Joseph S. Goveas

The COVID-19 pandemic caused an estimated 14.9 million excess deaths globally in 2020 and 2021 (WHO, 2022), including nearly 1.2 million in the U.S. (Ruhm, 2023). Heart disease, cancer and COVID-19...

Bereavement is a near-universal experience in late life, yet only some older adults develop prolonged grief disorder (PGD). While most transition from acute grief (AG) to integrated (adaptive) grief, the neurobiological substrates underlying divergent trajectories are unclear. Emotion regulation dysfunction is hypothesized to play a central role in PGD pathogenesis, but longitudinal neuroimaging data in bereaved adults are lacking. This study aims to identify functional brain circuit measures of emotional regulation that predict pathological versus adaptive grief trajectories, aligning with the Research Domain Criteria (RDoc) framework for the Negative Valence System (Loss) construct. This single-site, 1-year longitudinal study aims to enroll 170 adults aged 50–89 years: 115 with AG and 55 age- and gender-equated non-bereaved participants. Participants will complete comprehensive psychiatric, neuropsychological, and psychosocial assessments, alongside neuroimaging both at study baseline and after 12 months. Functional neuroimaging includes resting-state fMRI, a face–shape matching task probing emotion processing, and a stop-signal task probing inhibitory control. Functional neuroimaging data are acquired using a harmonized Human Connectome Project protocol on a GE Signa Premier 3T MRI scanner. We present a comprehensive overview of the eligibility criteria, clinical study procedures, and neuroimaging protocol. Baseline findings from 103 AG and 40 non-bereaved participants thus far enrolled show that the groups are demographically matched and provide high-quality neuroimaging data and robust task performance. This study is among the first longitudinal neuroimaging investigations of AG in older adults and may identify early biomarkers of PGD risk, potentially guiding precision prevention and intervention strategies for bereaved older adults.

Grief is a near-universal yet profoundly traumatic human experience, symbolizing a testament to the depth of our emotional bonds while reminding us of life’s fragility. Although most individuals adapt to loss over time, 3-10% develop Prolonged Grief Disorder (PGD), a chronic and debilitating condition recognized in both the DSM-5-TR and ICD-11. Older adults are particularly vulnerable: PGD in later life poses significant public health risks, including adverse physical health outcomes, cognitive decline, and increased premature mortality, underscoring the urgent need for early identification and effective interventions in this population. This narrative review examines psychological, social, and neurobiological perspectives on grief, highlighting distinctions between acute, integrated, and PGD trajectories. We trace the evolution of PGD as a diagnostic entity and review its risk factors, clinical presentation, comorbidities, assessment, and current treatment approaches. We then propose a neurobiological model of late-life PGD, grounded in cognitive neuroscience and emphasizing the roles of key intrinsic brain networks: the Salience Network, Default Mode Network, and Executive Control Network. Finally, we outline future directions for the field, calling for neuroimaging studies that integrate biological markers with psychosocial factors to refine diagnosis and inform targeted interventions. This review advocates for a biopsychosocial framework to advance understanding and treatment of PGD in older adults.

Mind body therapies, particularly yoga, may offer a simple, scalable, and effective intervention for prolonged grief disorder (PGD) in older adults. This pilot randomized controlled trial (RCT) compared Iyengar Yoga (IY) with Health Education (HE), an active control, assessing feasibility, safety, and clinical effects in those with probable PGD in later life. Thirty-nine bereaved adults (median age: 62.0 years) with probable PGD were randomized to IY (n = 19) or HE (n = 20). Participants attended 60-min weekly group sessions for 10 weeks. Feasibility, safety, IY instructor fidelity, and grief and depressive symptoms were assessed over time, with effect sizes (Hedges’ g) calculated to explore within-group and between-group clinical changes. Retention was 84.6%, with 100% of participants attending at least one session. Among completers (n = 33), 90.9% attended at least 80% of sessions. IY completers submitted an average of 8.65 weekly homework logs, and 82% practiced yoga at home for 60 + minutes weekly. All randomly selected IY classes met instructor fidelity. Participants in both groups reported high satisfaction; IY participants endorsed greater perceived benefits. No serious adverse events occurred. Both groups showed clinical improvements, with mean effect sizes ranging from 0.69 to 1.28 (medium to large) for overall grief and depressive symptoms, and 0.28 to 0.88 (small to large) for grief-specific symptoms. Between-group effect sizes for clinical outcomes were small. An IY and HE group intervention trial is feasible, safe, and acceptable for adults with PGD in later life. A larger, adequately powered RCT is needed to establish clinical efficacy of these interventions for late-life PGD. Trial registration. The trial is registered at ClinicalTrials.gov (NCT05026827, 08/30/2021).