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36 results

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  • Functional deficits and other psychiatric associations with abnormal scores on the Montreal Cognitive Assessment (MoCA) in older HIV-infected patients

  • James A. Bourgeois, Malcolm John, Roland Zepf, Meredith Greene, Steven Frankel, Nancy A. Hessol
  • Journal:
    International Psychogeriatrics / Volume 32 / Issue 1 / January 2020
    Published online by Cambridge University Press:
    24 April 2019, pp. 105-118
  • Objective:

    The authors assessed the association of physical function, social variables, functional status, and psychiatric co-morbidity with cognitive function among older HIV-infected adults.

    Design:

    From 2012–2014, a cross-sectional study was conducted among HIV-infected patients ages 50 or older who underwent comprehensive clinical geriatric assessment.

    Setting:

    Two San Francisco HIV clinics.

    Participants:

    359 HIV-infected patients age 50 years or older

    Measurements

    Unadjusted and adjusted Poisson regression measured prevalence ratios and 95% confidence intervals for demographic, functional and psychiatric variables and their association with cognitive impairment using a Montreal Cognitive Assessment (MoCA) score < 26 as reflective of cognitive impairment.

    Results

    Thirty-four percent of participants had a MoCA score of < 26. In unadjusted analyses, the following variables were significantly associated with an abnormal MoCA score: born female, not identifying as homosexual, non-white race, high school or less educational attainment, annual income < $10,000, tobacco use, slower gait speed, reported problems with balance, and poor social support. In subsequent adjusted analysis, the following variables were significantly associated with an abnormal MoCA score: not identifying as homosexual, non-white race, longer 4-meter walk time, and poor social support. Psychiatric symptoms of depressive, anxiety, and post-traumatic stress disorders did not correlate with abnormal MoCA scores.

    Conclusions:

    Cognitive impairment remains common in older HIV-infected patients. Counter to expectations, co-morbid psychiatric symptoms were not associated with cognitive impairment, suggesting that cognitive impairment in this sample may be due to neurocognitive disorders, not due to other psychiatric illness. The other conditions associated with cognitive impairment in this sample may warrant separate clinical and social interventions to optimize patient outcomes.

  • Geriatric gambling disorder: challenges in clinical assessment

  • Mara Smith, Ana Hategan, James A. Bourgeois
  • Journal:
    International Psychogeriatrics / Volume 29 / Issue 12 / December 2017
    Published online by Cambridge University Press:
    13 September 2017, pp. 2105-2106
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  • To the Editor: The gaming industry is growing rapidly, as is the proportion of older adults aged 65 years or older who participate in gambling (Tse et al., 2012). With casinos tailoring their venues and providing incentives to attract older adults, and with the increasing popularity of “pleasure trips” to casinos organized by retirement homes, plus active promotion of government-operated lotteries in many countries, this trend is likely to continue. Gambling disorder (GD) or “pathological” or “problem” gambling presents a public health concern in the geriatric population. However, ascertainment of its prevalence and diagnostic accuracy have proven challenging. This is largely due to the absence of diagnostic criteria specific to the geriatric age and rating scales validated for use in this population.

  • Aging with autism spectrum disorder: an emerging public health problem

  • Ana Hategan, James A. Bourgeois, Jeremy Goldberg
  • Journal:
    International Psychogeriatrics / Volume 29 / Issue 4 / April 2017
    Published online by Cambridge University Press:
    27 September 2016, pp. 695-697
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  • From 1943, when Leo Kanner originally described autism, and to the first objective criteria for “infantile autism” in DSM-III and the inclusion of Asperger's disorder in DSM-IV, the subsequent classification scheme for autistic disorders has led to a substantial change with the 2013 issuance of the DSM-5 by including subcategories into one umbrella diagnosis of autism spectrum disorder (ASD) (Baker, 2013). ASD is a lifelong neurodevelopmental disorder, characterized by social and communication impairments and restricted, stereotypical patterns of behavior (Baker, 2013). It is currently expected that most, or all of the actual cases of ASD, are identified in a timely way (i.e. in early childhood). However, there are many undiagnosed older adults who may have met the current diagnostic criteria for ASD as children, but never received such a diagnosis due to the fact it had yet to be established. In addition, some patients with relatively less impairing phenotypes may escape formal diagnosis in childhood, only to later be diagnosed in adulthood. Nevertheless, the first generation of diagnosed patients with ASD is now in old age. Many such ASD patients have needed family and institutional support for their lives subsequent to childhood diagnosis. Due to aging and death of their parents and other supportive figures leading to a loss of social structures, there is no better time than now for the medical community to act.

Comprehensive Care for Complex Patients
  • The Medical-Psychiatric Coordinating Physician Model
  • Steven A. Frankel, James A. Bourgeois, Philip Erdberg
  • Published online:
    05 November 2012
    Print publication:
    18 October 2012
  • 'Complex patients' are a sizeable population who generally require disproportionate attention for their management and respond poorly to treatment. Their systemic medical, psychiatric and personal needs have a tendency to drain or exceed the capabilities of those who treat them whilst overutilizing health care resources. As this patient population grows, we move ever closer to a crisis in health care delivery. This volume presents an innovative team-based approach for assessing and managing diagnostically complex and management intensive patients. The physician-led 'Medical-Psychiatric Coordinating Physician (MPCP)' model not only improves patient treatment, but also provides for the containment of costs by reducing redundancy and curbing excess in the use of services. Other benefits include improved diagnostic accuracy and decision making, as well as better communication among physicians and allied health professionals. This book is essential reading for psychiatrists, primary care physicians, and physicians, directors and administrators working in multidisciplinary specialty clinics.

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