551
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Kerssens C, Kumar R, Adams AE, Knott CC, Matalenas L, Sanford JA, Rogers WA. Personalized technology to support older adults with and without cognitive impairment living at home. Am J Alzheimers Dis Other Demen 2015; 30:85-97. [PMID: 25614507 PMCID: PMC4819239 DOI: 10.1177/1533317514568338] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although persons with dementia (PWD) and their family caregivers need in-home support for common neuropsychiatric symptoms (NPS), few if any assistive technologies are available to help manage NPS. This implementation study tested the feasibility and adoption of a touch screen technology, the Companion, which delivers psychosocial, nondrug interventions to PWD in their home to address individual NPS and needs. Interventions were personalized and delivered in home for a minimum of 3 weeks. Postintervention measures indicated the technology was easy to use, significantly facilitated meaningful and positive engagement, and simplified caregivers' daily lives. Although intervention goals were met, caregivers had high expectations of their loved one's ability to regain independence. Care recipients used the system independently but were limited by cognitive and physical impairments. We conclude the Companion can help manage NPS and offer caregiver respite at home. These data provide important guidance for design and deployment of care technology for the home.
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Affiliation(s)
| | - Renu Kumar
- Research & Innovation SimpleC, LLC, Atlanta, GA, USA
| | - Anne E Adams
- Research & Innovation SimpleC, LLC, Atlanta, GA, USA School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Laura Matalenas
- Research & Innovation SimpleC, LLC, Atlanta, GA, USA School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jon A Sanford
- Center for Assistive Technology & Environmental Access, College of Architecture, Georgia Institute of Technology, Atlanta, GA, USA Department of Veterans Affairs, Rehabilitation R & D Center of Excellence, Atlanta, GA, USA
| | - Wendy A Rogers
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
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552
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Hall JR, Wiechmann AR, Johnson LA, Edwards M, Barber RC, Cunningham R, Singh M, O'Bryant SE. The impact of APOE status on relationship of biomarkers of vascular risk and systemic inflammation to neuropsychiatric symptoms in Alzheimer's disease. J Alzheimers Dis 2015; 40:887-96. [PMID: 24577461 DOI: 10.3233/jad-131724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on the link between APOEε4 and neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) has been inconsistent. Previous work has shown a relationship between serum biomarkers of vascular risk and inflammation and NPS in AD. The current study investigated the impact of APOEε4 status on the relationship between biomarkers of cardiovascular risk, systemic inflammation, and NPS. The sample was drawn from the TARCC Longitudinal Research Cohort; the final sample of 190 consisted of 124 females and 66 males meeting the diagnostic criteria for mild to moderate AD. 115 individuals were APOEε4 carriers and 75 were non-carriers. Serum-based clinical biomarkers of vascular risk and biomarkers of inflammation related to AD were analyzed. NPS data was gathered from caretakers/family members using the Neuropsychiatric Inventory. The significant biomarkers differed for carriers and non-carriers with IL15 being a negative biomarker of total NPS accounting for 12% of the variance for carriers and IL18 and TNFα negative predictors for non-carriers (18% of variance). Patterns related to specific symptoms were similar. Stratification by gender revealed significant biomarkers of total NPS for female carriers were negative IL15 and IL1ra (18% of variance) and for female non-carriers were negative IL18 and positive homocysteine. Total cholesterol was a positive biomarker of total NPS for both male carriers (36% of variance) and non-carriers (negative TNFα and total cholesterol, 32% of variance). These findings suggest that dysregulation of inflammatory activity is related to NPS, that cholesterol is a significant factor in the occurrence of NPS, and that gender and APOE status need to be considered.
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Affiliation(s)
- James R Hall
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Psychiatry and Behavioral Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - April R Wiechmann
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Psychiatry and Behavioral Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Leigh A Johnson
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Melissa Edwards
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Robert C Barber
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rebecca Cunningham
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Meharvan Singh
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sid E O'Bryant
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
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553
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Singh TD, Duffy JR, Strand EA, Machulda MM, Whitwell JL, Josephs KA. Neuropsychiatric symptoms in primary progressive aphasia and apraxia of speech. Dement Geriatr Cogn Disord 2015; 39:228-38. [PMID: 25613190 PMCID: PMC4464666 DOI: 10.1159/000369062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/12/2022] Open
Abstract
AIM To conduct a prospective analysis of the neuropsychiatric symptoms (NPS) across the three categories of primary progressive aphasia (PPA) and progressive apraxia of speech (PAOS), compare the prevalence and nature of the symptoms, and look at which symptoms could be helpful to better differentiate these PPA and PAOS categories. METHODS A total of 106 consecutive patients with a diagnosis of semantic variant (n = 13), logopenic variant (n = 37), agrammatic variant (n = 15) or PAOS (n = 41) were included in this prospective study. The NPS were measured by the Neuropsychiatric Inventory Questionnaire. RESULTS There were 65 patients with PPA and 41 with PAOS diagnosis. The most distinguishing features between the two groups were anxiety, apathy, aberrant motor behavior and appetite, while among the subtypes of PPA they were disinhibition and appetite changes. PPA and PAOS patients initially exhibited depression, but with increased disease duration, PAOS patients showed apathy (55.5%) while PPA patients showed disinhibition (28.6%) and aberrant motor behavior (14.3%). CONCLUSION Mood symptoms like anxiety and appetite changes are more likely to be present at initial stages of PPA, whereas behavioral symptoms like aberrant motor behavior and apathy are likely to occur early in PAOS. The NPS seem to evolve with the progression of the disease in both PPA and PAOS.
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Affiliation(s)
- Tarun D. Singh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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554
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Duivenvoorden HJ, Bakker T. Minor impact of multiple psychiatric symptoms on quality of life (EQ5D) in psychogeriatric patients: a clinical-empirical structural modeling approach. Am J Geriatr Psychiatry 2014; 22:1652-62. [PMID: 24703570 DOI: 10.1016/j.jagp.2014.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship of clinical variables for cognitive functioning and other variables such as multiple neuropsychiatric symptoms and quality of life are usually analyzed bivariately and multivariately. In randomized controlled trials analyses are mostly performed on individual outcome variables. To unravel interdependencies of determinants and outcome variables, Structural Equation Modeling (SEM) was applied. METHODS Using SEM, we explored interdependencies of clinical determinants (MMSE, BI, and NPI-sum severity) and quality of life (EQ5D) in psychogeriatric patients (including dementia) suffering from cognitive problems and multiple neuropsychiatric symptoms. RESULTS MMSE and BI showed direct and indirect impact on EQ5D, but the association with NPI-sum severity was minor. The identified model showed that R(2) of EQ5D varied from 0.21 to 0.48. DISCUSSION This clinical-empirical study showed that SEM could be utilized to unravel and identify a model of complex direct and indirect effects of MMSE and BI on EQ5D. In relation to NPI-sum severity, however, the validity of EQ5D seemed insufficient in psychogeriatric patients. Consequently, the cost-benefit analyses and cost-effectiveness analyses using quality-adjusted life-year measures of an intervention in psychogeriatric patients with multiple neuropsychiatric symptoms, based on EQ5D, are considered questionable. Construction of a quality of life instrument that is more sensitive with regard to multiple neuropsychiatric symptoms in psychogeriatric patients is highly recommended.
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Affiliation(s)
- Hugo J Duivenvoorden
- Erasmus University Medical Centre, Erasmus Rotterdam, the Netherlands; Argos Care Institution, Rotterdam, the Netherlands
| | - Ton Bakker
- Argos Care Institution, Rotterdam, the Netherlands.
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555
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de Souto Barreto P, Lapeyre-Mestre M, Vellas B, Rolland Y. From rural to urban areas: differences in behavioural and psychological symptoms of dementia in nursing home residents according to geographical location. Psychogeriatrics 2014; 14:229-34. [PMID: 25495084 DOI: 10.1111/psyg.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 07/18/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND We determined whether the prevalence of behavioural and psychological symptoms of dementia (BPSD) in institutionalized older adults differed according to the geographical location of different facilities. METHODS This cross-sectional study covered 175 nursing homes (NH) in France (n = 6275; age, 86.0 ± 8.2 years; women, 73.7%). Information on NH residents' health status and NH structure and internal organization were recorded by the NH staff. Each participant was coded for the presence or absence of the following BPSD: aggressive, screaming, and wandering behaviours. NH were geographically defined as rural (<2000 inhabitants), low urban (2000 ≤ inhabitants < 10 000), intermediate urban (10 000 ≤ inhabitants < 100 000), or high urban (inhabitants ≥ 100 000). RESULTS Adjusted binary logistic regressions showed that, compared with residents living in rural NH, those living in NH located in high-urban areas had a significantly higher risk of aggressiveness (odds ratio = 1.33; 95% confidence interval = 1.06-1.67) and screaming (odds ratio = 1.43; 95% confidence interval = 1.05-1.95). The likelihood of aggressiveness was also higher in residents living in NH located in intermediate-urban areas (odds ratio = 1.36; 95% confidence interval = 1.13-1.65). CONCLUSIONS Rurality seems to play a positive role in the expression of BPSD. If this hypothesis were confirmed, it would encourage NH staff to develop activities that explore rural potentials for the management of BPSD.
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Affiliation(s)
- Philipe de Souto Barreto
- Gérontopôle of Toulouse, Institute of Ageing, University Hospital of Toulouse (CHU Toulouse), Toulouse, France; UMR7268 Aix-Marseille University Biocultural Anthropology Laboratory, Marseille, France
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556
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Guerrero-Berroa E, Kluger A, Schmeidler J, Sailor K, Lizardi H, Golomb J, Ferris S, Reisberg B. Neuropsychological and neuropsychiatric prediction of global cognitive status among older Spanish-speaking Hispanics and English-speaking whites. J Geriatr Psychiatry Neurol 2014; 27:266-75. [PMID: 24759088 PMCID: PMC4465291 DOI: 10.1177/0891988714532020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuropsychological and depression measures have been found to predict cognitive functioning. We compared these associations among whites and Spanish-speaking Hispanics. METHODS Fifty-two pairs of whites and Hispanics were matched demographically and clinically in a cross-sectional study. Hierarchical regression analyses predicted Global Deterioration Scale (GDS) rating by baseline neuropsychological tests and depression symptoms. RESULTS Neuropsychological tests predicted GDS better in whites; depression symptoms--specifically retardation--predicted well in Hispanics but not whites. Immediate recall of the New York University (NYU)-Paragraph Test and the Retardation item of the Hamilton Depression Rating Scale were associated with GDS in Hispanics and delayed recall of the NYU-Paragraph Test and Wechsler Adult Intelligence Scale-Digit Symbol in whites. Neuropsychological tests and depression symptoms predicted GDS differently in Hispanics and whites. DISCUSSION These results suggest that other measures should be considered to increase the predictive accuracy of neuropsychological tests when assessing cognitive status in Spanish-speaking Hispanics. Additional studies of specific ethnic/racial and sociodemographic subgroups are warranted.
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Affiliation(s)
| | - Alan Kluger
- Department of Psychology, Lehman College/City University of New York, New York, NY, USA, Alzheimer's Disease Center, Comprehensive Center on Brain Aging, New York University Langone Medical Center, New York, NY, USA
| | - James Schmeidler
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Sailor
- Department of Psychology, Lehman College/City University of New York, New York, NY, USA
| | - Humberto Lizardi
- Department of Psychology, Lehman College/City University of New York, New York, NY, USA
| | - James Golomb
- Alzheimer's Disease Center, Comprehensive Center on Brain Aging, New York University Langone Medical Center, New York, NY, USA
| | - Steven Ferris
- Alzheimer's Disease Center, Comprehensive Center on Brain Aging, New York University Langone Medical Center, New York, NY, USA
| | - Barry Reisberg
- Alzheimer's Disease Center, Comprehensive Center on Brain Aging, New York University Langone Medical Center, New York, NY, USA
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557
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Gitlin LN, Marx KA, Stanley IH, Hansen BR, Van Haitsma KS. Assessing neuropsychiatric symptoms in people with dementia: a systematic review of measures. Int Psychogeriatr 2014; 26:1805-48. [PMID: 25096416 DOI: 10.1017/S1041610214001537] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps. METHODS We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980-December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties. RESULTS Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties. CONCLUSIONS A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.
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558
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Tampi RR, Tampi DJ. Efficacy and tolerability of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia: a systematic review of randomized controlled trials. Am J Alzheimers Dis Other Demen 2014; 29:565-74. [PMID: 25551131 PMCID: PMC10852883 DOI: 10.1177/1533317514524813] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The objective of this review is to summarize the available data on the use of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia (BPSD) from randomized controlled trials (RCTs). A systematic search of 5 major databases, PubMed, MEDLINE, PsychINFO, EMBASE, and Cochrane Collaboration, yielded a total of 5 RCTs. One study compared diazepam to thioridazine, 1 trial compared oxazepam to haloperidol and diphenhydramine, 1 trial compared alprazolam to lorazepam, 1 trial compared lorazepam to haloperidol, and 1 trial compared intramuscular (IM) lorazepam to IM olanzapine and placebo. The data indicates that in 4 of the 5 studies, there was no significant difference in efficacy between the active drugs to treat the symptoms of BPSD. One study indicated that thioridazine may have better efficacy than diazepam for treating symptoms of BPSD. In 1 study, the active drugs had greater efficacy in treating BPSD when compared to placebo. There was no significant difference between the active drugs in terms of tolerability. However, in 2 of the 5 studies, about a third of the patients were noted to have dropped out of the studies. Available data, although limited, do not support the routine use of benzodiazepines for the treatment of BPSD. But these drugs may be used in certain circumstances where other psychotropic medications are unsafe for use in individuals with BPSD or when there are significant medication allergies or tolerability issues with certain classes of psychotropic medications.
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Affiliation(s)
- Rajesh R. Tampi
- Adult Psychiatry Residency, Regional Academic Health Center, University of Texas Health Science Center at San Antonio, Harlingen, TX, USA
| | - Deena J. Tampi
- Behavioral Health Services, Saint Francis Hospital and Medical Center, Hartford, CT, USA
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559
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Gavrilova SI, Preuss UW, Wong JWM, Hoerr R, Kaschel R, Bachinskaya N. Efficacy and safety of Ginkgo biloba extract EGb 761 in mild cognitive impairment with neuropsychiatric symptoms: a randomized, placebo-controlled, double-blind, multi-center trial. Int J Geriatr Psychiatry 2014; 29:1087-95. [PMID: 24633934 DOI: 10.1002/gps.4103] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 02/20/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The study was conducted to explore the effects of EGb 761 (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany) on neuropsychiatric symptoms (NPS) and cognition in patients with mild cognitive impairment (MCI). METHODS One hundred and sixty patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI) were enrolled in this double-blind, multi-center trial and randomized to receive 240 mg EGb 761 daily or placebo for a period of 24 weeks. Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory and the Geriatric Depression Scale. Further outcome measures were the Trail-Making Test (A/B) for cognition and global ratings of change. Statistical analyses followed the intention-to-treat principle. RESULTS The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761-treated group and by 5.5 ± 5.2 in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761 and in 55.7% of those receiving placebo (p = 0.002). Superiority of EGb 761 over placebo (p < 0.05) was also found for the State-Trait Anxiety Inventory score, the informants' global impression of change, and both Trail-Making Test scores. There were statistical trends favoring EGb 761 in the Geriatric Depression Scale and the patients' global impression of change. Adverse events (all non-serious) were reported by 37 patients taking EGb 761 and 36 patients receiving placebo. CONCLUSIONS EGb 761 improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.
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Affiliation(s)
- S I Gavrilova
- Mental Health Research Center of the Russian Academy of Medical Sciences, Moscow, Russia
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560
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Aboulafia-Brakha T, Suchecki D, Gouveia-Paulino F, Nitrini R, Ptak R. Cognitive-behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer's disease. Aging Ment Health 2014; 18:801-8. [PMID: 24499394 DOI: 10.1080/13607863.2014.880406] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Family caregivers of patients with dementia frequently experience psychological stress, depression and disturbed psychophysiological activity, with increased levels of diurnal cortisol secretion. OBJECTIVES To compare the effects of a cognitive-behavioural group therapy (CBT) to a psychoeducation group programme (EDUC) on cortisol secretion in caregivers of patients with moderate Alzheimer's disease (AD). METHOD Caregivers of AD outpatients were semi-randomly allocated to one of two intervention programmes (CBT or EDUC) consisting of eight weekly sessions. Twenty-six participants completed the study. Before and after intervention, salivary cortisol was collected at four different times of the day. Effects of the interventions were evaluated with self-report psychological scales and questionnaires related to functional abilities and neuropsychiatric symptoms of the AD relative. RESULTS Only in the CBT group did salivary cortisol levels significantly decrease after intervention, with a large effect size and high achieved power. Both groups reported a reduction of neuropsychiatric symptoms of their AD relative after intervention. CONCLUSION Psychoeducation for caregivers may contribute to a reduction of neuropsychiatric symptoms of AD patients while CBT additionally attenuates psychophysiological responses to stressful situations in caregivers, by reducing diurnal cortisol levels. This may lead to a positive impact in the general health of the caregiver, eventually resulting in better care of the AD patient.
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Affiliation(s)
- T Aboulafia-Brakha
- a Department of Clinical Neurosciences, Division of Neurology , Geneva University Hospitals , Geneva , Switzerland
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561
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Lai CKY. The merits and problems of Neuropsychiatric Inventory as an assessment tool in people with dementia and other neurological disorders. Clin Interv Aging 2014; 9:1051-61. [PMID: 25031530 PMCID: PMC4099101 DOI: 10.2147/cia.s63504] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The Neuropsychiatric Inventory (NPI) is one of the most commonly used assessment scales for assessing symptoms in people with dementia and other neurological disorders. This paper analyzes its conceptual framework, measurement mode, psychometric properties, and merits and problems. Method All articles discussing the psychometric properties and factor structure of the NPI were searched for in Medline via Ovid. The abstracts of these papers were read to determine their relevance to the purpose of this paper. If deemed appropriate, a full paper was then obtained and read. Results The NPI has reasonably good content validity and internal consistency, and good test–retest and interrater reliability. There is limited information about its sensitivity, specificity, positive and negative predictive values, and, in particular, responsiveness. Merits of the NPI include being comprehensive, avoiding symptom overlap, ease of use, and flexibility. It has problems in scoring (no multiples of 5, 7, and 11) and, therefore, analysis using parametric tests may not be appropriate. The use of individual subscales also warrants further investigation. Conclusion In terms of its content and concurrent validity, intra- and interrater reliability, test–retest reliability, and internal consistency, the NPI can be considered as valid and reliable, and can be used across different ethnic groups. The tool is most likely unable to deliver as good a performance in terms of discriminating between different disorders. More studies are required to further evaluate its psychometric properties, particularly in the areas of factor structure and responsiveness. The clinical utility of the NPI also needs to be further explored.
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Affiliation(s)
- Claudia K Y Lai
- School of Nursing, The Hong Kong Polytechnic University, Special Administrative Region of the People's Republic of China
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562
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Zahiu CDM, Rimbas M. Neuropsychiatric side-effects of interferon-alpha treatment: pathophysiology and therapeutic options. Maedica (Bucur) 2014; 9:121-126. [PMID: 25705266 PMCID: PMC4296753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/20/2014] [Indexed: 06/04/2023]
Abstract
Interferon alpha (IFN-α) is the approved standard of care for chronic hepatitis C and B. Unfortunately, it has neuropsychiatric side-effects that have a major impact upon the quality of life and the drug adherence. The mechanism of IFN-α-induced behavioral changes is complex, involving interactions between the immune system, the endocrine system, the monoaminergic systems and the opioid receptors. Recent studies support the neurodegeneration hypothesis as a possible mechanism of IFN-α-induced depressive behavior. Although a meta-analysis showed that antidepressant pretreatment effectively reduces the incidence and severity of depressive symptoms, irrespective of pre-existing psychiatric disorders, it is not approved for prophylactic use. The "on demand" treatment strategy is justified as the majority of patients have only mild depressive symptoms. Patients with risk factors for depression undergoing IFN-α therapy need to be regularly screened and followed-up by a psychiatric specialist. Further studies should be conducted to show which therapy is the most appropriate to reduce the neuropsychiatric symptoms that are related to the use of IFN-α and to investigate the clinical significance of IFN-α-induced neurodegeneration.
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Affiliation(s)
- Carmen Denise Mihaela Zahiu
- Division of Physiology and Neurosciences, Department of Functional Sciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania ; Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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563
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García-Alberca JM, Lara JP, Garrido V, Gris E, González-Herero V, Lara A. Neuropsychiatric Symptoms in Patients With Alzheimer's Disease: The Role of Caregiver Burden and Coping Strategies. Am J Alzheimers Dis Other Demen 2014; 29:354-61. [PMID: 24408750 PMCID: PMC10852959 DOI: 10.1177/1533317513518649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
This study was conducted to obtain data regarding the association of caregiver burden (CB) and neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease. We conducted a series of multiple linear regressions to determine the relationship between CB and NPSs and whether the caregiver coping strategies mediated this relationship. The NPSs were assessed using the Neuropsychiatric Inventory, and caregivers were evaluated with the Caregiver Burden Interview and the Inventory and the Coping Strategies Inventory. Results show that patients with more frequent and severe NPS were more likely to be cared for by more burdened caregivers, and this was partially mediated by caregiver coping strategies. More disengagement (β = .330,P< .001) and less engagement coping (β = -.347,P< .001) were predictors for NPS after adjusting for patient and caregiver characteristics. These results may be useful with a view to designing treatment interventions that aim to modify the use of caregiver coping strategies and to reduce NPSs.
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Affiliation(s)
- José María García-Alberca
- Dementia Unit, Instituto Andaluz de Neurociencia y Conducta, Málaga, Spain Cognitive Neurophysiology Unit, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain
| | - José Pablo Lara
- Cognitive Neurophysiology Unit, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain
| | - Victoria Garrido
- Dementia Unit, Instituto Andaluz de Neurociencia y Conducta, Málaga, Spain
| | - Esther Gris
- Dementia Unit, Instituto Andaluz de Neurociencia y Conducta, Málaga, Spain
| | | | - Almudena Lara
- Asociación Criptana de Enfermos de Alzheimer, Campo de Criptana, Spain
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Andreescu C, Teverovsky E, Fu B, Hughes TF, Chang CCH, Ganguli M. Old worries and new anxieties: behavioral symptoms and mild cognitive impairment in a population study. Am J Geriatr Psychiatry 2014; 22:274-84. [PMID: 23759435 PMCID: PMC3783616 DOI: 10.1016/j.jagp.2012.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/07/2012] [Accepted: 09/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To disentangle the complex associations of depression and anxiety with mild cognitive impairment (MCI) at the population level. We examined subgroups of anxiety symptoms and depression symptom profiles in relation to MCI, which we defined using both cognitive and functional approaches. METHODS We used an epidemiologic, cross-sectional study with an age-stratified, random, population-based sample of 1,982 individuals aged 65 years and over. Three definitions of MCI were used: 1) a purely cognitive classification into amnestic and nonamnestic MCI, 2) a combined cognitive-functional definition by International Working Group (IWG) criteria, and 3) a purely functional definition by the Clinical Dementia Rating (CDR) of 0.5. Three depression profiles were identified by factor analysis of the modified Center for Epidemiological Studies-Depression Scale: core mood, self-esteem/interpersonal, and apathy/neurovegetative profiles. Three anxiety groups, chronic mild worry, chronic severe anxiety, and recent-onset anxiety, were based on screening questions. RESULTS Recent-onset anxiety was associated with MCI by nonamnestic and IWG criteria, chronic severe anxiety was associated with MCI by all definitions, and chronic mild worry was associated with none. Of the depression profiles, the core mood profile was associated with CDR-defined MCI, the apathy/neurovegetative profile was associated with MCI by amnestic, IWG, and CDR definitions, and the self-esteem/interpersonal profile was associated with none. CONCLUSION In this population-based sample, subgroups with different anxiety and depression profiles had different relationships with cognitive and functional definitions of MCI. Anxiety, depression, and MCI are all multidimensional entities, interacting in complex ways that may shed light on underlying neural mechanisms.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Esther Teverovsky
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Bo Fu
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health
| | - Tiffany F. Hughes
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Chung-Chou H. Chang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health,Department of Medicine, University of Pittsburgh School of Medicine
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Neurology, University of Pittsburgh School of Medicine,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
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565
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Fauth EB, Gibbons A. Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms. Int J Geriatr Psychiatry 2014; 29:263-71. [PMID: 23846797 DOI: 10.1002/gps.4002] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/11/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) impact well-being for persons with dementia (PWD) and caregivers. Identifying the most problematic symptoms is vital in targeting interventions and allocating resources. The current study highlights inconsistencies in the "most problematic" symptoms when identified via prevalence, intensity, caregiver distress, or associations with caregiver depressive symptoms. METHODS Caregivers (N = 177) were mostly female (77%) and spouses of PWD (73%), with average age of 66.7 years (SD = 16.1). They reported BPSD frequency and distress via the Revised Memory and Behavior Problem Checklist (RMBPC) and Neuropsychiatric Inventory (NPI), and their own depressive symptoms via the Geriatric Depression Scale (GDS). BPSD were ranked by prevalence, average frequency, and average distress ratings. RMBPC subscales were correlated with GDS, and discriminant function analyses used NPI symptoms to discriminate between caregivers' normal (range 0-9) or elevated (10+) GDS. RESULTS Most prevalent NPI symptoms were Apathy, Depression, and Agitation. Most intense (frequency × severity) were Appetite, Motor behaviors, and Apathy, and most distressing were Delusions, Agitation, and Irritability. For RMBPC, Memory was most frequent but least distressing, whereas Disruptive was least frequent but most distressing. RMBPC frequency and distress subscales were significantly associated with caregiver GDS. Discriminant function analyses were statistically significant (Lambda = 0.822; χ(2) (12) = 30.62; p = 0.002. Canonical correlation = 0.442); NPI symptoms correctly classified caregivers GDS status 72% of the time. CONCLUSIONS Symptoms revealed as "most problematic" varied by measurement criterion. Common or frequent symptoms are not necessarily the most distressing or most predictive of caregiver depression.
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Affiliation(s)
- E B Fauth
- Department of Family, Consumer, and Human Development, Utah State University, Logan, UT, USA
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566
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Abstract
Neuropsychiatric symptoms are frequent in obesity. In addition to their substantial economic and health impact, these symptoms significantly interfere with the quality of life and social function of obese individuals. While the pathophysiological mechanisms underlying obesity-related neuropsychiatric symptoms are still under investigation and remain to be clearly identified, there is increasing evidence for a role of inflammatory processes. Obesity is characterized by a chronic low-grade inflammatory state that is likely to influence neuropsychiatric status given the well-known and highly documented effects of inflammation on brain activity/function and behavior. This hypothesis is supported by recent findings emanating from clinical investigations in obese subjects and from experimentations conducted in animal models of obesity. These studies converge to show that obesity-related inflammatory processes, originating either from the adipose tissue or gut microbiota environment, spread to the brain where they lead to substantial changes in neurocircuitry, neuroendocrine activity, neurotransmitter metabolism and activity, and neurogenesis. Together, these alterations contribute to shape the propitious bases for the development of obesity-related neuropsychiatric comorbidities.
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Affiliation(s)
- Nathalie Castanon
- UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), French National Institute for Agricultural Research (INRA), Bordeaux, France
- UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), University of Bordeaux, Bordeaux, France
| | - Julie Lasselin
- UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), French National Institute for Agricultural Research (INRA), Bordeaux, France
- UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), University of Bordeaux, Bordeaux, France
- Stress Research Institute (Stressforskningsinstitutet), Stockholm University, Stockholm, Sweden
| | - Lucile Capuron
- UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), French National Institute for Agricultural Research (INRA), Bordeaux, France
- UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), University of Bordeaux, Bordeaux, France
- *Correspondence: Lucile Capuron, UMR 1286, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), INRA, University of Bordeaux, 146 rue Léo Saignat, F-33076 Bordeaux, France e-mail:
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567
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Hall JR, Wiechmann AR, Johnson LA, Edwards M, Barber RC, Cunningham R, Singh M, O'Bryant SE. Total cholesterol and neuropsychiatric symptoms in Alzheimer's disease: the impact of total cholesterol level and gender. Dement Geriatr Cogn Disord 2014; 38:300-9. [PMID: 25011444 PMCID: PMC4201880 DOI: 10.1159/000361043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are a major factor in nursing home placement and a primary cause of stress for caregivers. Elevated cholesterol has been linked to psychiatric disorders and has been shown to be a risk factor for AD and to impact disease progression. The present study investigated the relationship between cholesterol and NPS in AD. METHODS Data on cholesterol and NPS from 220 individuals (144 females, 76 males) with mild-to-moderate AD from the Texas Alzheimer's Research and Care Consortium (TARCC) cohort were analyzed. The total number of NPS and symptoms of hyperactivity, psychosis, affect and apathy were evaluated. Groups based on total cholesterol (TC; ≥200 vs. <200 mg/dl) were compared with regard to NPS. The impact of gender was also assessed. RESULTS Individuals with high TC had lower MMSE scores as well as significantly more NPS and more symptoms of psychosis. When stratified by gender, males with high TC had significantly more NPS than females with high TC or than males or females with low TC. CONCLUSION The role of elevated cholesterol in the occurrence of NPS in AD appears to be gender and symptom specific. A cross-validation of these findings will have implications for possible treatment interventions, especially for males with high TC.
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Affiliation(s)
- James R. Hall
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Psychiatry and Behavioral Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - April R. Wiechmann
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Psychiatry and Behavioral Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Leigh A. Johnson
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Melissa Edwards
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Robert C. Barber
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rebecca Cunningham
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Meharvan Singh
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Sid E. O'Bryant
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, Texas, USA, Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
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568
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Apostolova LG, Di LJ, Duffy EL, Brook J, Elashoff D, Tseng CH, Fairbanks L, Cummings JL. Risk factors for behavioral abnormalities in mild cognitive impairment and mild Alzheimer's disease. Dement Geriatr Cogn Disord 2014; 37:315-26. [PMID: 24481207 PMCID: PMC4057985 DOI: 10.1159/000351009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavioral symptoms are common in both mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHODS We analyzed the Neuropsychiatric Inventory Questionnaire data of 3,456 MCI and 2,641 mild AD National Alzheimer's Coordinating Center database participants. Using factor analysis and logistic regression we estimated the effects of age, sex, race, education, Mini-Mental State Examination, functional impairment, marital status and family history on the presence of behavioral symptoms. We also compared the observed prevalence of behavioral symptoms between amnestic and nonamnestic MCI. RESULTS Four factors were identified: affective behaviors (depression, apathy and anxiety); distress/tension behaviors (irritability and agitation); impulse control behaviors (disinhibition, elation and aberrant motor behavior), and psychotic behaviors (delusions and hallucinations). Male gender was significantly associated with all factors. Younger age was associated with a higher prevalence of distress/tension, impulse control and psychotic behaviors. Being married was protective against psychotic behaviors. Lower education was associated with the presence of distress/tension behaviors. Caucasians showed a higher prevalence of affective behaviors. Functional impairment was strongly associated with all behavioral abnormalities. Amnestic MCI patients had more elation and agitation relative to nonamnestic MCI patients. CONCLUSIONS Younger age, male gender and greater functional impairment were associated with higher overall presence of behavioral abnormalities in MCI and mild AD. Marital status, lower education and race had an effect on selected behaviors.
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Affiliation(s)
| | - Li Jie Di
- Department of Neurology, UCLA, Los Angeles, CA
| | - Erin L. Duffy
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA
| | - Jenny Brook
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA
| | - Lynn Fairbanks
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA
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569
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van der Spek K, Gerritsen DL, Smalbrugge M, Nelissen-Vrancken MHJMG, Wetzels RB, Smeets CHW, Zuidema SU, Koopmans RTCM. PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol. BMC Psychiatry 2013; 13:307. [PMID: 24238392 PMCID: PMC3840691 DOI: 10.1186/1471-244x-13-307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/13/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use. METHODS A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored using multilevel regression analyses. For the qualitative study, in depth interviews with staff will be held and analyzed to identify and explore other unknown factors. DISCUSSION This study will provide insight into factors that are associated with the frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms. Understanding psychotropic drug use and its associations may contribute to better dementia care.
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Affiliation(s)
- Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Claudia HW Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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570
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Ibarra-Barrueta O, Palacios-Zabalza I, Mora-Atorrasagasti O, Mayo-Suarez J. Effect of concomitant use of montelukast and efavirenz on neuropsychiatric adverse events. Ann Pharmacother 2013; 48:145-8. [PMID: 24259633 DOI: 10.1177/1060028013510396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To report the case of an HIV patient who developed neuropsychiatric disturbances when montelukast was added to her therapy containing efavirenz. CASE SUMMARY A 41-year-old woman with HIV infection had been on treatment with efavirenz, emtricitabine, and tenofovir disoproxil fumarate since 2007 with good tolerance. In November 2011, montelukast was started for asthma and shortly thereafter neuropsychiatric symptoms appeared, consisting of disturbed sleep, vivid dreams, irritability, confusion, and concentration difficulties. In January 2012, 2 months after the introduction of montelukast, she continued to report unbearable symptoms without any improvement; so, montelukast was withdrawn and the psychiatric symptoms completely disappeared. DISCUSSION The combination of efavirenz and montelukast has not previously been associated with any pharmacokinetic interactions or worsening of neuropsychiatric symptoms. This case report indicates the possibility of adverse effects developing when the 2 drugs are used together. These symptoms might either be related to a drug-drug interaction or increased by the similar side effect profiles of the 2 drugs. The higher score on the Karch-Lasagna scale suggests that an adverse effect is the more likely explanation. We cannot, however, rule out a drug interaction, given that efavirenz inhibits the CYP 2C9, 2C19, and 3A4 isoenzymes and CYP 3A4, 2C9, and 2C8 are involved in the metabolism of montelukast. CONCLUSIONS Considering that efavirenz is frequently used in antiretroviral therapy and that neuropsychiatric symptoms can limit its use, clinicians should consider the possibility of worsening of these symptoms, such as mood disorders and abnormal dreams, when montelukast is introduced.
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571
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Cheng ST, Lam LCW, Kwok T. Neuropsychiatric symptom clusters of Alzheimer disease in Hong Kong Chinese: correlates with caregiver burden and depression. Am J Geriatr Psychiatry 2013; 21:1029-37. [PMID: 23567373 DOI: 10.1016/j.jagp.2013.01.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 06/19/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the relative effects of different neuropsychiatric syndromes of Alzheimer disease (AD) on caregiver burden and depression. METHODS One hundred forty-two Chinese family carers of persons with AD were individually interviewed using Neuropsychiatric Inventory (NPI), Revised Memory and Behavior Problems Checklist (RMBPC), Zarit Burden Interview, Pearlin's measure of role overload, Hamilton Depression Rating Scale, and other relevant measures (e.g., caregiving hours per week, relationship to care recipient [CR], CR's functional impairment). CRs were administered the Cantonese version of the Mini-Mental State Examination. AD severity was determined by Clinical Dementia Rating. NPI and RMBPC items were scored according to syndromal classifications (NPI: behavior problems, psychosis, mood disturbance, euphoria; RMBPC: disruptive behaviors, depression, memory-related problems). Data were analyzed using multiple regression, with caregiver gender, caregiving hours per week, and CR's functional impairment as covariates. The analysis with Hamilton depression as the outcome variable also included Zarit burden and role overload as predictors. RESULTS NPI behavior and NPI mood were consistent predictors of Zarit burden and role overload. RMBPC memory predicted Zarit burden. No other neuropsychiatric syndromes had independent effects on burden and overload. After partializing out the effects of burden, overload, and other covariates, NPI behavior was the only syndrome that predicted caregiver depression. CONCLUSIONS Not all neuropsychiatric symptoms affected caregiver burden and depression, and overt behavior problems and mood disturbances were consistent predictors of burden.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Psychological Studies and Center for Psychosocial Health and Aging, Hong Kong Institute of Education, Hong Kong.
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572
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Abstract
Depression and cognitive disorders, including dementia and mild cognitive impairment, are common in the elderly. Depression is also a common feature of cognitive impairment although the symptoms of depression in cognitive impairment differ from depression without cognitive impairment. Pre-morbid depression approximately doubles the risk of subsequent dementia. There are two predominant, though not mutually exclusive, constructs linking pre-morbid depression to subsequent cognitive impairment: Alzheimer's pathology and the vascular depression hypothesis. When evaluating a patient with depression and cognitive impairment, it is important to obtain caregiver input and to evaluate for alternative etiologies for depressive symptoms such as delirium. We recommend a sequential approach to the treatment of depression in dementia patients: (1) a period of watchful waiting for milder symptoms, (2) psychosocial treatment program, (3) a medication trial for more severe symptoms or failure of psychosocial interventions, and (4) possible ECT for refractory symptoms.
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Affiliation(s)
- Laurel D. Pellegrino
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA
| | - Christopher M. Marano
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA
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573
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Abstract
The objective of this critical review of the literature was to reveal the neural
circuits involved in the occurrence of neuropsychiatric symptoms (NPS) in
Alzheimer's disease (AD) patients through the association of these symptoms with
neuroimaging findings. The search for articles was performed on PUBMED from
January 2000 to May 2013, using the key words: Dementia AND BPSD; Dementia AND
Neuropsychiatric Symptoms; and Dementia AND Psychosis, Delusions,
Hallucinations, Agitation, Depression, Anxiety, Apathy, Euphoria, Disinhibition,
Irritability, Aberrant Motor Behavior, Sleep or Eating Disorders. Forty-six
articles were reviewed and important contributions, especially regarding the
psychopathological concepts discussed, were also considered even if not included
in this time period. The available evidence suggests the three most relevant
neurobiological models for neuropsychiatric symptoms in Alzheimer's disease are
the frontal-subcortical circuits, the cortico-cortical networks, and the
monoaminergic system. We discussed the association of the individual symptoms or
syndromes with these models.
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574
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Stella F, Forlenza OV, Laks J, de Andrade LP, Avendaño MA, Sé EV, Cação Jde C, Lyketsos CG, de Medeiros K. The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity in dementia. Int Psychogeriatr 2013; 25:1503-11. [PMID: 23763895 DOI: 10.1017/S1041610213000811] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort. METHODS Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI). RESULTS Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS. CONCLUSION The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains.
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575
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Abstract
The issue of this article concerned the discussion about tools frequently used
tools for assessing neuropsychiatric symptoms of patients with dementia,
particularly Alzheimer's disease. The aims were to discuss the main tools for
evaluating behavioral disturbances, and particularly the accuracy of the
Neuropsychiatric Inventory – Clinician Rating Scale (NPI-C). The clinical
approach to and diagnosis of neuropsychiatric syndromes in dementia require
suitable accuracy. Advances in the recognition and early accurate diagnosis of
psychopathological symptoms help guide appropriate pharmacological and
non-pharmacological interventions. In addition, recommended standardized and
validated measurements contribute to both scientific research and clinical
practice. Emotional distress, caregiver burden, and cognitive impairment often
experienced by elderly caregivers, may affect the quality of caregiver reports.
The clinician rating approach helps attenuate these misinterpretations. In this
scenario, the NPI-C is a promising and versatile tool for assessing
neuropsychiatric syndromes in dementia, offering good accuracy and high
reliability, mainly based on the diagnostic impression of the clinician. This
tool can provide both strategies: a comprehensive assessment of neuropsychiatric
symptoms in dementia or the investigation of specific psychopathological
syndromes such as agitation, depression, anxiety, apathy, sleep disorders, and
aberrant motor disorders, among others.
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Affiliation(s)
- Florindo Stella
- UNESP - Universidade Estadual Paulista, Instituto de Biociências, Campus de Rio Claro. Pesquisador do Laboratório de Neurociências, Instituto de Psiquiatria - Faculdade de Medicina, Universidade de São Paulo
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576
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Abstract
Neuropsychiatric symptoms (NPS) of dementia constitute one of the most related
factors to caregiver burden and patients' early institutionalization. Few
studies in Brazil have examined which symptoms are associated with higher levels
of caregiver distress.
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Affiliation(s)
- Annibal Truzzi
- MD, PhD. Centro de Estudos e Pesquisa do Envelhecimento, Instituto Vital Brasil e Centro para Pessoas com Doença de Alzheimer, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro
| | - Letice Valente
- Centro para Pessoas com Doença de Alzheimer, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro
| | - Eliasz Engelhardt
- MD, PhD. Cognitive and Behavioral Neurology Unit - INDC-CDA/IPUB - Universidade Federal do Rio de Janeiro
| | - Jerson Laks
- MD, PhD. Centro para Pessoas com Doença de Alzheimer, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro
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577
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Folquitto JC, Marques RDCG, Tatsch MF, Bottino CMDC. Correlation between neuropsychiatric symptoms and caregiver burden in a population-based sample from São Paulo, Brazil: a preliminary report. Dement Neuropsychol 2013; 7:258-262. [PMID: 29213848 PMCID: PMC5619196 DOI: 10.1590/s1980-57642013dn70300005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neuropsychiatric symptoms and caregiver burden are highly prevalent in older adults with Alzheimer's disease (AD).OBJECTIVE: To evaluate the correlation between neuropsychiatric symptoms and caregiver burden in a community-based sample from São Paulo, Brazil. METHODS A total of 1,563 randomly-selected subjects were assessed by the Mini-Mental State Examination, Fuld Object Memory Evaluation, Informant Questionnaire on Cognitive Decline in the Elderly and Bayer - Activities of Daily Living Scale. Subjects considered screen-positives were submitted to a dementia workup and diagnosis was determined according to ICD-10 criteria. The neuropsychiatric Inventory was applied to caregivers to evaluate neuropsychiatric symptoms and the Zarit Burden Interview was also applied to assess caregivers' burden. RESULTS Sixty-one AD patients, 25 Cognitively Impaired Non Demented (CIND) and 79 healthy elderly subjects were evaluated. Zarit mean scores for controls, CIND and AD were 2.32, 3.92 and 20.11, respectively. There was strong positive correlation between total NPI and Zarit scores. CONCLUSION In conclusion, neuropsychiatric symptoms showed a significant association with higher rates of caregiver stress.
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578
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Trzepacz PT, Saykin A, Yu P, Bhamditipati P, Sun J, Dennehy EB, Willis B, Cummings JL. Subscale validation of the neuropsychiatric inventory questionnaire: comparison of Alzheimer's disease neuroimaging initiative and national Alzheimer's coordinating center cohorts. Am J Geriatr Psychiatry 2013; 21:607-22. [PMID: 23602309 PMCID: PMC3913908 DOI: 10.1016/j.jagp.2012.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 10/17/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms are prevalent in mild cognitive impairment (MCI) and Alzheimer disease (AD) and commonly measured using the Neuropsychiatric Inventory (NPI). Based on existing exploratory literature, we report preliminary validation of three NPI Questionnaire (NPI-Q-10) subscales that measure clinically meaningful symptom clusters. METHODS Cross-sectional results for three subscales (NPI-Q-4-Frontal, NPI-Q-4-Agitation/Aggression, NPI-Q-3-Mood) in amnestic MCI and AD dementia cases from the National Alzheimer's Coordinating Center (NACC) and Alzheimer's Disease Neuroimaging Initiative (ADNI) databases were analyzed using confirmatory unrotated principal component analysis. RESULTS ADNI contributed 103 MCI, 90 MCI converters, and 112 AD dementia cases, whereas NACC contributed 1,042 MCI, 763 MCI converters, and 3,048 AD dementia cases. NACC had higher baseline mean age (75.7 versus 74.6), and more impaired mean scores (at month 24) on Mini-Mental State Exam (19.5 versus 22.4) and NPI-Q-10 (5.0 versus 4.3), and all NPI-Q subscales than ADNI. Medians were not different between cohorts for NPI-Q-4-Agitation/Aggression, and NPI-Q-3-Mood, however. Each item on all scales/subscales contributed variance in principal component analysis Pareto plots. All items in Factor (F) 1 for each scale/subscale projected in a positive direction on biplots (revealing coherence), whereas F2 and F3 items showed more spatial separation (revealing independence). There were remarkable similarities between cohorts for factor loadings and spatial patterns of item projections, although factor item identities varied somewhat, especially beyond F1. CONCLUSION The similar pattern of results across two cohorts support validity of these subscales, which are worthy of further psychometric evaluation in MCI and AD patients and preliminary application in clinical settings.
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579
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Siqueira-Neto JI, Pontes-Neto OM, do Vale FDAC, dos Santos JV, Sales PMG, dos Santos JV, Santos AC. Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil. Dement Neuropsychol 2013; 7:263-268. [PMID: 29213849 PMCID: PMC5619197 DOI: 10.1590/s1980-57642013dn70300006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/04/2013] [Indexed: 11/22/2022] Open
Abstract
Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries. OBJECTIVE We aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic. METHODS We reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation. RESULTS Two hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors. CONCLUSION We found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.
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Affiliation(s)
- José Ibiapina Siqueira-Neto
- MD, PhD. Associate Professor of Neurology, Clinical
Medicine Department, Faculty of Medicine, Federal University of Ceará,
Brazil
| | - Octávio Marques Pontes-Neto
- MD, PhD. Associate Professor of Neurology, Department of
Neuroscience and Behavior Sciences, University of São Paulo, University
Hospital of Ribeirao Preto, Brazil
| | | | | | | | | | - Antônio Carlos Santos
- MD, PhD. Associate Professor of Neuroradiology in Center
of Sciences of Imaging and Medical Physics of São Paulo
University-Ribeirão Preto, Ribeirão Preto University Central Hospital,
Brazil
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580
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Conde-Sala JL, Reñé-Ramírez R, Turró-Garriga O, Gascón-Bayarri J, Juncadella-Puig M, Moreno-Cordón L, Viñas-Diez V, Vilalta-Franch J, Garre-Olmo J. Factors associated with the variability in caregiver assessments of the capacities of patients with Alzheimer disease. J Geriatr Psychiatry Neurol 2013; 26:86-94. [PMID: 23514974 DOI: 10.1177/0891988713481266] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies have identified certain caregiver factors that can produce variability in their assessments of the capacities of patients with Alzheimer disease (AD). OBJECTIVES To identify the caregiver variables associated with variability in their ratings of patients' capacities. METHODS Consecutive sample of 221 outpatients with AD and their family caregivers. The capacities evaluated by caregivers were the degree of functional disability, using the Disability Assessment for Dementia (DAD); psychological and behavioral symptoms, via the Neuropsychiatric Inventory (NPI); anosognosia, with the Anosognosia Questionnaire-Dementia (AQ-D); and quality of life, using the Quality of Life in AD (QOL-AD). The relationship between these measures and caregiver's gender, burden, depression, and health was analyzed by means of a bivariate analysis, calculating the effect size (Cohen d) and subsequently by a regression analysis, calculating the contribution coefficient (CC). RESULTS The greatest variability in caregiver assessments was observed in relation to patients with early-stage dementia, where caregiver's burden was the main factor associated with a more negative evaluation (d = 1.02-1.25). Depression in the caregiver was associated with less variability and only in the assessments of patients with moderate dementia (d = 0.38-0.69). In the regression analysis, caregiver factors were associated with greater variance in scores on the NPI (CC = 37.4%) and QOL-AD (CC = 27.2%), and lower variance in AQ-D (CC = 21.6%) and DAD (CC = 10.3%) scores. CONCLUSIONS Caregiver's burden and depression were associated with more negative assessments of patients' psychological and behavioral symptoms and quality of life.
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581
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Trzepacz PT, Cummings J, Konechnik T, Forrester TD, Chang C, Dennehy EB, Willis BA, Shuler C, Tabas LB, Lyketsos C. Mibampator (LY451395) randomized clinical trial for agitation/aggression in Alzheimer's disease. Int Psychogeriatr 2013; 25:707-19. [PMID: 23257314 DOI: 10.1017/S1041610212002141] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mibampator, an amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor potentiator, was evaluated for treatment of agitation and aggression (A/A) in Alzheimer's disease (AD). METHODS Outpatients (n = 132) with probable AD and A/A randomized to 12 weeks of double-blind treatment with 3-mg po mibampator or placebo were assessed using the 4-domain A/A subscale of the Neuropsychiatric Inventory (NPI-4-A/A) derived from the Neuropsychiatric Inventory. Secondary measures included the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Frontal Systems Behavior Inventory (FrSBe), and Alzheimer's Disease Assessment Scale-Cognitive. Efficacy was analyzed using mixed-effects model repeated measures from baseline to endpoint. Adverse events (AEs), labs, vital signs, and electrocardiograms were monitored. RESULTS Baseline characteristics were comparable between groups. Both groups improved on the NPI-4-A/A, but without group differences. Among secondaries, mibampator was significantly better (p = 0.007) than placebo only on the FrSBe. AEs were similar between groups. One death occurred in the placebo group. CONCLUSION Possible explanations for no significant group differences include caregiver, drug target engagement, and design issues. This trial is registered on ClinicalTrials.gov; ID: NCT00843518.
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582
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Ramakers IHGB, Verhey FRJ, Scheltens P, Hampel H, Soininen H, Aalten P, Rikkert MO, Verbeek MM, Spiru L, Blennow K, Trojanowski JQ, Shaw LM, Visser PJ. Anxiety is related to Alzheimer cerebrospinal fluid markers in subjects with mild cognitive impairment. Psychol Med 2013; 43:911-920. [PMID: 22954311 PMCID: PMC4104501 DOI: 10.1017/s0033291712001870] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anxiety, apathy and depression are common in subjects with mild cognitive impairment (MCI) and may herald Alzheimer's disease (AD). We investigated whether these symptoms correlated with cerebrospinal fluid (CSF) markers for AD in subjects with MCI. Method Subjects with MCI (n=268) were selected from the 'Development of screening guidelines and criteria for pre-dementia Alzheimer's disease' (DESCRIPA) and Alzheimer's Disease Neuroimaging Initiative (ADNI) studies. We measured amyloid β(1-42) protein (Aβ42) and total tau (t-tau) in CSF. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory. RESULTS Depressive symptoms were reported by 55 subjects (21%), anxiety by 35 subjects (13%) and apathy by 49 subjects (18%). The presence of anxiety was associated with abnormal CSF Aβ42 [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6-3.3] and t-tau (OR 2.6, 95% CI 1.9-3.6) concentrations and with the combination of abnormal concentrations of both Aβ42 and t-tau (OR 3.1, 95% CI 2.0-4.7). The presence of agitation and irritability was associated with abnormal concentrations of Aβ42 (agitation: OR 1.6, 95% CI 1.1-2.3; irritability: OR 2.2, 95% CI 1.5-3.3). Symptoms of depression and apathy were not related to any of the CSF markers. CONCLUSIONS In subjects with MCI, symptoms of anxiety, agitation and irritability may reflect underlying AD pathology, whereas symptoms of depression and apathy do not.
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Affiliation(s)
- I H G B Ramakers
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands.
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583
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Gono T, Kawaguchi Y, Yamanaka H. Discoveries in the pathophysiology of neuropsychiatric lupus erythematosus: consequences for therapy. BMC Med 2013; 11:91. [PMID: 23556481 PMCID: PMC3616809 DOI: 10.1186/1741-7015-11-91] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 11/10/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a multi-system inflammatory disorder characterized by the presence of several autoantibodies, including anti-double-stranded DNA. Neuropsychiatric (NP)LE contributes to the prognosis of SLE, and is divided into 19 NPLE syndromes. Its mechanisms are mediated through autoantibodies, complement components, and cytokines. The pathophysiology and diagnosis of NPLE are diverse and complicated. Recent studies have shown that several autoantibodies cross-react with human brain tissue and cause NPLE symptoms in SLE. It is known that in mice, depression and hippocampus-related memory impairment are induced by anti-ribosomal P antibody and anti-NR2 antibody, respectively. In a BMC Medicine research article, Kivity et al. demonstrated novel work showed that the 16/6 Id antibody impaired visual memory and spatial memory by causing hippocampal injury in mice. Given differences in the cross-reactivity of each autoantibody with the nervous system, the clinical features might be different and diverse in NPLE. Identification of autoantibody targets could lead to the development of novel therapies. Investigators and clinicians should consider not only the inhibition of autoantibody synthesis but also the protection of neuronal cells in the treatment strategy for NPLE.See related Research article: http://www.biomedcentral.com/1741-7015/11/90.
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Affiliation(s)
- Takahisa Gono
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
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584
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Yi DS, Bertoux M, Mioshi E, Hodges JR, Hornberger M. Fronto-striatal atrophy correlates of neuropsychiatric dysfunction in frontotemporal dementia (FTD) and Alzheimer's disease (AD). Dement Neuropsychol 2013; 7:75-82. [PMID: 29213823 PMCID: PMC5619548 DOI: 10.1590/s1980-57642013dn70100012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Behavioural disturbances in frontotemporal dementia (FTD) are thought to reflect mainly atrophy of cortical regions. Recent studies suggest that subcortical brain regions, in particular the striatum, are also significantly affected and this pathology might play a role in the generation of behavioural symptoms. OBJECTIVE To investigate prefrontal cortical and striatal atrophy contributions to behavioural symptoms in FTD. METHODS One hundred and eighty-two participants (87 FTD patients, 39 AD patients and 56 controls) were included. Behavioural profiles were established using the Cambridge Behavioural Inventory Revised (CBI-R) and Frontal System Behaviour Scale (FrSBe). Atrophy in prefrontal (VMPFC, DLPFC) and striatal (caudate, putamen) regions was established via a 5-point visual rating scale of the MRI scans. Behavioural scores were correlated with atrophy rating scores. RESULTS Behavioural and atrophy ratings demonstrated that patients were significantly impaired compared to controls, with bvFTD being most severely affected. Behavioural-anatomical correlations revealed that VMPFC atrophy was closely related to abnormal behaviour and motivation disturbances. Stereotypical behaviours were associated with both VMPFC and striatal atrophy. By contrast, disturbance of eating was found to be related to striatal atrophy only. CONCLUSION Frontal and striatal atrophy contributed to the behavioural disturbances seen in FTD, with some behaviours related to frontal, striatal or combined fronto-striatal pathology. Consideration of striatal contributions to the generation of behavioural disturbances should be taken into account when assessing patients with potential FTD.
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Affiliation(s)
- Dong Seok Yi
- Neuroscience Research Australia, Sydney, Australia
| | - Maxime Bertoux
- University Pierre and Marie Curie - Paris VI, Sorbonne Universités, Paris, France
| | - Eneida Mioshi
- Neuroscience Research Australia, Sydney, Australia. School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia. ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia. School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Michael Hornberger
- Neuroscience Research Australia, Sydney, Australia. ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia. School of Medical Sciences, University of New South Wales, Sydney, Australia
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585
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Balthazar MLF, Pereira FRS, Lopes TM, da Silva EL, Coan AC, Campos BM, Duncan NW, Stella F, Northoff G, Damasceno BP, Cendes F. Neuropsychiatric symptoms in Alzheimer's disease are related to functional connectivity alterations in the salience network. Hum Brain Mapp 2013; 35:1237-46. [PMID: 23418130 DOI: 10.1002/hbm.22248] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 11/06/2012] [Accepted: 12/03/2012] [Indexed: 11/12/2022] Open
Abstract
Neuropsychiatric syndromes are highly prevalent in Alzheimer's disease (AD), but their neurobiology is not completely understood. New methods in functional magnetic resonance imaging, such as intrinsic functional connectivity or "resting-state" analysis, may help to clarify this issue. Using such approaches, alterations in the default-mode and salience networks (SNs) have been described in Alzheimer's, although their relationship with specific symptoms remains unclear. We therefore carried out resting-state functional connectivity analysis with 20 patients with mild to moderate AD, and correlated their scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective syndrome, and psychosis) with maps of connectivity in the default mode network and SN. In addition, we compared network connectivity in these patients with that in 17 healthy elderly control subjects. All analyses were controlled for gray matter density and other potential confounds. Alzheimer's patients showed increased functional connectivity within the SN compared with controls (right anterior cingulate cortex and left medial frontal gyrus), along with reduced functional connectivity in the default-mode network (bilateral precuneus). A correlation between increased connectivity in anterior cingulate cortex and right insula areas of the SN and hyperactivity syndrome (agitation, irritability, aberrant motor behavior, euphoria, and disinhibition) was found. These findings demonstrate an association between specific network changes in AD and particular neuropsychiatric symptom types. This underlines the potential clinical significance of resting state alterations in future diagnosis and therapy.
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Affiliation(s)
- Marcio L F Balthazar
- Neuroimaging Laboratory, Department of Neurology, Medical Sciences School, University of Campinas (UNICAMP), Brazil
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586
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Varjassyová A, Hořínek D, Andel R, Amlerova J, Laczó J, Sheardová K, Magerová H, Holmerová I, Vyhnálek M, Bradáč O, Geda YE, Hort J. Recognition of facial emotional expression in amnestic mild cognitive impairment. J Alzheimers Dis 2013; 33:273-80. [PMID: 22954669 PMCID: PMC3918473 DOI: 10.3233/jad-2012-120148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined whether recognition of facial emotional expression would be affected in amnestic mild cognitive impairment (aMCI). A total of 50 elderly persons met the initial inclusion criteria; 10 were subsequently excluded (Geriatric Depression Score > 5). 22 subjects were classified with aMCI based on published criteria (single domain aMCI [SD-aMCI], n = 10; multiple domain aMCI [MD-aMCI], n = 12); 18 subjects were cognitively normal. All underwent standard neurological and neuropsychological evaluations as well as tests of facial emotion recognition (FER) and famous faces identification (FFI). Among normal controls, FFI was negatively correlated with Mini-Mental Status Examination scores and positively correlated with executive function. Among patients with aMCI, FER was correlated with attention/speed of processing. No other correlations were significant. In a multinomial logistic regression model adjusted for age, gender, and education, a poorer score on FER, but not on FFI, was associated with greater odds of being classified as MD-aMCI (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.05-13.91; p = 0.042). This association was not explained by memory or global cognitive score. There was no association between FER or FFI and SD-aMCI (OR, 1.13; 95% CI, 0.36-3.57; p = 0.836). Therefore, FER, but not FFI, may be impaired in MD-aMCI. This implies that in MD-aMCI, the tasks of FER and FFI may involve segregated neurocognitive networks.
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Affiliation(s)
- Alexandra Varjassyová
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Daniel Hořínek
- Department of Neurosurgery, 1 Medical School, Charles University and Central Military Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Philipps-Universität Marburg, Marburg, Germany
| | - Ross Andel
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jana Amlerova
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Jan Laczó
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Kateřina Sheardová
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Magerová
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | | | - Martin Vyhnálek
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, 1 Medical School, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Yonas E. Geda
- Departments of Psychiatry & Psychology, Neurology, and Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jakub Hort
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
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587
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Rosenberg PB, Mielke MM, Han D, Leoutsakos JS, Lyketsos CG, Rabins PV, Zandi PP, Breitner JCS, Norton MC, Welsh-Bohmer KA, Zuckerman IH, Rattinger GB, Green RC, Corcoran C, Tschanz JT. The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease. Int J Geriatr Psychiatry 2012; 27:1248-57. [PMID: 22374884 PMCID: PMC3448859 DOI: 10.1002/gps.3769] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The use of psychotropic medications in Alzheimer's disease (AD) has been associated with both deleterious and potentially beneficial outcomes. We examined the longitudinal association of psychotropic medication use with cognitive, functional, and neuropsychiatric symptom (NPS) trajectories among community-ascertained incident AD cases from the Cache County Dementia Progression Study. METHODS A total of 230 participants were followed for a mean of 3.7 years. Persistency index (PI) was calculated for all antidepressants, selective serotonin reuptake inhibitors (SSRIs), antipsychotics (atypical and typical), and benzodiazepines as the proportion of observed time of medication exposure. Mixed-effects models were used to examine the association between PI for each medication class and Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-Sum), and Neuropsychiatric Inventory - Total (NPI-Total) trajectories, controlling for appropriate demographic and clinical covariates. RESULTS At baseline, psychotropic medication use was associated with greater severity of dementia and poorer medical status. Higher PI for all medication classes was associated with a more rapid decline in MMSE. For antidepressant, SSRI, benzodiazepine, and typical antipsychotic use, a higher PI was associated with a more rapid increase in CDR-Sum. For SSRIs, antipsychotics, and typical antipsychotics, a higher PI was associated with more rapid increase in NPI-Total. CONCLUSIONS Psychotropic medication use was associated with more rapid cognitive and functional decline in AD, and not with improved NPS. Clinicians may tend to prescribe psychotropic medications to AD patients at risk of poorer outcomes, but one cannot rule out the possibility of poorer outcomes being caused by psychotropic medications.
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Affiliation(s)
- P. B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA,Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M. M. Mielke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA,Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA,Section of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - D. Han
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA,Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J. S. Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA,Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C. G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA,Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P. V. Rabins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA,Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - P. P. Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J. C. S. Breitner
- Department of Psychiatry, Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - M. C. Norton
- Department of Psychology, Utah State University, Logan, UT, USA,Department of Family Consumer and Human Development, Utah State University, Logan, UT, USA
| | - K. A. Welsh-Bohmer
- Department of Psychiatry, Duke University, Durham, NC, USA,Division Medical Psychology, Duke University, Durham, NC, USA
| | - I. H. Zuckerman
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - G. B. Rattinger
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - R. C. Green
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - C. Corcoran
- Department of Psychology, Utah State University, Logan, UT, USA
| | - J. T. Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA
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588
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Ornstein K, Gaugler JE. The problem with "problem behaviors": a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. Int Psychogeriatr 2012; 24:1536-52. [PMID: 22612881 DOI: 10.1017/S1041610212000737] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSDs) are routinely cited as important predictors of caregiver burden and depression. Although BPSDs include a wide variety of patient behaviors, they are routinely grouped together as one construct to differentiate them from cognitive symptoms of dementia. Determining the specific BPSDs that result in increased depression and burden for caregivers may elucidate the stress process for caregivers and facilitate the development of effective interventions for caregivers. METHODS We conducted a systematic review of English-language articles published from 1990 to 2010 to determine whether there are known symptoms or symptom clusters which exert undue negative impact on caregiver depression and burden. Additionally, we review systems used for classifying BSPD symptom clusters and determine whether there have been any mechanisms studied by which individual BPSD symptoms negatively affect caregivers. Finally, we examine how the role of timing of symptoms has been examined within the literature. RESULTS Thirty-five original research articles examined the impact of an individual behavior symptom on caregiver burden or depression/depressive symptoms. The studies had no consistent system for categorizing symptoms. Although depression, aggression, and sleep disturbances were the most frequently identified patient symptoms to impact negatively on caregivers, a wide range of symptoms was associated with caregiver burden and depression. CONCLUSIONS The evidence is not conclusive as to whether some symptoms are more important than others. The studies reviewed were largely exploratory relative to the differential impact of individual BPSDs and did not focus on testing causal mechanisms by which specific symptoms exert more impact on caregiver mental health than others. Future research may benefit from the re-conceptualization of BPSDs from the perspective of their impact on the caregiver to examine hypothesis-driven differences among BPSD symptom clusters.
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589
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Tighe SK, Oishi K, Mori S, Smith GS, Albert M, Lykestos CG, Mielke MM. Diffusion tensor imaging of neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's dementia. J Neuropsychiatry Clin Neurosci 2012; 24:484-8. [PMID: 23224456 PMCID: PMC3533244 DOI: 10.1176/appi.neuropsych.11120375] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuropsychiatric symptoms (NPS) occur frequently in mild cognitive impairment (MCI) and Alzheimer's dementia (AD). The authors examined the relationship between NPS and white-matter integrity in these conditions. Twenty-two individuals with MCI and 23 with mild AD underwent clinical assessments including the Neuropsychiatric Inventory Questionnaire and 3.0-tesla magnetic resonance scans. Fractional anisotropy (FA) was measured in the following manually-drawn regions of interest (ROI): fornix, cingulum bundle, splenium, and cerebral peduncles (control region). The probability of having NPS by tertile of ROI FA was assessed by logistic regression. Because associations were similar within MCI and AD groups, the two groups were combined. Compared with those in the highest tertile, participants within the lowest anterior cingulum (AC) FA tertile were more likely to exhibit irritability, agitation, dysphoria, apathy, and nighttime behavioral disturbances. After adjusting for Mini-Mental State Exam status, participants in the lowest versus highest tertile of AC FA were more likely to report irritability. Using DTI, low AC FA was associated with increased odds of irritability in mild AD and MCI participants. Further imaging studies are necessary to elucidate the role of the AC in the pathophysiology of neuropsychiatric symptoms in AD and MCI.
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590
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Abstract
Mild cognitive impairment (MCI) is the intermediate stage between the cognitive changes of normal aging and dementia. MCI is important because it constitutes a high risk group for dementia. Ideally, prevention strategies should target individuals who are not even symptomatic. Indeed, the field is now moving towards identification of asymptomatic individuals who have underlying Alzheimer's disease (AD) pathology that can be detected using biomarkers and neuroimaging technologies. To this effect, the Alzheimer's Association and the National Institute on Aging have developed a new classification scheme that has categorized AD into a preclinical phase (research category), MCI due to AD, and dementia of Alzheimer's type. However, there are also ongoing research studies to understand high-risk groups for non-Alzheimer's dementia.
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Affiliation(s)
- Yonas E. Geda
- Associate Professor of Neurology and Psychiatry, Consultant, Departments of Psychiatry & Psychology and Neurology, Collaborative Research Building, Mayo Clinic, Scottsdale, Arizona
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591
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Abstract
Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis, and treatment response may be useful in the clinical practice. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social, and biological factors. Recent studies have emphasized the role of neurochemical, neuropathological, and genetic factors underlying the clinical manifestations of BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes associated with BPSD.
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Affiliation(s)
- J Cerejeira
- Serviço de Psiquiatria, Centro Hospitalar Psiquiátrico de Coimbra Coimbra, Portugal
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592
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Lee GJ, Lu PH, Hua X, Lee S, Wu S, Nguyen K, Teng E, Leow AD, Jack CR, Toga AW, Weiner MW, Bartzokis G, Thompson PM. Depressive symptoms in mild cognitive impairment predict greater atrophy in Alzheimer's disease-related regions. Biol Psychiatry 2012; 71:814-21. [PMID: 22322105 PMCID: PMC3322258 DOI: 10.1016/j.biopsych.2011.12.024] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/18/2011] [Accepted: 12/06/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND Depression has been associated with higher conversion rates from mild cognitive impairment (MCI) to Alzheimer's disease (AD) and may be a marker of prodromal AD that can be used to identify individuals with MCI who are most likely to progress to AD. Thus, we examined the neuroanatomical changes associated with depressive symptoms in MCI. METHODS Two-hundred forty-three MCI subjects from the Alzheimer's Disease Neuroimaging Initiative who had brain magnetic resonance imaging scans at baseline and 2-year follow-up were classified into depressed (n = 44), nondepressed with other neuropsychiatric symptoms (n = 93), and no-symptom (NOSYMP; n = 106) groups based on the Neuropsychiatric Inventory Questionnaire. Tensor-based morphometry was used to create individual three-dimensional maps of 2-year brain changes that were compared between groups. RESULTS Depressed subjects had more frontal (p = .024), parietal (p = .030), and temporal (p = .038) white matter atrophy than NOSYMP subjects. Those whose depressive symptoms persisted over 2 years also had higher conversion to AD and more decline on measures of global cognition, language, and executive functioning compared with stable NOSYMP subjects. Nondepressed with other neuropsychiatric symptoms and NOSYMP groups exhibited no differences in rates of atrophy. CONCLUSIONS Depressive symptoms were associated with greater atrophy in AD-affected regions, increased cognitive decline, and higher rates of conversion to AD. Depression in individuals with MCI may be associated with underlying neuropathological changes, including prodromal AD, and may be a potentially useful clinical marker in identifying MCI patients who are most likely to progress to AD.
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Affiliation(s)
- Grace J Lee
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, USA.
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593
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Wadsworth LP, Lorius N, Donovan NJ, Locascio JJ, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Neuropsychiatric symptoms and global functional impairment along the Alzheimer's continuum. Dement Geriatr Cogn Disord 2012; 34:96-111. [PMID: 22922821 PMCID: PMC3549662 DOI: 10.1159/000342119] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Neuropsychiatric symptoms in Alzheimer's disease (AD) are highly prevalent. We sought to determine whether neuropsychiatric symptoms were related to global functional impairment at baseline and over a 3-year period in older normal control (NC), mild cognitive impairment (MCI) and mild AD dementia subjects. METHODS Eight hundred and twelve subjects (229 NC, 395 MCI, 188 AD) from the Alzheimer's Disease Neuroimaging Initiative study underwent cognitive and behavioral assessments over 3 years. RESULTS Greater hallucinations, anxiety and apathy were associated with greater global functional impairment at baseline, while the presence of hallucinations and apathy at baseline was associated with greater global functional impairment over time across all subjects. The following neuropsychiatric symptoms were not significantly associated with global functioning: delusions, agitation, depression, euphoria, disinhibition, irritability, aberrant motor behaviors, sleep and appetite. CONCLUSIONS These results suggest that increased baseline hallucinations, apathy and anxiety are associated with current and future disease progression in AD.
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Affiliation(s)
- Lauren P. Wadsworth
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Natacha Lorius
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Nancy J. Donovan
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA 02139, USA
| | - Joseph J. Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dorene M. Rentz
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Keith A. Johnson
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA,Correspondence to: Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, 221 Longwood Avenue, BL-104H, Boston, MA 02115, P: 617-732-8085, F: 617-264-5212,
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594
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Margari F, Sicolo M, Spinelli L, Mastroianni F, Pastore A, Craig F, Petruzzelli MG. Aggressive behavior, cognitive impairment, and depressive symptoms in elderly subjects. Neuropsychiatr Dis Treat 2012; 8:347-53. [PMID: 22888255 PMCID: PMC3415308 DOI: 10.2147/ndt.s33745] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients with dementia often have neuropsychiatric symptoms. The objective of this study was to evaluate the relationship between neuropsychiatric symptoms and progressive cognitive decline by assessing cognitive impairment, depressive symptoms, and aggressive behavior in a sample of elderly subjects. The study sample consisted of 201 subjects admitted to nursing homes. For the purpose of the present study each subject was evaluated using the Mini-Mental State Examination, the Geriatric Depression Scale, and the Modified Overt Aggression Scale. The results show that aggressive behavior and depressive symptoms are associated with progressive cognitive decline in elderly subjects. Early assessment of these conditions can promote rational therapeutic strategies that may improve the quality of life and delay institutionalization for elderly patients.
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Affiliation(s)
- Francesco Margari
- Psychiatry Unit, Department of Neuroscience and Sense Organs, Hospital Polyclinic of Bari, University of Bari "Aldo Moro"
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595
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Ryan KA, Weldon A, Persad C, Heidebrink JL, Barbas N, Giordani B. Neuropsychiatric symptoms and executive functioning in patients with mild cognitive impairment: relationship to caregiver burden. Dement Geriatr Cogn Disord 2012; 34:206-15. [PMID: 23128102 PMCID: PMC3698846 DOI: 10.1159/000339955] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caregivers of patients with mild cognitive impairment (MCI) need similar levels of support services as Alzheimer's disease (AD) caregivers, but it is unclear if this translates to increased caregiver burden. METHODS 135 participants and their caregivers (40 MCI, 55 AD and 40 normal controls, NC) completed questionnaires, and the patients were administered neuropsychological tests. RESULTS The MCI caregivers reported significantly more overall caregiving burden than the NC, but less than the AD. They showed similar levels of emotional, physical and social burden as the AD caregivers. Among the MCI caregivers, the neuropsychiatric symptoms and executive functioning of the patients were related to a greater burden, and the caregivers with a greater burden reported lower life satisfaction and social support, and a greater need for support services. CONCLUSION These results indicate that MCI caregivers are at increased risk for caregiver stress, and they require enhanced assistance and/or education in caring for their loved ones.
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Affiliation(s)
- Kelly A. Ryan
- The University of Michigan Health System, Ann Arbor, Mich., USA
| | - Anne Weldon
- The University of Michigan Health System, Ann Arbor, Mich., USA
| | - Carol Persad
- The University of Michigan Health System, Ann Arbor, Mich., USA
| | - Judith L. Heidebrink
- The University of Michigan Health System, Ann Arbor, Mich., USA
,Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Mich., USA
| | - Nancy Barbas
- The University of Michigan Health System, Ann Arbor, Mich., USA
,Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Mich., USA
| | - Bruno Giordani
- The University of Michigan Health System, Ann Arbor, Mich., USA
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596
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Abstract
Methyl iodide is a monohalomethane and with a chemical formula CH(3)I. Acute exposures to methyl iodide have frequently occurred in the workplace. Predominantly, neuropsychiatric symptoms of acute exposure to monohalomethanes consist of headache, nausea, vomiting, drowsiness, dizziness, giddiness, diarrhea, confusion, ataxia, slurred speech, paralysis, convulsions, delirium, coma, and death. We report two cases who presented to our emergency services after accidental exposure to methyl iodide for a short duration. These case reports highlighted concurrence of frankly psychotic features and acute confusional state in workers vulnerable to industrial exposure to toxic chemicals. Understanding the mechanism of neuro-toxicity will perhaps throw some light on co-existence of both psychiatric and neurological symptoms. Awareness of these toxic effects at vulnerable work places will lead to timely and appropriate interventions. Importance of safety precautions and education of both workers and supervisors cannot be overemphasized here.
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Affiliation(s)
| | - Tushita S. Mayanil
- Department of Psychiatry, Seth G.S.M.C. & K.E.M. Hospital, Mumbai, India
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597
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Buhagiar K, Afzal N, Cosgrave M. Behavioural and psychological symptoms of dementia in primary care: a survey of general practitioners in Ireland. Ment Health Fam Med 2011; 8:227-34. [PMID: 23205063 PMCID: PMC3487602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Management of neuropsychiatric symptoms is a challenging task in primary care. Aims To assess self-reported confidence and knowledge of general practitioners (GPs) regarding the identification and management of behavioural and psychological symptoms of dementia (BPSD).Methods A self-designed two-page paper questionnaire was sent to a random sample of 160 GPs practising in north Dublin. They were asked to evaluate their confidence and knowledge on several aspects of diagnosis and management of BPSD.Results Completed questionnaires were returned from 109 GPs (response rate = 68%), of which 106 were usable. In general, GPs were somewhat critical of their self-reported skills in diagnosing (76.4%) and managing (77.4%) BPSD, as well as in discriminating BPSD from other behavioural disturbances (71.7%). Many of them (67.9%) also encountered difficulty accessing specialist services. There was no correlation between demographic characteristics of GPs or patient caseload with respect to their responses to questionnaire items. Although many GPs (92.5%) highly valued the important role of non-pharmacological interventions in BPSD, none of them reported recommending these in their daily practice.Conclusions Despite the fact that GPs have a wealth of knowledge about BPSD, they are largely critical of their knowledge and management skills of these symptoms. Efforts should be focused on supporting GPs by means of educational interventions that consider all aspects of dementia, but additionally highlight the more challenging neuropsychiatric components of the illness. Health services need to be structured in a way that promotes collaboration between GPs and mental health professionals for a seamless delivery of care.
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Affiliation(s)
- Kurt Buhagiar
- Academic Clinical Fellow, Department of Mental Health Sciences, University College London Medical School, London, UK
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598
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Hanfelt JJ, Wuu J, Sollinger AB, Greenaway MC, Lah JJ, Levey AI, Goldstein FC. An exploration of subgroups of mild cognitive impairment based on cognitive, neuropsychiatric and functional features: analysis of data from the National Alzheimer's Coordinating Center. Am J Geriatr Psychiatry 2011; 19:940-50. [PMID: 22024618 PMCID: PMC3202691 DOI: 10.1097/jgp.0b013e31820ee9d2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To empirically expand the existing subtypes of mild cognitive impairment (MCI) by incorporating information on neuropsychiatric and functional features, and to assess whether cerebrovascular disease (CVD) risk factors are associated with any of these subgroups. DESIGN Latent class analysis using 1,655 patients with MCI. SETTING Participants in the Uniform Data Set (UDS) from 29 National Institutes of Health-supported Alzheimer's Disease Centers. PARTICIPANTS Patients with a consensus diagnosis of MCI from each center and with a Mini-Mental State Examination score of 22 or greater. MEASUREMENTS UDS cognitive battery, Neuropsychiatric Inventory Questionnaire, and Functional Assessment Questionnaire administered at initial visit. RESULTS Seven empirically based subgroups of MCI were identified: 1) minimally impaired (relative frequency, 12%); 2) amnestic only (16%); 3) amnestic with functional and neuropsychiatric features (16%); 4) amnestic multidomain (12%); 5) amnestic multidomain with functional and neuropsychiatric features (12%); 6) functional and neuropsychiatric features (15%); and 7) executive function and language impairments (18%). Two of these subgroups with functional and neuropsychiatric features were at least 3.8 times more likely than the minimally impaired subgroup to have a Rosen-Hachinski score of 4 or greater, an indicator of probable CVD. CONCLUSIONS Findings suggest that there are several distinct phenotypes of MCI characterized by prominent cognitive features, prominent functional features, and neuropsychiatric features or a combination of all three. Subgroups with functional and neuropsychiatric features are significantly more likely to have CVD, which suggests that there may be distinct differences in disease etiology from the other phenotypes.
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Affiliation(s)
- John J Hanfelt
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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599
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Poulin SP, Dautoff R, Morris JC, Barrett LF, Dickerson BC. Amygdala atrophy is prominent in early Alzheimer's disease and relates to symptom severity. Psychiatry Res 2011; 194:7-13. [PMID: 21920712 PMCID: PMC3185127 DOI: 10.1016/j.pscychresns.2011.06.014] [Citation(s) in RCA: 244] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
Abstract
Despite numerous studies on the role of medial temporal lobe structures in Alzheimer's disease (AD), the magnitude and clinical significance of amygdala atrophy have been relatively sparsely investigated. In this study, we used magnetic resonance imaging (MRI) to compare the level of amygdala atrophy to that of the hippocampus in very mild and mild AD subjects in two large samples (Sample 1 n=90; Sample 2 n=174). Using a series of linear regression analyses, we investigated whether amygdala atrophy is related to global cognitive functioning (Clinical Dementia Rating Sum of Boxes: CDR-SB; Mini Mental State Examination: MMSE) and neuropsychiatric status. Results indicated that amygdala atrophy was comparable to hippocampal atrophy in both samples. MMSE and CDR-SB were strongly related to amygdala atrophy, with amygdala atrophy predicting MMSE scores as well as hippocampal atrophy, but predicting CDR-SB scores less robustly. Amygdala atrophy was related to aberrant motor behavior, with potential relationships to anxiety and irritability. These results suggest that the magnitude of amygdala atrophy is comparable to that of the hippocampus in the earliest clinical stages of AD, and is related to global illness severity. There also appear to be specific relationships between the level of amygdala atrophy and neuropsychiatric symptoms that deserve further investigation.
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Affiliation(s)
- Stéphane P. Poulin
- Department Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca Dautoff
- Department Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John C. Morris
- Department of Neurology and Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Feldman Barrett
- Department Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Psychology, Northeastern University, Boston, MA, USA
| | - Bradford C. Dickerson
- Department Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Frontotemporal Dementia Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Corresponding author: Bradford C. Dickerson, M.D., Frontotemporal Dementia Unit, Massachusetts General Hospital, 149 13th St., Suite 2691, Charlestown, MA 02129, Tel: (617) 726-5571, Fax: (617) 726-5760,
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600
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Kochhann R, Borba E, Cerveira MO, Onyszko D, de Jesus A, Forster L, Franciscatto L, Godinho C, Camozzato AL, Chaves MLF. Neuropsychiatric symptoms as the main determinant of caregiver burden in Alzheimer's disease. Dement Neuropsychol 2011; 5:203-208. [PMID: 29213745 PMCID: PMC5619480 DOI: 10.1590/s1980-57642011dn05030008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Caregiver burden is common in Alzheimer’s disease (AD), decreasing the quality of
life among caregivers and patients. Projections of aging and aging-related
diseases such as AD in developing countries justify additional data about this
issue because people living in these countries have shown similarly high levels
of caregiver strain as in the developed world.
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Affiliation(s)
- Renata Kochhann
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine, Porto Alegre RS, Brazil
| | - Ericksen Borba
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine, Porto Alegre RS, Brazil
| | - Maria Otília Cerveira
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Diego Onyszko
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Alyne de Jesus
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Letícia Forster
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Luisa Franciscatto
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Cláudia Godinho
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine, Porto Alegre RS, Brazil
| | - Ana Luiza Camozzato
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine, Porto Alegre RS, Brazil.,Internal Medicine Department and Health Sciences Post-Graduation Course, UFCSPA School of Medicine, Porto Alegre RS, Brazil
| | - Márcia Lorena F Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine, Porto Alegre RS, Brazil.,Internal Medicine Department, UFRGS School of Medicine, Porto Alegre RS, Brazil
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