A large body of historical evidence describes the use of hallucinogenic compounds, such as psilocybin mushrooms, for religious purposes. But few scientific studies have attempted to measure or characterize hallucinogen-occasioned spiritual experiences. The present study examined the factor structure of the Mystical Experience Questionnaire (MEQ), a self-report measure that has been used to assess the effects of hallucinogens in laboratory studies. Participants (N=1602) completed the 43-item MEQ in reference to a mystical or profound experience they had had after ingesting psilocybin. Exploratory factor analysis of the MEQ retained 30 items and revealed a 4-factor structure covering the dimensions of classic mystical experience: unity, noetic quality, sacredness (F1); positive mood (F2); transcendence of time/space (F3); and ineffability (F4). MEQ factor scores showed good internal reliability and correlated with the Hood Mysticism Scale, indicating convergent validity. Participants who endorsed having had a mystical experience on psilocybin, compared to those who did not, had significantly higher factor scores, indicating construct validity. The 4-factor structure was confirmed in a second sample (N=440) and demonstrated superior fit compared to alternative models. The results provide initial evidence of the validity, reliability, and factor structure of a 30-item scale for measuring single, hallucinogen-occasioned mystical experiences, which may be a useful tool in the scientific study of mysticism.

Background: Deep brain stimulation (DBS) is used to modulate the activity of dysfunctional brain circuits. The safety and efficacy of DBS in dementia is unknown.Objective: To assess DBS of memory circuits as a treatment for patients with mild Alzheimer’s disease (AD).Methods: We evaluated active “on” versus sham “off” bilateral DBS directed at the fornix-a major fiber bundle in the brain’s memory circuit-in a randomized, double-blind trial (ClinicalTrials.gov NCT01608061) in 42 patients with mild AD. We measured cognitive function and cerebral glucose metabolism up to 12 months post-implantation.Results: Surgery and electrical stimulation were safe and well tolerated. There were no significant differences in the primary cognitive outcomes (ADAS-Cog 13, CDR-SB) in the “on” versus “off” stimulation group at 12 months for the whole cohort. Patients receiving stimulation showed increased metabolism at 6 months but this was not significant at 12 months. On post-hoc analysis, there was a significant interaction between age and treatment outcome: in contrast to patients <65 years old (n = 12) whose results trended toward being worse with DBS ON versus OFF, in patients≥65 (n = 30) DBS-f ON treatment was associated with a trend toward both benefit on clinical outcomes and a greater increase in cerebral glucose metabolism.Conclusion: DBS for AD was safe and associated with increased cerebral glucose metabolism. There were no differences in cognitive outcomes for participants as a whole, but participants aged≥65 years may have derived benefit while there was possible worsening in patients below age 65 years with stimulation.

Objectives To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders. Design 18-month randomized controlled trial of 303 community-living elders. Setting: 28 postal code areas of Baltimore, MD. Participants Age 70+, with a cognitive disorder, community-living, English-speaking, and having a study partner available. Intervention 18-month care coordination intervention to systematically identify and address dementia-related care needs through individualized care planning; referral and linkage to services; provision of dementia education and skill building strategies; and care monitoring by an interdisciplinary team. Measurements Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months. Results Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37% (HR = 0.63, 95% CI 0.42 to 0.94) compared to control participants. While there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months, the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls. Intervention participants had a significant improvement in self-reported quality of life (QOL) relative to control participants. No group differences were found in proxy-rated QOL, neuropsychiatric symptoms, or depression. Conclusions A home-based dementia care coordination intervention delivered by non-clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home, reduced unmet needs, and improved self-reported QOL.

Background Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). Methods Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. Results Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. Conclusion Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.

Acute adverse psychological reactions to classic hallucinogens (“bad trips”, or “challenging experiences”), while usually benign with proper screening, preparation, and support in controlled settings, remain a safety concern in uncontrolled settings (such as illicit use contexts). Anecdotal and case reports suggest potential adverse acute symptoms including affective (panic, depressed mood), cognitive (confusion, feelings of losing sanity), and somatic (nausea, heart palpitation) symptoms. Responses to items from several hallucinogen-sensitive questionnaires (Hallucinogen Rating Scale, the States of Consciousness Questionnaire, and the 5-Dimensional Altered States of Consciousness questionnaire) in an internet survey of challenging experiences with the classic hallucinogen psilocybin were used to construct and validate a Challenging Experience Questionnaire (CEQ). The stand-alone CEQ was then validated in a separate sample. Seven CEQ factors (grief, fear, death, insanity, isolation, physical distress, and paranoia) provide a phenomenological profile of challenging aspects of experiences with psilocybin. Factor scores were associated with the difficulty, meaningfulness, spiritual significance, and change in well-being attributed to the challenging experiences. The factor structure did not differ based on gender or prior struggle with anxiety or depression. The CEQ provides a basis for future investigation of predictors and outcomes of challenging experiences with psilocybin, and should be explored as a measure of challenging experiences with the broad class of classic hallucinogens.

While highly specific, neither CAM-ICU nor NuDESC (threshold ≥2) are adequately sensitive to identify delirium post-operatively; NuDESC (threshold ≥1) increases sensitivity, but reduces specificity.

OBJECTIVES Based on a multi-factorial model of delirium, we compared the types and magnitude of pre- and intra-operative predisposing factors for incident delirium in a stratified sample of acute hip fracture repair patients with and without pre-operative dementia. DESIGN and SETTING A prospective cohort study based in an academic medical center. PARTICIPANTS 425 non-delirious, acute hip fracture patients (mean age: 80.2 +/− 6.8; female: 73.2%; “probable dementia”: 33.1%) admitted to the multi-disciplinary hip fracture repair service. MEASUREMENTS Each participant was assessed for delirium by a research nurse based on the Confusion Assessment Method (CAM) before study enrollment and from the second postoperative day until hospital discharge. RESULTS The incidence of delirium was higher in the Probable Dementia Group than in the No Dementia Group (54% vs. 26%; p≤ 0.001). In the No Dementia group (n = 284), age (OR: 1.07; 95% CI: 1.02-1.13), male gender (OR: 2.81; 95% CI: 1.40-5.64), BMI (OR: 0.92; 95% CI: 0.86-0.99), number of medical comorbidities (OR: 1.15; 95% CI: 1.01-1.32), and duration of surgery longer than two hours (OR: 2.53; 95% CI: 1.20-4.88) were independently associated with a post-operative delirium. In the Probable Dementia group, only the lag time from emergency room to operation room was significantly associated (OR: 2.83; 95% CI: 1.24-2.25) with delirium. CONCLUSION Pre-operative determination of dementia status is important for risk stratification for incident delirium after acute hip fracture repair surgery because types and magnitude of predisposing risk factors for post-operative delirium substantially differ based on their pre-operative dementia status.

Introduction Neuropsychiatric symptoms (NPSs) are nearly universal in cognitive disorders. The mild behavioral impairment construct postulates that NPS may be the first symptom of impending dementia. Methods Participants were cognitively normal volunteers followed up approximately annually at Alzheimer's Disease Centers, who were assessed on the Neuropsychiatric Inventory and had at least one follow-up visit during which they were diagnosed with mild cognitive impairment (MCI) or dementia. Descriptive statistics were used to determine sequencing of NPS presence with cognitive diagnoses. Results Data were available for 1998 participants who progressed to MCI or dementia. Over 59% developed NPS before the diagnosis of any cognitive disorder. Depression and irritability were the most common NPSs to precede cognitive diagnoses (24 and 21%, respectively). Discussion NPSs precede a cognitive diagnosis in most people who develop cognitive decline, both MCI and dementia. These individuals are an important group to focus clinical and research efforts.