Geriatric Psychiatry Research Update: January 2017

Jan 16, 2017

Three new studies offer insights into psychiatric disorders in the elderly.

References:

1. Quarmley M, Moberg PJ, Mechanic-Hamilton D, et al. Odor identification screening improves diagnostic classification in incipient Alzheimer’s disease. J Alzheimer Dis. 2017;55:1497-1507.

2. Bruce ML, Lohman MC, Greenberg RL, et al. Integrating depression care management into Medicare home health reduces risk of 30- and 60-day hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial. J Am Geriatr Soc. 2016;64:2196-2203.

3. Haeberlein SB, et al. Aducanumab 24-month data from Prime: a randomized, double-blind, placebo-controlled phase 1B study in patients with prodromal or mild Alzheimer’s disease. Presented at: 9th Annual Clinical Trials on Alzheimer’s Disease 2016; December 9, 2016; San Diego, CA.

Three new studies in older patients with psychiatric disorders show that a simple “sniff test” may help diagnose early dementia; an integrated depression management program can reduce hospitalizations; and a monoclonal antibody may lead to sustained cognitive benefit in mild Alzheimer disease.[1-3] Scroll through the slides for the latest findings and take-home messages.

1. A Simple Odor Identification Test May Help Diagnose Early Dementia: The test can clinically categorize mild cognitive impairment (MCI) and Alzheimer disease-and even identify patients at highest risk for worsening disease. In a study of 728 elderly people, a cognitive test alone correctly classified only 75% of those with MCI. That percentage rose to 87% when an odor identification test was added. Combining the 2 tests also enabled more accurate diagnosis of Alzheimer dementia.[1]

Clinical Implications for Study 1: A decline in the sense of smell may be used to identify patients at risk years before dementia develops.

2. Integrating Depression Management Into Medicare Home Health Care Reduces the Risk of Hospitalization and Re-hospitalization: In a study of 755 persons aged 65 and older who screened positive for depression on starting Medicare home health, those who received extensive depression care had a 35% lower risk of being hospitalized within 30 days and a 28% lower risk within 60 days than those who received usual care. Also, those who were referred to home health care directly from the hospital had about a 55% lower relative risk of being re-hospitalized.[2]

Clinical Implications for Study 2: In older adults with depression, basic assessment, care coordination, medication management, education, and goal setting may prompt clinical and psychosocial responses that ultimately reduce the risk of hospitalization.

3. Aducanumab May Offer Benefits for Patients With Mild Alzheimer Disease: Aducanumab, a human monoclonal antibody that binds aggregated forms of beta amyloid, has been shown in mice to remove amyloid plaques from the brain. In a 12-month, long-term extension of the phase 1b PRIME trial, exploratory endpoints of decreased amyloid plaque burden and changes from baseline on clinical endpoints showed statistically significant benefits and no new safety signals. Phase 3 trials of aducanumab in Alzheimer disease are planned.[3]

Clinical Implications for Study 3: Aducanumab has the potential to halt amyloid pathology by removing brain amyloid during the preclinical stage of disease.