Objectives: Shared decision-making (SDM) is a promising approach to promote patient and person-centeredness in psychiatric clinical practice. Despite being an ethical requirement, implementing SDM might be challenging, particularly for patients with severe mental illnesses who may not always be recognized as having decision-making capacity, leading to physicians often taking control.

Methods: Case Report.

Results: Mrs. D, an 84-year-old Caucasian woman with a history of multiple depressive episodes since age 24 and hypertension, was brought to the Emergency Department by her daughters due to weight loss, depressed mood, hopelessness, anhedonia. She repeated that she had no heart and expressed fears of being hospitalized, believing doctors would remove her organs, which were no longer working, and described her arms as crumbling like sand. She was initially assessed for food refusal and delusional nihilistic thoughts, which started four months prior to presenting to the hospital after discontinuation of lithium carbonate due to intoxication and got progressively worse.

The patient met the criteria for MDD with Cotard Syndrome. Recommended treatments included ECT and pharmacotherapy. During her first ECT session, she presented a 10-second post-seizure asystole. After reevaluating her treatment, her daughters asked about alternatives. Although there were no contraindications to ECT treatment, the team, in collaboration with family members, explored options. A therapeutic strategy with venlafaxine, mirtazapine, olanzapine, aripiprazole, lithium carbonate, subcutaneous dextrocetamine was implemented.

Two months later, following 15 dextrocetamine infusions, she showed partial resolution of symptoms and was discharged with no delusional content in speech. She continued outpatient dextrocetamine infusions and achieved complete symptom remission within six months, regaining her autonomy and returning to gardening. After remission, the patient expressed a desire to avoid ECT if possible, should it be indicated in the future.

Conclusions: This report highlights the potential of SDM to explore and discuss scenarios during the informed consent process and gather information on the patient’s preferences in the event of a temporary decrease in capacity. SDM with elderly can be supported by advance care planning and directives, decision aids, training clinical staff, encouraging patient questions. Key steps include creating decision aids, training staff, and familiarizing older adults with SDM.

Objectives: Evaluate the chronobiological rhythm of elderly people with type I bipolar disorder (BD), stable and without dementia, compared to controls.

Methods: A cross-sectional study was performed with 20 patients diagnosed with type I bipolar disorder, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and 20 controls. Actigraphic records were gathered from all participants over 7 days, besides clinical and demographic information. Non-parametric chronobiological measurements were calculated to evaluate the activity-rest cycle. Comparisons between groups were evaluated using Student’s t-test or Mann-Whitney test, for data with normal and non- normal distribution, respectively. All procedures were conducted following the principles outlined in the Declaration of Helsinki.

Results: Compared to controls, patients with type I BD exhibited lower M10 values, which represent the average activity during the 10 hours of peak movement within 24 hours. Additionally, they showed increased daytime and nighttime inactivity, decreased exposure to nighttime light, and higher sleep fragmentation, as evaluated by the Hurst exponent. No differences were observed between the groups about L5 values, a parameter that indicates the average activity time in the 5 hours of least activity within 24 hours, exposure to daylight, and autocorrelation, a measure that assesses sleep synchronization.

Conclusions: Differences in chronobiological patterns were observed between elderly patients with type I BD and controls. In general, patients exhibited reduced activity levels, both during the daytime and nighttime. These findings may be related to the progression of the disease, as well as prolonged exposure to medications to treat BD, such as mood stabilizers and antipsychotics. The increased sleep fragmentation observed in patients may also be associated with these factors. To date, there is a lack of data assessing the chronobiological rhythm and sleep patterns in elderly individuals with TB, underscoring the need for further studies involving thispopulation.

Objectives: Insomnia, defined by sleep initiation or maintenance difficulties, is linked to fatigue, depression, and chronic diseases. Though non-pharmacological treatment approaches are preferred, drugs like benzodiazepines and Z drugs are commonly prescribed, despite significant risks. Hypnotics, used by 9% of the general population and 11.9% of older women, can lead to severe side effects, especially among the elderly, including falls and increased mortality. This study aims to assess sleep quality, hypnotic use, and their impact on mortality among Brazilian older adults.

Methods: Using data from 8,004 cases from the Brazilian Longitudinal Study of Aging and sleep measures were collected from the first wave (2015–2016), and mortality data from the second wave (2019–2021). A cox hazard model was performed to analyze self-reported sleep quality (Likert scale from very poor to very good, and one yes/no question evaluating whether the individual had restful sleep for the most part of the past week) and sleeping pill use (past month frequency) in relation to mortality risk. Covariates included age, sex, marital status, education, income, comorbidities, smoking, alcohol consumption, and physical activity level.

Results: We found no association between self-reported sleep quality or experiencing restful and mortality risk after 4-6 years. On the other hand, when compared to individuals who did not take sleeping pills during the past month, hazard ratios (HR) for death were, respectively, 1.79 (1.11–2.88, p = 0.016) and 1.31 (1.03–1.65, p = 0.026) for those who took medication 1–2 times a week and those who took medication 3 or more times a week. Taking sleeping pills less than once a week had no association with mortality. While the top 3 mortality causes for individuals who did not use sleeping pills were stroke, myocardial infarction and diabetes, the top 3 causes for heavy users were myocardial infarction, lung cancer and chronic obstructive pulmonarydisease.

Conclusions: Insomnia must be adequately treated, but awareness of medication risks is vital. This study highlights higher mortality risk with frequent sedative-hypnotic use in older adults. Warranting non-drug treatments and careful hypnotic use could enhance health outcomes.

Summary: Age-related neurocognitive decline is often an irreversible health issue from onset. The concomitant costs could be exponential if left unchecked. There is a need to be able to delay the onset of age-related neurocognitive decline or possibly avoid it altogether. Previous studies have shown that there is a strong positive relationship between the fitness of neurocognitive function and cognitive training. Our laboratory conducted two pilot trials (Lee et al., 2013 & 2015) and one larger scale randomised controlled trial (RCT) (Yeo et al., 2018) investigating the usability and efficacy of a brain-computer interface (BCI) based attention and memory cognitive training system on older adults between ages 60 to 80. The participants across all three trials found the different iterations of our attention-memory training system to be usable and acceptable, with adherence rates surpassing 90%.

Interestingly, a growing number of studies suggest combined cognitive training and physical activity may result in a better neurocognitive outcome as compared to only cognitive training. Combining the insights from those studies and our previous trials, we developed a novel personalized multimodal BCI-based cognitive and physical training system, NeeuroCycle, for neurocognitive protection and enhancement in older adults. NeeuroCycle comprises of a stationary recumbent bicycle and a gamified cognitive training system paired with real-time frontal electroencephalogram (EEG) neurofeedback. The cognitive training program consists of six different tasks that target attention, immediate/working and delayed memory, decision- making, and visuospatial abilities. Certain parts of the gameplay are directly impacted by the partcipant’s own real-time EEG signals. NeeuroCycle has also been designed to include locally relevant stimuli and designs for our Singaporean older adult participants. Evaluation of NeeuroCycle’s efficacy is ongoing. The current study employs a three-arm RCT approach (physical- and-cognitive training [mBCI], cognitive training only [nBCI], and active control [AC] groups). We hypothesise that mBCI par1cipants will perform significantly better on cognitive assessments compared to nBCI and AC participants. Findings of the study will be presented at the IPA Congress. If tested to be effective, we expect NeeuroCycle to be an accessible, safe, and cost-effective way for older adults to maintain or improve cognitive health, which is beneficial for ageing societies.

Objectives: Primary age-related tauopathy (PART) is associated with cognitive impairment, characterized by the presence of neurofibrillary tangles composed of tau protein, independent of amyloid plaque deposition. In this study, we examined the differences in neuropsychological assessments between PART and Alzheimer’s disease (AD) over a three-year follow-up period in patients with amnestic mild cognitive impairment (amnestic MCI).

Methods: Ten patients (mean age = 75.9; SD = 7.0; Global Clinical Dementia Rating Scale = 0 or 0.5) were recruited from Memory Clinic at Keio University Hospital. They were classified into two groups of five patients with amnestic MCI or subjective cognitive impairment due to either PART (amyloid-/tau+) or AD (amyloid+/tau+) based on the results of [18 F]PM-PBB3 and [18F]Florbetaben Positron Emission Tomography imaging scanning. A battery of neuropsychological tests: Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale (ADAS), Logical memory test of Wechsler Memory Scale–Revised, Word fluency, Trail Making Test (TMT), was administered at baseline (the first visit) and after three years.

Results: All patients remained as MCI (Global CDR = 0.5) at three-year follow-up. Although ADAS score was deteriorated more in AD than PART group at three-year follow-up (p < 0.05), PART and AD groups did not differ in overall cognitive abilities including memory. However, in PART group, the TMT A & B completion time tended to be prolonged compared to AD group (p = 0.98). On the other hand, TMT B/A indicated as executive function was indifferent in both groups.

Conclusions: Patterns of cognitive decline trajectory differed between PART and AD in amnestic MCI, suggesting a difference in the neuropathological course leading to progression to AD. PART may show greater decline in visuospatial attention compared to AD. It implies that PART has distinct neuropathological and clinical features compared to AD.

Background: Psychosis represents a major unmet medical need in patients with Alzheimer’s disease (AD) dementia. With no approved medications for AD dementia psychosis (ADP), current treatment relies on off-label uses of antipsychotics with limited efficacy and significant safety concerns. Xanomeline is an M1/M4 preferring

muscarinic receptor agonist that has previously been shown to have antipsychotic effects in subjects with AD (Bodick et al., 1997). While xanomeline had promising efficacy for potentially treating psychosis in AD, cholinergic adverse events limited further clinical development of xanomeline. Xanomeline and trospium is an investigational treatment that combines xanomeline with trospium, an FDA-approved non- specific muscarinic receptor antagonist. Unlike xanomeline, trospium does not measurably cross the blood-brain barrier, providing a mechanism to mitigate peripheral cholinergic effects of xanomeline while maintaining its muscarinic receptor agonist activities in the brain.

Methods: ADEPT-2 trial is a phase 3, randomized, double-blind, placebo-controlled, parallel group study to evaluate the safety and efficacy of xanomeline and trospium for the treatment of ADP. Subjects aged 55-90 years with moderate to severe psychosis associated with mild to severe AD dementia will be enrolled into the study. Eligible subjects will be randomized to receive either xanomeline and trospium or placebo in a double-blinded manner for 12 weeks and subjects who complete the study will be eligible to participate in a one-year, open-label safety extension study.

Results: The primary efficacy endpoint of the study is change from baseline to end of Week 12 in the Neuropsychiatric Inventory-Clinical (NPI-C): Hallucinations and Delusions (H+D) score and the key secondary efficacy endpoint is change from baseline to end of Week 12 in the Cohen- Mansfield Agitation Inventory (CMAI). The safety endpoints include the evaluation of safety and tolerability of xanomeline and trospium compared with placebo in subjects with ADP. The study started in 2023 and will enroll approximately 360 subjects with psychosis associated with AD dementia.

Conclusions: ADEPT-2 is designed to assess the safety and efficacy of xanomeline and trospium for the treatment of psychosis in patients with AD dementia. If ADEPT-2 is successful, xanomeline and trospium have the potential to be the first in a new class of pharmacologic treatment for AD psychosis based on muscarinic receptor agonism.

Introduction: Young and older adults with bipolar disorder (BD) commonly present with cognitive deficits. Many also report subjective or perceived cognitive failures.

Objectives: For this study, we identified four distinct clusters of adults with BD on the basis of both BD symptoms (depression and hypo/mania) and perceived cognitive errors (i.e., forgetfulness, distractibility, false triggering). We hypothesized that participants reporting more BD symptoms and cognitive errors would report lower psychological well-being (i.e., self-efficacy, life scheme, life satisfaction).

Methods: From the BADAS (Bipolar Affective Disorder and older Adults) Study, we identified 281 adults with BD (M = 44.27 years of age, range 19–81), recruited via micro-targeted social media advertising (vs. mass marketing to general samples). All clusters significantly differed across all grouping variables except symptoms of hypo/mania due to low frequency.

Results: Across clusters, perceived cognitive failures and BD symptoms increased in lockstep; that is, those reporting more cognitive errors also reported significantly higher symptoms of both depression and hypo/mania. As hypothesized, they also reported significantly lower psychological well-being.

Conclusions: Of note, age did not significantly differ across clusters in contrast to existing research in which cognition is Objectivesly measured. That is, perceived cognitive errors are significantly associated with lower psychological well-being for both young and older adults with BD.

Objectives: Effectively adapting innovative mental health evidence-based community interventions is critical, yet underdeveloped, for reducing the treatment gap among older adults with depressive and anxiety symptoms. The Program to Encourage Active, Rewarding Lives (PEARLS) is an evidence-based community intervention designed to reduce symptoms of depression and improve quality of life among older adults. PEARLS includes 6-8 sessions of in- home visits of trained social workers to deliver a multi-component intervention: problem- solving, behavioral activation activities, and psychoeducation. We used the Framework for Reporting Adaptations and

Modifications-Enhanced (FRAME) to document process and changes made to adapting PEARLS, branded as VIDACTIVA (Vidas Activas y Valiosas) in an urban, low- resource community in Lima, Peru.

Methods: We obtained data in two stages. First, we conducted formative interviews with several stakeholders, including older adults, health professionals, community health workers (CHWs), city officials, and church leaders from the community. Second, during the iterative pilot phase, we used a mixed-Methods approach, integrating interviews with fidelity assessments, field notes, and training evaluations. We employed an iterative, rapid content analytic approach to triangulate findings from multiple sources and stakeholders, allowing us to identify needed adaptations.

Results: We made several adaptations. Most adaptations occurred during the formative phase focused on the training plan for CHWs (VIDACTIVA delivers). We also made adaptations of the components of the intervention (problem-solving) and in the way supervision sessions were conducted. Adaptations involved researchers, CHWs, health professionals and older adults. All adaptations were fidelity-consistent with PEARLS. Due to this is the early stage of implement VIDACTIVA, the most common goal across adaptations was increased feasibility and acceptability of the intervention.

Conclusions: The current study is an early effort to apply FRAME in the low-income urban context in Lima, Peru. FRAME guided systematic documentation of the adaptation decision- making process while successfully balancing fidelity. These observations lend insight to continue implementation efforts of VIDACTIVA intervention, which is undergoing a pilot clinical trial.

Objectives: Intravenous ketamine (IVK) and intranasal esketamine (ESK) are increasingly used in treatment- resistant depression (TRD). There is limited data on head-to-head comparison as well as few reports on effects across age groups.

Methods: A retrospective chart review was conducted with patients from a specialized TRD program who received acute courses of IVK (6 infusions) (n = 113) or ESK (8 intranasal insufflations) (n = 35) between February 2017 and May 2023. Clinical response (defined as 50% decrease in mood scores) and symptomatic improvement were assessed using Beck Depression Inventory (BDI). An analysis was conducted between patients younger or older than 60 years.

Results: In IVK, patients under 60 (n = 57; 58.1% female; mean age 44.4 (± 9.8)) had 22.8% response (BDI at infusion 1: 30.4 (± 9.70); infusion 6: 21.2 (± 10.9). Patients over 60 (n = 56; 49.6% female; mean age 73.2 (± 7.6)) response rate was 26.8% (BDI infusion 1: 24.9 (± 11.0); infusion 6: 19.0 (± 11.6). There was a statistically significant reduction in BDI scores between baseline and the end of the acute course (p < 0.0001). No difference between the two age groups was observed (p = 0.1165). For ESK patients under 60 (n = 22; 68.1% female; mean age 44.0 (± 8.3)), response rate was 22.78% (BDI at infusion 1: M = 30.4, SD = 9.70; and at infusion 6: M = 21.2, SD = 10.9). In older patients (n = 13; 69.2% female; mean age 72.6 ± 7.4 years)) response rate was 30.8% (BDI at infusion 1: M = 24.9, SD = 11.0; at infusion 6: M = 19.0, SD = 11.6). BDI score decline between baseline and end of the acute course was statistically significant (p < 0.0001). No difference between the two age groups was observed (p = 0.5420). No statistical difference was found in patients > 60 between IVK and ESK (p = 0.31) as well as in patients < 60 etween IVK and ESK (p = 0.4632).

Conclusions: Antidepressant response and reduction of depressive symptoms was similar between IVK and ESK, with no difference between young and old populations.

Summary: Melatonin serves as an endogenous synchronizer of biological rhythms. Age-related changes are evident with a significant reduction in melatonin observed in 24-hour secretion. Melatonin exerts a significant cytoprotective action by buffering free radicals and reversing inflammation. However, few studies have explored the association between physical activity and melatonin level. In this study, we compared melatonin level and actigraphy-derived sleep and activity indicators in older adults across two levels of exercise habit (sedentary-to- light exercise and moderate -to-vigorous exercise), as well as the association of these indicators with melatonin levels. We recruited 104 participants (aged 57– 84 years) who wore a wristwatch device to monitor their activity (MotionWatch 8; CamNtech, Cambridge, UK) for 14 days. Circadian rhythms were estimated using cosinor analysis, lag 1440 mins correlation coefficient, interdaily stability, and non-parametric analysis. Saliva samples were collected every 30 mins from 18:00 pm till one hour before usual bedtime, and maximum melatonin level during this period. A 5-minute Psychomotor Vigilance Task (PVT) was used to evaluate attention. Habits of physical activities were self-reported. Melatonin level was not significantly different between participants with sedentary- to-light and moderate-to-vigorous exercise habits. Analysis showed that participants who had moderate-vigorous exercise habit were older (p = 0.04), having longer sports time (p < 0.001) and WASO (p = 0.02), more occurrence of daytime naps (intradaily variability) (p = 0.05), more fragmentated 24-h sleep-wake cycle (interdaily stability, p = 0.01), and less regular 24h rhythm (lag 1140 mins correlation, p = 0.04). They also showed shorter response time (p = 0.05), and a smaller number of lapses (p = 0.04) in PVT. Regression analysis results showed that weekly exercise time is positively associated with melatonin level. Additionally, a later start hour of M10 is associated with 5.95 pg/ml increase in melatonin level. In consistent, exercise in older adults did not promote a robust sleep- wake cycle but is related to better cognitive function and higher melatonin levels.

Objectives: The aim of this study was to evaluate the association between self-reported sleep quality, use of sleep medications and cognitive impairment among a representative sample of the Brazilian elderly population.

Methods: We conducted a secondary analysis using the baseline data of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative sample of non-institutionalized older adults, aged 50 years or over, living across the five Brazilian regions. We divided our sample into groups according to self-rated sleep quality and the use of sleep medication, and descriptively reported sociodemographic and general health characteristics with their respective associations to each group. Subsequently, we analyzed the associations between these sleep measures and cognitive performance using linear regression.

Results: Data from 8,592 respondents were included, of which poor sleep perception was reported by 17.8% of participants, 16.2% were users of sleeping pills and 12.9% met criteria for cognitive impairment. Female sex, not having a partner, current smoking, having less education and more comorbidities were associated with poor sleep perception prevalence. Regarding the use of sleep aid, female sex, older age, not having a partner, having less education, more comorbidities and a problematic drinking behavior were associated to a current use. Any use of sleep medication (–0.06 (95% CI; –0.10 to –0.02)) and poor sleep perception (–0.06 (95% CI, –0.09 to –0.02)) were both associated with worse cognitive performance after adjustments in the multivariate analysis. Sensitivity analysis revealed that, when compared to individuals who reported “very good” sleep quality, the group who reported “poor” sleep quality was associated with worse cognitive scores (p = 0.015) When compared to not using sleeping medication, the group that used medication 3 or more times a week was associated with worse cognitive measures (p < 0.001).

Conclusions: We describe an association of sleep aid use and poor sleep perception with worse cognitive performance. We also report different frequencies of sleep quality perception and sleep aid use in accordance with a set of characteristics of this sample that can be considered potential risk factors for the development of sleep disorders and that can impact older adults’ quality of life.

Key words: Cognition, older adults, sleep quality, sleeping pills.

Objectives: To evaluate the effect and safety of Cannabidiol (CBD) on behavioral and psychological symptoms in elderly with Vascular dementia (VD).

Methods: Double- blind, randomized, placebo-controlled clinical trial involving elderly patients with VD at the psychogeriatrics and vascular dementia outpatient clinic at Hospital das Clínicas de Ribeirão Preto. The intervention evaluated was the use of CBD 300mg/day compared to placebo. The instruments used are: Neuropsychiatric Inventory, Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale, Side Effects Scale, Mini- Mental State Examination, Brief Cognitive Screening Battery, Katz Index of Independence in Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, Informant Questionnaire on Cognitive Decline in the Elderly, Zarit Burden Inventory. The included participants were assessed at the beginning of the study (baseline assessment), in the first, second and fourth weeks after the start of the clinicaltrial.

Results: 30 participants were included. The mixed ANOVA with repeated measures showed that there is an effect of the interaction time and group (F (2.12; 59.43) = 4.02; p < 0.05; ηp2 = 0.13) on the total score of the brief scale psychiatric assessment and neuropsychiatric inventory (F (1.58; 44.31) = 3.61; p =0.05; ηp2 = 0.11). The mixed ANOVA of repeated measures showed no effect of the interaction of time and group for the mini-mental state examination, brief cognitive screening battery. Adverse effects were mild and transient, and similar to the placebo group.

Conclusions: In this study, cannabidiol reduced psychological and behavioral symptoms in patients with vascular dementia. Future studies with larger samples are needed to confirm the findings. (F(1.58;44.31) = 3.61; p =0.05; ηp2 = 0.11). The mixed ANOVA of repeated measures showed no effect of the interaction of time and group for the mini-mental state examination, brief cognitive screening battery. Adverse effects were mild and transient, and similar to the placebo group.

Objectives: This systematic review aims to analyze the safety of mirtazapine in patients aged 60 years or older, as well as its side effects in this population.

Methods: A systematic literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Searches were conducted in the Embase, LILACS, PsycINFO, PubMed, Scopus, and Web of Science for articles published in any language using the terms Mirtazapine AND (pharmacovigilance OR ‘side effect*’ OR ‘adverse reaction*’ OR ‘adverse event*’ OR safety). This review was registered in PROSPERO: CRD42023492249.

Results: Seventy-two papers met the inclusion criteria. A total of 12.983.837 patients aged 60 or over included the studies selected for this systematic review. Most of the reported indications (54.1%) were for depression. The most reported adverse events were drowsiness (5–30%), dry mouth (1–37.5%), constipation (3.9–23.2%), urinary infection (8.8–24%), fractures (0.3–18.6%) and risk of death (0.28–1.7%). From the included randomized controlled trials, comparing mirtazapine with placebo, mirtazapine resulted in higher rates of dry mouth. Compared with amitriptyline, mirtazapine had lower risk of dry mouth and drowsiness, and a higher risk of constipation. Compared with fluoxetine, mirtazapine had higher rates of drowsiness and dry mouth.

Conclusions: This work provides full characterization of mirtazapine safety in older people, which may help healthcare providers better anticipate, prevent and manage adverse events in this population.

Objectives: Describe the relationship between suicide rates and deconfinement government policies in Chilean elderly.

Methods: Information on elderly deaths by suicide during de 2021–2023 period was taken from the Health Statistical Information Department of Chile (open access). Suicide rates were calculated, and monthly basis trends built. Government quarantine- deconfinement measures were reviewed for describing the relationship between policies and suicide rates.

Results: In the three-year period analyzed, suicide rates increased from 9.1 per 100,000 inhabitants to 11.4% during 2022 and decreased during 2023 to 10 per 100,000 inhabitants. Monthly suicide rates by each year are shown in Figure 1.

Conclusions: Between 2021–2023, the highest suicide rates occurred in 2022. When analyzing the trend on a monthly basis, it can be seen that there might be a relation with government quarantine-deconfinement measures. The most restrictive ones (March–June) seemed associated with the lowest rates. On the contrary, lower social restrictions (July and November) increased the deaths by suicide in the elderly.

Summary: Sexuality, often one of the least understood aspects of human behavior, encounters numerous prejudices, particularly in Latin American countries characterized by a repressive and machismo-infused education influenced by religious values, such as Catholicism. This cultural backdrop places women at a distinct disadvantage. According to the World Health Organization (WHO), sexuality encompasses various dimensions including sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Attitudes toward sexuality are shaped by past experiences, including affective, cognitive, and behavioral aspects. Societal norms for sexual activity, in the context of older adults have changed significantly. Research emphasizes the crucial role of sexual satisfaction in older adults’ overall health. The interaction of sexuality, communication, and relationship conflicts directly affects partnership satisfaction and well-being. Lack of sexual satisfaction is linked to emotional distress and physical issues, highlighting the need for medical attention and overcoming reluctance to seek help. These findings emphasize the complexity of older adults’ sexuality and the importance of a comprehensive approach considering social, cultural, and gender factors.

Objectives: To understand the attitudes of older adults receiving care at a Psychogeriatric clinic and to contrast them with the degree of sexual satisfaction they experience.

Methods: An observational, prospective, cross-sectional, descriptive, and non-comparative study was carried out to explore the attitudes of older adults with psychiatric comorbidities receiving care at a specialized clinic in Mexico City. Two questionnaires were employed to investigate biases and attitudes regarding the practice of sexuality, as well as satisfaction with their life and sexual expression: the Questionnaire of Attitudes towards Sexuality in Old Age and the Sexual Satisfaction Inventory, respectively.

Results: Participants were recruited from the Psychogeriatrics clinic of the National Institute of Psychiatry (n = 52). The average age of participants was 69.4 ± 6.4 years, with an average of 10.4 ± 5.1 years of education. Two questionnaires were utilized to assess attitudes and sexual satisfaction (Questionnaire of Attitudes Towards Sexuality in Old Age and the Sexual Satisfaction Inventory, respectively).

A statistically significant difference was found in sexual satisfaction between men and women. Men exhibited higher levels of overall sexual satisfaction (X¯ = 109.2, S.D. = 25.0) compared to women (X¯ = 87.0, S.D. = 35.7), with W = 424, p = 0.01. Women tended to harbor more negative attitudes (X¯ = 15.5, S.D. = 6.8) towards sexuality than men (X¯ = 19.5, S.D. = 6.6), with W = 399 and p = 0.01.

The correlation between sexual satisfaction and attitudes towards sexuality in older adults was analyzed using the Spearman correlation coefficient. A result of –0.1 was obtained, indicating a weak and negative correlation between the two variables evaluated (p = 0.5).

A linear regression analysis was conducted using the sexual satisfaction score (dependent variable), attitudes score (independent), and sex as a dichotomous independent factor (male or female). The contribution of sex to the model was statistically significant (p = 0.01), with an expected Sexual Satisfaction Inventory score 26.5 points lower in women compared to men. The proposed model accounted for approximately 14.0% of the variability.

Conclusions: Despite not finding a correlation between attitudes and sexual satisfaction, the gender disparities in satisfaction levels indicate that attitudes may exert differential influence on men and women. These findings underscore the significance of integrating the gender dimension when addressing sexual satisfaction in older adults. Moreover, there appears to be a restricted perspective on individual sexuality, emphasizing the imperative to overcome cultural and religious stigmas that could impact the mental health and sexual well-being of this demographic.

Objectives: The Objectives of this study is to demonstrate the response of patients with neurocognitive disorders to a combination of antidementia drugs and repetitive transcranial magnetic stimulation (rTMS).

Methods: We conducted a descriptive and retrospective study with a sample of 13 geriatric patients, randomly selected from the private psychogeriatric clinic at the Nina Institute of Clinical Neurosciences in Santo Domingo. These patients were presented with various neurocognitive disorders: 3 with mild cognitive impairment, 3 with Alzheimer’s dementia, 2 with vascular dementia, and 5 with mixed dementia. All patients signed an informed consent form. Prior to starting rTMS treatment, they underwent EEG, laboratory analysis, and neuropsychological testing using the Mini-Mental State Examination (MMSE). Additionally, they were medicated with rivastigmine (12 mg) and memantine (20 mg). The rTMS parameters for the 20-session protocol were as follows: for mild cognitive impairment, 110% motor threshold (MT), 10 Hz, and 2,000 pulses; for Alzheimer’s diagnosis, 80% MT, 20 Hz, 1,200 pulses, 80% MT, 5 Hz, 600 pulses, and theta wave at 10 Hz, 110% MT, and 2,500 pulses. The results were tabulated, and consistent were drawn.

Results: Our findings showed that all the patients improved their levels of cognitive impairment.

Conclusions: Patients improved their cognitive impairment level with the combination treatment of antidementia drugs: cholinesterase inhibitors and memantine, along with repetitive transcranial magnetic stimulation (rTMS). Repetitive transcranial magnetic stimulation (rTMS) is a developing treatment, and further clinical studies are needed to confirm its potential in treating Alzheimer’s disease and other neurocognitive disorders alongside antidementia medications.

Introduction: Transcranial Direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are neuromodulatory techniques capable of modifying the altered cerebral hyperexcitability in amnestic mild cognitive impairment (aMCI). Cortical excitability can be estimated with motor evoked potentials (MEPs) and synaptic plasticity can be induced with a 5 Hz rTMS paradigm applied to the motor cortex (M1). An increase in MEP amplitude reflects a better capacity for plasticity in M1, and these measures can, in turn, be associated with cognitive performance. Cognitive stimulation (CS) and tDCS in aMCI can modify excitability and improve cognition.

Objectives: Study the effect of the combination of CS and tDCS (real vs. placebo) on cognitive performance and cortical excitability.

Methods: Randomized, double-blind, placebo-controlled clinical trial in aMCI. The diagnosis was established through a clinical evaluation by a psychogeriatrician and a neuropsychological assessment. To determine the effect of the interventions, evaluations were conducted at two time points: before (T0) and after administering 9 sessions of CS and 15 sessions of tDCS over three weeks (T1). The evaluations included: MEP amplitude, Montreal Cognitive Assessment (MoCA), and Screening for Cognitive Impairment in Psychiatry (SCIP-S). For data analysis, ARTool in RStudio was used to perform aligned rank transformation for non-parametric analysis of variance in factorial models with fixed and random effects, applying a factorial ANOVA for each response variable.

Results: A total of 18 participants were enrolled (real n = 8 and placebo n = 10). Comparing T0 and T1, differences were found in both groups in MEP amplitude after applying the paradigm (F = 5.479; p = 0.032) as well as in the total MoCA score (F = 4.808; p = 0.043). When comparing the groups, differences were found in the delayed verbal learning domain assessed with SCIP-S (F = 6.038; p = 0.025) and in MEP amplitude (F = 6.165; p = 0.024). No differences were found in any of the evaluations when studying the effect of the GroupxTimeinteraction.

Conclusions: Both groups benefit from cognitive stimulation, and the use of tDCS does not appear to enhance the cognitive effect or the MEPs. It seems that cognitive stimulation alone is capable of modifying cortical excitability and improving cognitive performance.

Objectives: Cancer’s impact on physical and mental health varies by sex. This study explores physical and neurocognitive characteristics among elderly cancer survivors and investigates sex- specific differences in cortical thickness related to a history of cancer.

Methods: This study is part of the Arakawa geriatric cohort study for people aged 65 years or older, consisting of 1,098 individuals. Participants provided a self-reported history of cancer and underwent face-to-face diagnostic interviews, Mini-Mental State Examination (MMSE), Geriatric depression scale 15 (GDS-15), Pittsburgh Sleep Quality Index (PSQI), and three- dimensional T1-weighted magnetic resonance imaging. Cortical thickness was measured using FreeSurfer software. We explored the associations between cortical thickness, cancer history, and clinical-demographic data using univariate and multivariable regression analyses. Each analysis was conducted for the entire sample and then stratified by sex.

Results: Of 1,098 participants, 189 (17.2%) reported a history of cancer. These individuals were generally older, with a higher proportion being men. Among men, those with cancer history had lower BMI, a higher prevalence of sleep disorders (PSQI ≥ 6), lower MMSE registration scores, and more MMSE comprehension impairments. Women with a cancer history showed no significant differences in sleep or cognitive functions. After adjusting for age, imaging acquisition site, education, estimated total intracranial volume, and dementia diagnosis, cortical thicknesses of cancer survivors was found to be reduced in the left posterior cingulate in men (B [95%CI)] = 0.31 [0.12–0.78]) and in the left paracentral lobule in women (B [95%CI] = 0.22 [0.02–0.54)]).

Conclusions: Cancer history in elderly adults is associated with sex-specific differences in physical, psychological, and brain structural characteristics. In men, links were observed with underweight, sleep disturbances, and specific cognitive dysfunctions alongside reduced cortical thickness in the left 2024 International Psychogeriatric Association International Congress, IPA posterior cingulate cortex. In women, no neuropsychological changes were noted, although reduction in left paracentral cortical thickness were identified. Future research should employ longitudinal Methods to deepen understanding of cancer’s long-term psychophysical effects, with an emphasis on sex-based differences.

Objectives: To analyze psychotic symptoms following pontine stroke to better understand the neuroanatomy underlying the symptoms.

Methods: A case series including three cases of poststroke psychosis following pontine lesions and a literature review will be presented.

Results: Case 1: 67-year-old female with hypertension, hyperlipidemia, hypothyroidism, chronic kidney disease, and stroke. She presented with daily tactile hallucinations on her left face and neck that felt like a snake wrapped around her, occasional visual and tactile hallucinations of a cat, and occasional sensations that her body was on fire. Initial MRI showed diffuse atrophy, small vessel ischemic changes, and chronic hemosiderin staining of the pons and left superior basal ganglia. Repeat MRI identified bilateral thalamic lacunar infarcts, an old left caudate/corona radiata intracranial hemorrhage, and prior left occipital intracranial hemorrhage. Symptoms were managed with quetiapine 12.5mg daily.

Case 2: 74-year-old female with anemia, hypothyroidism, orthostasis, depression, mild cognitive impairment, temporal lobe epilepsy, and two strokes. She presented with near-daily distressing tactile hallucinations of worms, rubber bands, insects, snakes, and toy car wheels in her mouth. MRI showed chronic ischemic changes and central pontine and periventricular white matter lesions bilaterally with mild/moderate atrophy. Multiple medication trials and ECT treatment were aborted due to confusion and paranoia. Symptoms were managed with risperidone 2mg daily.

Case 3: 80-year-old female with hypertension, hyperlipidemia, coronary artery disease, atrial fibrillation, gastrointestinal bleed, and depression. She presented with distressing delusions that she was infested with pinworms throughout her gastrointestinal tract, along with visual hallucinations of the worms. MRI showed nonspecific white matter changes and a small T2 hyperintensity in the left pons of either a lacunar infarct or ischemic microangiopathic changes. After a partial hospitalization program enrollment and a subsequent hospitalization, symptoms were managed with risperidone 1.5mg daily.

Conclusions: Few case reports exist that describe peduncular hallucinosis, auditory hallucinations, or persistent tactile hallucinations following ischemic or hemorrhagic pontine lesions. The above cases demonstrate additional evidence of tactile and visual hallucinations following pontine stroke in geriatric patients, with imaging data localizing the lesions. Further research is needed to better understand the differing presentations, functional circuits, and neurochemical imbalances of psychosis following pontine lesion to improve diagnosis and treatments.

Introduction: Cardiac complications during electroconvulsive therapy (ECT) occur more frequently in medically frail, geriatric patients and those with catecholamine-secreting tumors including pheochromocytoma (PCC) or paraganglioma (PGL). Patients with hereditary PGL/PCC syndromes develop these tumors at higher rates, however, little is known of the safety of ECT in individuals with hereditary PGL/PCC without an active tumor who may benefit from treatment.

Methods: A case report of a patient with hereditary PGL/PCC receiving ECT for treatment resistant depression (TRD) and a literature review are presented.

Results: 59-year-old female with hereditary PGL/PCC (TMEM 127 mutation, family history), hypothyroidism, essential tremor, migraine, and TRD, presenting for hospitalization to initiate ECT for her TRD >20 years that consisted of persistent hopelessness, anhedonia, and depressed mood with two hospitalizations for suicidal ideation. Upon admission, her medications were adjusted to bupropionXR 300mg and nortriptyline 25mg at bedtime. She complained of headaches and sweating but has no history of hypertension. No abnormalities were found on 24-hour urine metanephrine, ECG, or PET-CT. Her geriatric psychiatry team, in collaboration with anesthesiology and endocrinology, felt it safe to proceed with ECT. To date, the acute course has consisted of 6 ultrabrief right unilateral ECT treatments, all without hemodynamic complications (systolic blood pressure ∼120- 150, heart rate ∼60-90). Mood, interest, motivation, and energy are improving, and passive suicidal ideation has resolved. Beck’s Depression Inventory (BDI) score decreased from 33 to 29, Clinical Global Impression (CGI) Severity score decreased from 6 to 4, and CGI Improvement score was 3.

Conclusions: PCC was previously considered an absolute contraindication to ECT based on the limited literature on the subject. While a recent systematic review recommended conducting a risk-benefit analysis before ECT in patients with PCC, there are no known cases describing approaches to ECT in patients with hereditary PGL/PCC in the absence of an active tumor. This case exemplifies the safety and efficacy of ECT in an older patient with hereditary PGL/PCC, who received careful evaluation and monitoring. The benefits of ECT for TRD in older individuals with hereditary PGL/PCC may outweigh potential risks of treatment, and complications can be mitigated through multidisciplinary pre-treatment medical evaluations and comprehensive periprocedural monitoring.