The latest news in geriatric psychiatry covers olfactory deficits in cognitively impaired patients, a smartphone app for older adults with serious mental illness, and adjunctive ketamine for late-life depression.
The latest news in geriatric psychiatry includes the detection of olfactory deficits in patients with mild cognitive impairment; a smartphone app for older adults with serious mental illness; and ketamine as an adjunct to ECT for the treatment of late-life depression.[1-3] Scroll through the slides for findings and take-home messages.
1. Olfactory Dysfunction Is More Common in Patients With Mild Cognitive Impairment (MCI) Than in Healthy Controls: A meta-analysis of olfactory function included 31 studies with a total of 1993 patients with MCI and 2861 healthy older adults. The studies compared odor identification, discrimination, detection threshold, and/or memory between cases and controls. Olfactory deficits were moderately greater in patients with MCI than in healthy older adults.
Clinical Implications for Study 1: A simple test of odor identification may be helpful in screening those at risk for Alzheimer disease.
2. A Smartphone App Can Bring Meaningful Improvements to the Management of Serious Mental Illness in Older Patients: The smartphone app was adapted from a psychosocial self-management intervention and tested on 10 patients, mean age 55.3 years, with serious mental illness and comorbid chronic health conditions. The patients reported a high level of usability and satisfaction with the smartphone application after 3 months. They showed improvements in medical and psychiatric self-management, quality of life, social support, self-efficacy, and hope.
Clinical Implications for Study 2: Smartphone apps can be successfully implemented as a component of community-based services for older adults with serious psychiatric and medical conditions.
3. Ketamine in Conjunction With ECT May Lead to Modest Improvements in Mood and Cognition in Older Adults With Depressive and Other Disorders: A systematic review of 16 studies that evaluated ketamine as an adjunct to ECT for severe depression in older adults included patients with MDD, bipolar depression, and schizoaffective disorder. The combination treatment alleviated depression in 4 of 8 studies involving older adults. In addition, 5 studies found a significant improvement in cognitive function in elderly patients.
Clinical Implications for Study 3: Ketamine used adjunctively with ECT may provide faster relief of depression in older patients, with the most significant improvement occurring in the first 3 or 4 sessions of ECT.
1. Roalf DR, Moberg MJ, Turetsky BI, et al. A quantitative meta-analysis of olfactory dysfunction in mild cognitive impairment. J Neurol Neurosurg Psychiatry. 2017;88:226-232.
2. Whiteman KL, Lohman MC, Gill LE, et al. Adapting a psychosocial intervention for smartphone delivery to middle-aged and older adults with serious mental illness. Am J Geriatr Psychiatry. 2017 Jan 5. pii: S1064-7481(16)30336-0. doi: 10.1016/j.jagp.2016.12.007.
3. Saxena P, Espinoza R. Ketamine in electroconvulsive therapy. Am J Geriatr Psychiatry. 2017;25(suppl):S69.