization of psychiatric drugs and differences by sex, age, and race. JAMA Intern Med. 2017;177:274-275.
3. Novak P, Schmidt R, Kontsekova E, et al. Safety and immunogenicity of the tau vaccine AADvac1 in patients with Alzheimer's disease: a randomised, double-blind, placebo-controlled, phase 1 trial. Lancet Neurology. 2017;16:123-134.
Highlights of 3 new studies in geriatric psychiatry include evidence that cognitive decline begins in women at about age 50, about 25% of adults age 60 to 85 use psychiatric drugs, and a first-in-class tau-targeting vaccine shows favorable safety and immunogenicity results in Alzheimer disease.[1-3] Scroll through the slides for the latest findings and take-home messages.
1. Study Shows That Women Begin to Have Declines in Mental Sharpness, Particularly Processing Speed, at About Age 50: The large longitudinal study included 2124 women, average age 54 at baseline, the majority of whom were postmenopausal. The women underwent annual tests of processing speed, verbal episodic memory (immediate and delayed), and working memory. After 7185 cognitive assessments with median follow-up time of 6.5 years, mean decline in cognitive speed was 4.9% in 10 years, and mean decline in verbal episodic memory (delayed testing) was 2% in 10 years.
Clinical Implications for Study 1: A decline in processing speed in midlife of 5% may be normal and is not a harbinger of declines in other domains of functioning.
2. The Use of Psychiatric Drugs Increases With Age, and Most Patients Continue the Drugs for a Long Time: An evaluation of data from the 2013 Medical Expenditure Panel Survey, which included information on the use of antidepressants, antipsychotics and anxiolytics, sedatives, and hypnotics among 242 million US adults aged 18 to 85 years, found that 16.7% filled one or more prescriptions for psychiatric drugs in 2013. Among those aged 60 to 85 years, 25% used psychiatric drugs, compared with 9% of those aged 18 to 39 years. Overall, most psychiatric drug use was considered long-term.
Clinical Implications for Study 2: The results highlight the need to monitor the long-term prescribing of sedative-hypnotics to potentially vulnerable patients, such as older adults.
3. An Active Vaccine, AADvac1, Against Pathological Tau Proteins Shows Promise in a Phase 1 Trial: The randomized, double-blind, placebo-controlled study of AADvac1 included 30 patients aged 50 to 85 years with mild to moderate Alzheimer disease. They received 3 subcutaneous doses of AADvac1 (24 patients) or placebo (6 patients) at monthly intervals, and then entered a 12-week, open-label extension phase, in which all patients were given 3 doses of AADvac1 at monthly intervals. Some 29 of the 30 patients developed an IgG immune response. Baseline values of CD3+ CD4+ lymphocytes correlated with achieved antibody titers. AADvac1 had a favorable safety profile.
Clinical Implications for Study 3: With a need to target mechanisms other than amyloid in Alzheimer disease, this vaccine may offer a strategy to attack tau.