The Johns Hopkins Department of Psychiatry and Behavioral Sciences is bringing new leadership to its geriatric psychiatry team, at a particularly exciting time for a field with a growing patient population. 

Decades of study are finally yielding important breakthroughs, as researchers begin to unravel some of the mysteries of dementias and mood disorders — such as depression, apathy and agitation — that often accompany age and declining cognition. New diagnostic tools and treatments have been introduced, and more seem likely to follow. 

Leading these efforts at Johns Hopkins is Paul Rosenberg, who was recently named both director of the geriatric psychiatry and neuropsychiatry division and the Richman Family Professor for Alzheimer’s and Related Diseases.

“I feel very fortunate to move into this leadership position now, because it’s such an exciting time to be in the Alzheimer’s and geriatric psychiatry field,” he says. 

Rosenberg joined Johns Hopkins 22 years ago after treating patients for many years at Georgetown University and the Veterans Administration. 

“I was practicing geriatric psychiatry, and I wanted to be part of the solution,” he says. “Hopkins offered me the opportunity to study newer and better treatments.”

The division has 19 faculty and staff members, based at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. Geriatric psychiatry focuses on psychiatric disorders, while neuropsychiatry specializes in brain diseases such as stroke and dementia, though there is much overlap between the two specialties, Rosenberg says. Facilities include an 11-bed inpatient unit at The Johns Hopkins Hospital and several outpatient locations. 

“The division’s very strong,” he says. “We’re robust on all fronts: clinical, education and research.” 

Clinicians work closely with neurologists and general practitioners to help patients who are experiencing age-related mood disorders often linked to Alzheimer’s disease and other dementias. “Often, treating mood disorders is good for cognition as well,” he notes. 

Researchers, meanwhile, are exploring new avenues for treating age-related cognition and psychiatric conditions, including studies examining the potential benefits of improved sleep, tetrahydrocannabinol (THC, a compound in cannabis), music therapy and psilocybin. 

The division also hosts two fellowships, fostering the next generation of geriatric psychiatry leaders. The geriatric psychiatry fellowship is led by Susan Lehmann, and Milap Nowrangi helms the neuropsychiatry fellowship. 

The Promise of Precision Medicine

Following her residency in psychiatry at Johns Hopkins and a one-year fellowship in geriatric psychiatry at Mass General Brigham, Clio Franklin returned to Baltimore in August as a faculty member. Splitting her time between clinical care and research allows her to provide mood disorder care in inpatient and outpatient settings, while delving into research that could improve treatments for depression and other illnesses, she says. 

Franklin has a particular interest in using precision medicine to find effective treatments for geriatric mood disorders, and was lead author of a review published in June in the American Journal of American Genetics, which examined the role of genetics in responses to treatments including electroconvulsive therapy, transcranial magnetic stimulation, ketamine and esketamine. 

“Antidepressant medication trials in general are typically not focused on older adults, and we don’t necessarily have robust data on their efficacy in this population,” she says. “But we already have all this real-world data, and we can tease out what may be most effective.” 

Precision medicine is providing data-crunching power behind other studies as well. 

One such study examines long-term outcomes of people with depression to determine whether antidepressants are beneficial or harmful to cognition. 

“It’s not a clinical trial,” Rosenberg notes. “We’re using real-world data from people who take prescribed medications, and comparing them to people who don’t. The verdict is not in, but we think in the long run we’re going to learn a great deal.”

One of Rosenberg’s interests is the role of sleep in improving cognition. He is working with Barry Greenberg, associate professor of neurology, on a clinical trial of people with early dementia, to see if brain function related to memory improves with trazodone, an antidepressant that is widely prescribed for sleep. 

“The novelty is not in targeting sleep but in measuring whether improving sleep improves cognition in early dementia,” he says.