2019 Annual Meeting: March 7-9, 2019
Psychopathology and Aging
 The meeting will address critical issues in psychopathology and aging from various perspectives – from the molecular to the societal level. There will be a focus on Alzheimer’s and other dementing illnesses as well as the outcomes of other types of mental disorders. Psychosocial and physical stressors common in later life (e.g., isolation, bereavement, failing health) increase risk of depression, demoralization, despair, and suicide. There will also be a focus on positive aspects of aging. The program includes prominent experts in various aging-related domains and the intended audience is researchers and clinicians interested in aging as well as students.
Michael J. Lyons, PhD
President 2019
Program
Thursday, March 7
Welcoming Remarks
Michael J. Lyons, PhD, APPA President,
Boston University
Session I: Mental Disorders in Later Life, Deborah L. Levy, PhD, Harvard Medical School, Chair & Discussant
Anxiety Disorders in Later Life
David H. Barlow, PhD, Boston University
Anxiety in the elderly is associated with many challenges including decreased physical activity, decreased life satisfaction, and greater preoccupation with poor health compared to elderly individuals without clinical anxiety. Yet unlike geriatric depression, anxiety disorders in the elderly are relatively rarely studied despite the fact that the prevalence exceeds that of depression. In fact, these two conditions are highly comorbid in the elderly. Several barriers exist in screening and diagnosing anxiety in older adults including substantial medical comorbidity and increasing rates of cognitive impairment. Also, even at similar levels of severity some anxiety disorders present differently in the elderly compared to younger age groups. Some data exist on efficacious pharmacological and psychological treatments but certain medications such as benzodiazepines introduce complications. Also, limited information on treatment matching makes translation to practice difficult.
Presentation of Hoch Award
Stephen V. Faraone, PhD, State University of New York, Upstate Medical University
Attention Deficit Disorders in Later Life
Stephen V. Faraone, PhD, State University of New York, Upstate Medical University
Posttraumatic Stress Disorders in Later Life
Terrence M. Keane, PhD, National Center for PTSD
The purpose of this lecture is to review the available literature on aging in Posttraumatic Stress Disorder (PTSD). There is a wealth of information in the mental health literature about the phenotypic components of PTSD in the elderly that compares and contrasts the symptomatology in PTSD in earlier developmental stages of adult life. There are fewer studies that follow the life course of people who were diagnosed with PTSD in an earlier developmental stage through to later stages. This talk will summarize the extant findings as they pertain to combat related PTSD in elderly patients. Further, information will be presented from Project VALOR, a longitudinal study initiated in 2008 with follow ups (four completed) continuing till the current time. Project VALOR is a national PTSD registry of 1649 veterans of the current wars; half are male and half female, and they are racially and ethnically representative of those using VA Healthcare. Seventy five percent of participants were selected to comprise the PTSD cohort while twenty-five percent are help seeking participants without PTSD or other Psychiatric conditions. Data for this Registry derive from the Electronic Medical Record, Diagnostic Interviews, and self report questionnaires. Findings across multiple domains of functioning will be presented characterizing the major issues affecting these military veterans over these past ten years.
An Opioid and Benzodiazepine Epidemic in an Elderly Rural Population
Suzanne Holroyd, MD, Marshall University
Psychopathology in Older People with Neurodevelopmental Disabilities
James C. Harris, MD, Johns Hopkins University
Emotional, behavioral and mental disorders are diagnosed in approximately 1/3 of all individuals diagnosed with Intellectual Disability/Intellectual Developmental Disorder (ID/IDD). The co-occurrence of these diagnoses contributes to their functional disability and is an additional burden for affected individuals and families already coping with the consequences of their cognitive and adaptive deficits. Those affected are burdened by continuing stigma; they remain in need of supports throughout their lives. With advances in medical care life expectancy is similar to that of the general population for those in the mild to moderate range of severity. It is estimated by the year 2030 there will be 1.2 million over age 60, a near doubling from the beginning of the 21st century. Aging adults with mild to moderate ID/IDD present with the full range of psychiatric symptoms and disorders similar to typically developing persons. Co-occurring mental disorders differ for those in the severe to profound range; especially impulse control disorders and self-injurious behavior. Dementia is more prevalent with aging in Down Syndrome and Psychosis in 22q11 deletion syndrome. With recognition of co-occurrence of disorders, the evidence base for effective personalized psychosocial, behavioral and pharmacotherapies is growing allowing affected individuals to be treated in community settings.
Session IIa: Biology of Aging, Monica Uddin, PhD, University of South Florida, Chair & Discussant
Genetic Epidemiology of Aging Research
M. Daniele Fallin, PhD, Johns Hopkins University
Presentation of Hamilton Award to Michael J. Lyons, PhD
Boston University
Interaction of Physical and Mental Health in Later Life
Michael J. Lyons, PhD, Boston University
Clinical Psychopharmacology in the Elderly Patient
Carl Salzman, MD, Harvard Medical School; Beth Israel Deaconess Medical Center
Session IIb: Positive Aging, Lawrence H. Yang, PhD, New York University, Chair & Discussant
Positive Aging
George E. Vaillant, MD, Harvard Medical School; Massachusetts General Hospital; Brigham and Women's Hospital
I will report on a prospective follow-up study of College men from age 18 to age 90 illustrating the determinants of aging physically, mentally and socially well. Relationships, smoking and alcohol history were very important; cholesterol and longevity of ancestors not very important.
The Relationship of Lifestyle to Positive Aging
Arthur F. Kramer, PhD, Northeastern University
The presentation will focus on recent research that has examined the effects of exercise training interventions and physical activity on cognitive and brain health. I will discuss research that has examined changes in brain structure and/or function along with behavioral measures of cognition in interventions lasting from several weeks to 1 year. Study populations will include children, young and middle-aged individuals, and the elderly in addition to a variety of patient groups. Although the focus will be on training to improve cardiorespiratory fitness I will also briefly cover resistance training and well as multi-modal cognitive and exercise training program. Finally, the presentation will identify gaps in the literature and potential solutions.
Poster Session
Friday, March 8
Session III: Alzheimer's and Other Dementing Illnesses, Chiadikaobi U. Onyike, MD, Johns Hopkins University, Chair & Discussant
Mild Cognitive Impairment
William S. Kremen, PhD, University of California, San Diego
Cognitive Reserve and Resilience
Yaakov Stern, PhD, Columbia University
Perspectives of the National Institute on Aging
Richard J. Hodes, MD, National Institute on Aging
Non-Alzheimer's Dementia: Etiology and Epidemiology
Sudha Seshadri, MD, Boston University
APPA Annual Business Meeting (Members Only)
Session IV: Alzheimer's and Other Dementing Illnesses (continued), Daniel N. Klein, PhD, Stony Brook University, Chair & Discussant
Presentation of Zubin Award to Evelyn J. Bromet, PhD
Stony Brook University
Prospects for Emerging Treatments for Alzheimer's Disease
Howard Feldman, MD, University of California, San Diego
Epidemiology of Dementia with an Emphasis on Mechanisms Responsible for Disparities
Jennifer J. Manly, PhD, Columbia University
Psychiatric Nosology in Later Life: The DSM is Not Adequate and New Approach is Needed to Develop More Effective Therapies
Constantine George Lyketsos, MD, Johns Hopkins University
Saturday, March 9
Session V: Depression, Grief, and Suicide, Thomas F. Oltmanns, PhD, Washington University, Chair & Discussant
Depression During Later Life
George S. Alexopoulos, MD, Weill Cornell Medical College
Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging- and disease-related processes have generated pathogenetic hypotheses and provided treatment targets.
Targeting risk factors of vascular disease in mid-life is a logical approach to prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson’s disease and their efficacy needs to be assessed in these two syndromes. Modified Problem Solving Therapy has be found efficacious in the depression executive dysfunction syndrome of late-life. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied.
Efficacious psychotherapies for late-life depression exist but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation.
Suicide During Later Life
Yeates Conwell, MD, University of Rochester Medical Center
Normal Bereavement
Paula J. Clayton, MD, Washington University & University of Minnesota
Mental Health at the End of Life
Holly G. Prigerson, PhD, Weill Cornell Medical College
With the meeting’s them of “psychopathology and aging,” it is fitting that my talk, scheduled at the end of the program, addresses mental health at the end-of-life. As we age, we inevitably confront the psychological challenges associated with the loss of close others, physical decline, and, ultimately, our own death. In this talk, I’ll begin with a discussion of the psychological states, symptoms, and syndromes that accompany death, dying, and bereavement. This will address psychological symptoms commonly heightened among terminally ill patients and the significant others who care for and, most often, survive them. We will then review empirical tests of the controversial stages, or states, of grief both in dying patients facing their own death, as well as in their significant others before and after their loved one has died. We will review data demonstrating how peaceful acceptance – the emotional state of peacefulness -- coupled with cognitive acknowledgment of one’s impending death – has been linked to better end-of-life outcomes both for the dying patient (e.g., less burdensome care, better quality of death) and the bereaved survivor (lower rates of Posttraumatic Stress Disorder, Major Depressive Disorder, and Prolonged Grief Disorder). Finally, I will introduce our “Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience of Caregivers of ICU Cancer Patients” (EMPOWER) psychosocial intervention, funded by the National Cancer Institute, as an approach designed to promote better end-of-life outcomes for critically ill patients and their loved ones alike. Preliminary findings will be presented, and future directions will be discussed.
APPA 2018-2019 Council
President
Michael J. Lyons, PhD (Boston University)
President Elect
Deborah S. Hasin, PhD (Columbia University)
Vice President
James Potash, MD (Johns Hopkins University)
Secretary
William S. Stone, PhD (Harvard Medical School)
Treasurer
Joshua Breslau, ScD (RAND Corporation)
Local Arrangements Chair
Gary Heiman, PhD (Rutgers University)
Membership Chair
Monica Uddin, PhD (University of South Florida)
Coordinator
Jo-Ann L. Donatelli, PhD (Brown University)
Councilors
E. Jane Costello, PhD (Duke University) (Past President, Councilor 2018-2019)
Raymond DePaulo, MD (Johns Hopkins University School of Medicine) (2017-2021)
Stephen E. Gilman, ScD (Eunice Kennedy Shriver National Institute of Child Health and Human Development) (2016-2020)
Antonia S. New, MD (Mt. Sinai School of Medicine) (2018-2019)
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