LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Prim Care Companion CNS Disord. 2023;25(6):23f03544
Author affiliations are listed at the end of this article.
Free Access: Please Log In
This content is completely free—but you need to be logged in to read the full article. If you already have an account, please log in below. Otherwise, register for free to unlock instant access.
References (64)
- Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24(4):709–711. PubMed
- Segal DL, June A, Payne M, et al. Development and initial validation of a self-report assessment tool for anxiety among older adults: the Geriatric Anxiety Scale. J Anxiety Disord. 2010;24(7):709–714. PubMed CrossRef
- Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. (published correction appears in J Am Geriatr Soc. 2019;67(9):1991) J Am Geriatr Soc. 2005;53(4):695–699. PubMed CrossRef
- Lind KE, Hildreth K, Lindrooth R, et al. The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates. Health Serv Res. 2021;56(2):193–203. PubMed CrossRef
- Chen YX, Liang N, Li XL, et al. Diagnosis and treatment for mild cognitive impairment: a systematic review of clinical practice guidelines and consensus statements. Front Neurol. 2021;12:719849. PubMed CrossRef
- Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry. 2018;33(2):379–388. PubMed CrossRef
- Molnar FJ, Benjamin S, Hawkins SA, et al. One size does not fit all: choosing practical cognitive screening tools for your practice. J Am Geriatr Soc. 2020;68(10):2207–2213. PubMed CrossRef
- Owens DK, Davidson KW, Krist AH, et al; US Preventive Services Task Force. Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;323(8):757–763. PubMed CrossRef
- Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922–935. PubMed CrossRef
- Buschke H, Kuslansky G, Katz M, et al. Screening for dementia with the memory impairment screen. Neurology. 1999;52(2):231–238. PubMed CrossRef
- Jorm AF. The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr. 2004;16(3):275–293. PubMed CrossRef
- Morley JE, Tumosa N. Saint Louis University Mental Status Examination (SLUMS). APA PsycTests; 2002. [Database record]. doi: 10.1037/t27282-000.
- Borson S, Scanlan JM, Chen P, et al. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc. 2003;51(10):1451–1454. PubMed CrossRef
- Graf C. The Lawton instrumental activities of daily living scale. Am J Nurs. 2008;108(4):52–62, quiz 62–63. PubMed CrossRef
- Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology. 2005;65(4):559–564. PubMed CrossRef
- Pfeffer RI, Kurosaki TT, Harrah CH Jr, et al. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323–329. PubMed CrossRef
- Edemekong P, Bomgaars D, et al. Activities of daily living. In: StatPearls [Internet]. Treasure Island, Florida: StatPearls Publishing; 2023.
- Shelkey M, Wallace M. Katz index of independence in activities of daily living. J Gerontol Nurs. 1999;25(3):8–9. PubMed CrossRef
- Ward A, Tardiff S, Dye C, et al. Rate of conversion from prodromal Alzheimer’s disease to Alzheimer’s dementia: a systematic review of the literature. Dement Geriatr Cogn Disord Extra. 2013;3(1):320–332. PubMed CrossRef
- Roberts RO, Knopman DS, Mielke MM, et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology. 2014;82(4):317–325. PubMed CrossRef
- Petersen R, Lopez O, Armstrong M, et al. Practice guideline update summary: mild cognitive impairment: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. 2018;90(3):126–135.
- Manly JJ, Jones RN, Langa KM, et al. Estimating the prevalence of dementia and mild cognitive impairment in the US: the 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project. JAMA Neurol. 2022;79(12):1242–1249. PubMed CrossRef
- Rajan KB, Weuve J, Barnes LL, et al. Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020-2060). Alzheimers Dement. 2021;17(12):1966–1975. PubMed CrossRef
- Rabinovici GD, Gatsonis C, Apgar C, et al. Association of amyloid positron emission tomography with subsequent change in clinical management among Medicare beneficiaries with mild cognitive impairment or dementia. JAMA. 2019;321(13):1286–1294. PubMed CrossRef
- Selkoe DJ. Alzheimer’s disease: genes, proteins, and therapy. Physiol Rev. 2001;81(2):741–766. PubMed CrossRef
- Liu PP, Xie Y, Meng XY, et al. History and progress of hypotheses and clinical trials for Alzheimer’s disease. Signal Transduct Target Ther. 2019;4(1):29. PubMed CrossRef
- Ma C, Hong F, Yang S. Amyloidosis in Alzheimer’s disease: pathogeny, etiology, and related therapeutic directions. Molecules. 2022;27(4):1210. PubMed CrossRef
- Roberson ED, Scearce-Levie K, Palop JJ, et al. Reducing endogenous tau ameliorates amyloid β-induced deficits in an Alzheimer’s disease mouse model. Science. 2007;316(5825):750–754. PubMed CrossRef
- Rapoport M, Dawson HN, Binder LI, et al. Tau is essential to β -amyloid-induced neurotoxicity. Proc Natl Acad Sci U S A. 2002;99(9):6364–6369. PubMed CrossRef
- Therriault J, Pascoal TA, Lussier FZ, et al. Biomarker modeling of Alzheimer’s disease using PET-based Braak staging. Nat Aging. 2022;2(6):526–535. PubMed CrossRef
- La Joie R, Visani AV, Baker SL, et al. Prospective longitudinal atrophy in Alzheimer’s disease correlates with the intensity and topography of baseline tau-PET. Sci Transl Med. 2020;12(524):eaau5732. PubMed CrossRef
- Largent EA, Grill JD, O’Brien K, et al. Testing for Alzheimer disease biomarkers and disclosing results across the disease continuum. Neurology. 2023;100(21):1010–1019. PubMed CrossRef
- Korczyn AD. Mixed dementia–the most common cause of dementia. Ann N Y Acad Sci. 2002;977(1):129–134. PubMed CrossRef
- Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–446. PubMed CrossRef
- Bucholc M, McClean PL, Bauermeister S, et al. Association of the use of hearing aids with the conversion from mild cognitive impairment to dementia and progression of dementia: a longitudinal retrospective study. Alzheimers Dement (N Y). 2021;7(1):e12122. PubMed CrossRef
- Consensus recommendations for the postmortem diagnosis of Alzheimer’s disease. The National Institute on Aging, and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer’s Disease. Neurobiol Aging. 1997;18(suppl):S1–S2. PubMed
- Chen A, Metzger E, Osser D. Improving pharmacologic management of behavioral and psychological symptoms of dementia (BPSD): an algorithm for real-world care. Am J Geriatr Psychiatry. 2022;30(suppl):S2. CrossRef
- McDermott CL, Gruenewald DA. Pharmacologic management of agitation in patients with dementia. Curr Geriatr Rep. 2019;8(1):1–11. PubMed CrossRef
- Gerlach LB, Kales HC. Managing behavioral and psychological symptoms of dementia. Psychiatr Clin North Am. 2018;41(1):127–139. PubMed CrossRef
- Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med. 2004;351(24):2509–2518. PubMed CrossRef
- FDA Drug Safety Communication. Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. FDA website. Accessed March 17, 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-revised-recommendations-celexa-citalopram-hydrobromide-related
- Leong C, Alessi-Severini S, Enns MW, et al. Cerebrovascular, cardiovascular, and mortality events in new users of selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. J Clin Psychopharmacol. 2017;37(3):332–340. PubMed CrossRef
- Tampi RR, Bhattacharya G, Marpuri P. Managing behavioral and psychological symptoms of dementia (BPSD) in the era of boxed warnings. Curr Psychiatry Rep. 2022;24(9):431–440. PubMed CrossRef
- Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–1960. PubMed CrossRef
- Lloyd EC, Gandhi TN, Petty LA. Monoclonal antibodies for COVID-19. JAMA. 2021;325(10):1015. PubMed CrossRef
- LiverTox: An Online Resource for Information on Drug-induced Liver Injury. NIDDK website. Accessed March 17, 2023. https://www.niddk.nih.gov/news/archive/2022/livertox-online-resource-information-drug-induced-liver-injury
- Lu RM, Hwang YC, Liu IJ, et al. Development of therapeutic antibodies for the treatment of diseases. J Biomed Sci. 2020;27(1):1. PubMed CrossRef
- Shi M, Chu F, Zhu F, et al. Impact of anti-amyloid-beta monoclonal antibodies on the pathology and clinical profile of Alzheimer’s disease: a focus on aducanumab and lecanemab. Front Aging Neurosci. 2022;14:870517. PubMed CrossRef
- Alexander GC, Knopman DS, Emerson SS, et al. Revisiting FDA approval of aducanumab. N Engl J Med. 2021;385(9):769–771. PubMed CrossRef
- Salloway S, Chalkias S, Barkhof F, et al. Amyloid-related imaging abnormalities in 2 phase 3 studies evaluating aducanumab in patients with early Alzheimer disease. JAMA Neurol. 2022;79(1):13–21. PubMed CrossRef
- National Coverage Analysis (NCA). Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease. (CAG-00460N) - Proposed Decision Memo. CMS.gov website. Accessed March 17, 2023. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=305
- Aduhelm. ALZFORUM website. Accessed March 17, 2023. https://www.alzforum.org/therapeutics/aduhelm
- van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer’s disease. N Engl J Med. 2023;388(1):9–21. PubMed CrossRef
- FDA Grants Accelerated Approval for Alzheimer’s Disease Treatment. FDA website. Accessed March 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-disease-treatment
- Cummings J, Apostolova L, Rabinovici GD, et al. Lecanemab: appropriate use recommendations. J Prev Alzheimers Dis. 2023;10(3):362–377. PubMed CrossRef
- Sims JR, Zimmer JA, Evans CD, et al; TRAILBLAZER-ALZ 2 Investigators. Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA. 2023;330(6):512–527. PubMed CrossRef
- Rashad A, Rasool A, Shaheryar M, et al. Donanemab for Alzheimer’s disease: a systematic review of clinical trials. Healthcare (Basel). 2022;11(1):32. PubMed CrossRef
- Lacorte E, Ancidoni A, Zaccaria V, et al. Safety and efficacy of monoclonal antibodies for alzheimer’s disease: a systematic review and meta-analysis of published and unpublished clinical trials. J Alzheimers Dis. 2022;87(1):101–129. PubMed CrossRef
- Robinson JC. Why is aducanumab priced at $56,000 per patient? lessons for drug-pricing reform. N Engl J Med. 2021;385(22):2017–2019. PubMed CrossRef
- Ross EL, Weinberg MS, Arnold SE. Cost-effectiveness of aducanumab and donanemab for early Alzheimer disease in the US. JAMA Neurol. 2022;79(5):478–487. PubMed CrossRef
- Mafi JN, Leng M, Arbanas JC, et al. Estimated annual spending on aducanumab in the US Medicare program. JAMA Health Forum. 2022;3(1):e214495. PubMed CrossRef
- Statement: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval | CMS. Accessed Nov 10, 2023. https://www.cms.gov/newsroom/press-releases/statement-broader-medicare-coverage-leqembi-available-following-fda-traditional-approval
- Cummings J, Lee G, Nahed P, et al. Alzheimer’s disease drug development pipeline: 2022. Alzheimers Dement (N Y). 2022;8(1):e12295. PubMed CrossRef
- Carrarini C, Russo M, Dono F, et al. Agitation and dementia: prevention and treatment strategies in acute and chronic conditions. Front Neurol. 2021;12:644317. PubMed CrossRef
Please sign in or purchase this PDF for $40.