601
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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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602
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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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603
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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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604
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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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605
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Tschanz JT, Corcoran CD, Schwartz S, Treiber K, Green RC, Norton MC, Mielke MM, Piercy K, Steinberg M, Rabins PV, Leoutsakos JM, Welsh-Bohmer KA, Breitner JC, Lyketsos CG. Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with Alzheimer dementia: the Cache County Dementia Progression study. Am J Geriatr Psychiatry 2011; 19:532-42. [PMID: 21606896 DOI: 10.1097/JGP.0b013e3181faec23] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [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: 01/15/2023]
Abstract
OBJECTIVES Progression of Alzheimer dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains. DESIGN Longitudinal, prospective cohort study. SETTING Cache County (Utah). PARTICIPANTS Three hundred twenty-eight persons with a diagnosis of possible/probable AD. MEASUREMENTS Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI). RESULTS Over a mean follow-up of 3.80 (range: 0.07-12.90) years, the mean (SD) annual rates of change were -1.53 (2.69) scale points on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) on the NPI. Among surviving participants, 30% to 58% progressed less than 1 point per year on these measures, even 5 to 7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r = -0.62, df = 201, p < 0.001) and between the CDR-sb and NPI (r = 0.20, df = 206, p < 0.004). Female subjects (LR χ = 8.7, df = 2, p = 0.013) and those with younger onset (likelihood ratio [LR] χ = 5.7, df = 2, p = 0.058) declined faster on the MMSE. Although one or more apolipoprotein E ε 4 alleles and ever use of FDA-approved antidementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain. CONCLUSIONS A significant proportion of persons with AD progresses slowly. The results underscore differences between population-based versus clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD.
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606
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Rosenberg PB, Mielke MM, Appleby B, Oh E, Leoutsakos JM, Lyketsos CG. Neuropsychiatric symptoms in MCI subtypes: the importance of executive dysfunction. Int J Geriatr Psychiatry 2011; 26:364-72. [PMID: 20845402 PMCID: PMC3204866 DOI: 10.1002/gps.2535] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [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: 05/14/2009] [Accepted: 03/16/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) is a syndrome thought to be a prodrome of dementia for some patients. One subtype, amnestic MCI (aMCI), may be specifically predispose patients to develop Alzheimer's dementia (AD). Since dementia has been associated with a range of neuropsychiatric symptoms (NPS), we sought to examine the prevalence of NPS in MCI and its subtypes. METHODS One thousand seven hundred seventy-nine participants in the National Alzheimer's Coordinating Center (NACC) with MCI were included in this study. All participants were evaluated systematically with a thorough cognitive battery, clinical interview, and consensus diagnoses, and subtyped as: (1) amnestic (aMCI) (single- or multiple-domain) versus non-amnestic (non-aMCI); (2) executive dysfunction-MCI (exMCI) (single- or multiple-domain) versus no executive dysfunction-MCI (non-exMCI); (3) both aMCI and exMCI; and (4) neither aMCI nor exMCI. Additionally, aMCI versus non-aMCI and exMCI versus non-exMCI dichotomies were explored. NPS were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Geriatric Depression Scale (GDS). RESULTS 1379 participants (77.5%) met criteria for aMCI and 616 (34.6%) for exMCI. No differences were observed in the prevalence of NPS between aMCI versus non-aMCI. However, exMCI was associated with greater severity of depression, anxiety, agitation, disinhibition, irritability, and sleep problems, although these differences do not persist after adjustment for multiple comparisons. CONCLUSIONS While there were few associations between aMCI and NPS, the presence of executive dysfunction in MCI was associated with greater severity of symptoms and specifically with depression (evidenced by GDS score) and anxiety. These findings may have implications for MCI prognosis and need to be explored in longitudinal studies.
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Affiliation(s)
- Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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607
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da Silva EM, Braga RDCOP, Avelino-Silva TJ, Gil Junior LA. Antipsychotics in Alzheimer's disease: A critical analysis. Dement Neuropsychol 2011; 5:38-43. [PMID: 29213718 PMCID: PMC5619137 DOI: 10.1590/s1980-57642011dn05010007] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 02/10/2011] [Indexed: 11/23/2022] Open
Abstract
The estimated worldwide prevalence of dementia among adults older than 60 years of age was 3.9% in 2005. About 90% of demented patients will develop neuropsychiatric symptoms (NS) such as delirium, delusion, aggressiveness and agitation. The treatment of NS involves non-pharmacologic strategies (with varying degrees of success according to the scientific literature) and pharmacologic treatment (PT). The present review of literature examined the current role of AP in the management of NS in dementia. METHODS A thematic review of medical literature was carried out. RESULTS 313 articles were found, 39 of which were selected for critical analysis. Until 2005, the best evidence for PT had supported the use of selective serotonin re-uptake inhibitors (SSRIs), anticholinesterases, memantine and antipsychotics (AP). In 2005, the U.S. Food and Drug Administration (FDA) disapproved the use of atypical APs to treat neuropsychiatric symptoms in individuals with dementia (the same occurred with the typical APs in 2008). After this, at least two important randomized placebo-controlled multicenter trials were published examining the effectiveness of atypical APs in Alzheimer's disease (CATIE-AD) and the effects of interrupting AP treatment (DART-AD). CONCLUSIONS Based on the current evidence available, APs still have a place in treatment of the more serious psychotic symptoms, after the failure of non-pharmacological treatment and of an initial approach with selective inhibitors of serotonin uptake, anticholinesterases and memantine.
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Affiliation(s)
- Eduardo Marques da Silva
- Department of Geriatrics, Clinical Hospital of The University of
São Paulo, São Paulo SP, Brazil
| | | | | | - Luiz Antonio Gil Junior
- Department of Geriatrics, Clinical Hospital of The University of
São Paulo, São Paulo SP, Brazil
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608
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Stella F, Canonici AP, Gobbi S, Galduroz RFS, Cação JDC, Gobbi LTB. Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial. Clinics (Sao Paulo) 2011; 66:1353-60. [PMID: 21915483 PMCID: PMC3161211 DOI: 10.1590/s1807-59322011000800008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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: 03/14/2011] [Accepted: 04/28/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study.
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Affiliation(s)
- Florindo Stella
- UNESP - Universidade Estadual Paulista, Biosciences Institute, Aging and Physical Activity Laboratory, Campus of Rio Claro/SP, Brazil.
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609
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Bicket MC, Samus QM, McNabney M, Onyike CU, Mayer LS, Brandt J, Rabins P, Lyketsos C, Rosenblatt A. The physical environment influences neuropsychiatric symptoms and other outcomes in assisted living residents. Int J Geriatr Psychiatry 2010; 25:1044-54. [PMID: 20077498 PMCID: PMC3143504 DOI: 10.1002/gps.2460] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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: 11/07/2022]
Abstract
OBJECTIVE Although the number of elderly residents living in assisted living (AL) facilities is rising, few studies have examined the AL physical environment and its impact on resident well-being. We sought to quantify the relationship of AL physical environment with resident outcomes including neuropsychiatric symptoms (NPS), quality of life (QOL), and fall risk, and to compare the effects for demented and non-demented residents. METHODS Prospective cohort study of a stratified random sample of 326 AL residents living in 21 AL facilities. Measures included the Therapeutic Environmental Screening Scale for Nursing Homes and Residential Care (TESS-NH/RC) to rate facilities and in-person assessment of residents for diagnosis (and assessment of treatment) of dementia, ratings on standardized clinical, cognitive, and QOL measures. Regression models compared environmental measures with outcomes. TESS-NH/RC is modified into a scale for rating the AL physical environment AL-EQS. RESULTS The AL Environmental Quality Score (AL-EQS) was strongly negatively associated with Neuropsychiatric Inventory (NPI) total score (p < 0.001), positively associated with Alzheimer Disease Related Quality of Life (ADRQL) score (p = 0.010), and negatively correlated with fall risk (p = 0.042). Factor analysis revealed an excellent two-factor solution, Dignity and Sensory. Both were strongly associated with NPI and associated with ADRQL. CONCLUSION The physical environment of AL facilities likely affects NPS and QOL in AL residents, and the effect may be stronger for residents without dementia than for residents with dementia. Environmental manipulations that increase resident privacy, as well as implementing call buttons and telephones, may improve resident well-being.
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Affiliation(s)
- Mark C Bicket
- Johns Hopkins School of Medicine, Johns Hopkins Medicine, MD, USA
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610
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de Medeiros K, Robert P, Gauthier S, Stella F, Politis A, Leoutsakos J, Taragano F, Kremer J, Brugnolo A, Porsteinsson AP, Geda YE, Brodaty H, Gazdag G, Cummings J, Lyketsos C. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010; 22:984-94. [PMID: 20594384 PMCID: PMC3314709 DOI: 10.1017/s1041610210000876] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [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: 02/07/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). METHODS Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. RESULTS Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. CONCLUSION Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.
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611
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David R, Mulin E, Mallea P, Robert PH. Measurement of Neuropsychiatric Symptoms in Clinical Trials Targeting Alzheimer's Disease and Related Disorders. Pharmaceuticals (Basel) 2010; 3:2387-2397. [PMID: 27713359 PMCID: PMC4033930 DOI: 10.3390/ph3082387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Received: 06/02/2010] [Revised: 06/21/2010] [Accepted: 07/20/2010] [Indexed: 11/16/2022] Open
Abstract
Behavioral and psychological symptoms (BPSD) are now known to be frequently associated to cognitive and functional decline in Alzheimer's disease and related disorders. They are present since the early stages of the disease and have negative impact on the disease process. BPSD assessment is crucial in clinical practice and also in future clinical trials targeting disease-modifying therapies for dementia. In this article, we will first review current assessment tools for BPSD, mainly global and domain-specific scales, and new assessment methods, currently available or in development, including new scales, diagnostic criteria and new technologies such as ambulatory actigraphy.
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Affiliation(s)
- Renaud David
- Centre Mémoire de Ressources et de Recherche/Hôpital de Cimiez, 4 av Reine Victoria, 06000 Nice, France.
| | - Emmanuel Mulin
- Centre Mémoire de Ressources et de Recherche/Hôpital de Cimiez, 4 av Reine Victoria, 06000 Nice, France.
| | - Patrick Mallea
- Centre d'Innovation et d'Usage en Santé (CIU-S) / Hôpital de Cimiez, 4 av Reine Victoria, 06000 Nice, France.
| | - Philippe H Robert
- Centre Mémoire de Ressources et de Recherche/Hôpital de Cimiez, 4 av Reine Victoria, 06000 Nice, France.
- Centre d'Innovation et d'Usage en Santé (CIU-S) / Hôpital de Cimiez, 4 av Reine Victoria, 06000 Nice, France.
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612
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Franz CE, Barker JC, Kim K, Flores Y, Jenkins C, Kravitz RL, Hinton L. When help becomes a hindrance: mental health referral systems as barriers to care for primary care physicians treating patients with Alzheimer's disease. Am J Geriatr Psychiatry 2010; 18:576-85. [PMID: 20593538 DOI: 10.1097/jgp.0b013e3181a76df7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 11/26/2022]
Abstract
OBJECTIVES To describe structural barriers to mental health specialists and consequences of these barriers to care for patients with dementia and neuropsychological symptoms and their primary care physicians (PCPs). DESIGN Cross-sectional qualitative interview study of PCPs. SETTING Physicians' offices, primarily managed care. PARTICIPANTS Forty PCPs in Northern California. MEASUREMENTS Open-ended interviews lasted 30-60 minutes. The interview guide covered clinician background, practice setting, clinical care of a particular patient, and general approach to managing patients with Alzheimer disease or related dementias.Interviews were transcribed and themes reflecting referrals identified. RESULTS Ninety-three percentage of the PCPs described problematic access to and communication with mental health specialists (in particular psychiatrists and neuropsychologists) as impediments to effective care for dementia patients. Thematic analysis identified structural barriers to mental health referrals ranging from problems with managed care and reimbursement policies to lack of trained providers and poor geographic distribution of specialists. Structural barriers compromised care for patients with dementia because the barriers limited PCP treatment options, and resources, impacted office staff and time with other patients, impeded and delayed care, and fostered poor communication and lack of coordinated care. Negative consequences for PCPs included increased frustration,conflict, and burnout. CONCLUSION PCPs viewed problems created by onerous referral systems, such as mental health carve outs, as particularly burdensome for elderly patients with comorbid dementia and neuropsychiatric problems. These problems were cited by PCPs across different types of practice settings. PCPs managed treatment of neurobehavioral symptoms as best they could despite lack of specialist support.
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613
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Abstract
To investigate the influence of neuropsychiatric manifestations and functional
performance on quality of life (QOL) of AD patients and their caregivers/family
members.
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Affiliation(s)
- Marcia M P C Novelli
- Occupational Therapy Course, Department of Health Sciences, Federal University of São Paulo, Santos SP, Brazil.,Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil.,Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
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614
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Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are common in patients with mild cognitive impairment (MCI). Little is known, however, about how NPS vary by MCI subtype (i.e. amnestic, single domain non-memory, and multiple domain). In addition, it is unclear whether NPS increase risk of progression to dementia. We investigated the distribution of NPS across MCI subtypes and determined whether NPS increase risk of progression to dementia. METHOD Participants were 521 patients diagnosed with MCI at the Alzheimer's Research Centers of California between 1988 and 1999. At baseline, patients were classified into MCI subtypes and were assessed for NPS. RESULTS The mean number of NPS was 2.3 (range 0-9.6; 74% had > or =1 NPS). Patients with > or =4 NPS had more medical comorbidities and greater functional impairment (p < or = 0.0001 for both). Patients with > or =4 NPS were more likely than patients with 0-3 NPS to have amnestic MCI (81% vs 71%, respectively, p = 0.03), and patients with amnestic MCI were more likely than those with other subtypes to exhibit depressive symptoms. Patients with > or =4 NPS had nearly 2.5 times the odds of developing dementia at follow-up than patients with 0-3 NPS (adjusted OR = 2.44, 95% CI 1.07, 5.55). CONCLUSION NPS are common in MCI patients. Those with an elevated number of NPS may be more likely to have the amnestic subtype of MCI, and depression may be more common in amnestic MCI than in other subtypes. An elevated number of NPS may increase risk of progression to dementia for patients with MCI.
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Affiliation(s)
- Emily R Edwards
- Department of Psychiatry, University of California, San Francisco, CA, USA
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615
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Fialho PPA, Koenig AM, Dos Santos EL, Guimarães HC, Beato RG, Carvalho VA, Machado TH, Caramelli P. Dementia caregiver burgen in a brasilian sample: Association to neuropsychiatric symptoms. Dement Neuropsychol 2009; 3:132-135. [PMID: 29213624 PMCID: PMC5619231 DOI: 10.1590/s1980-57642009dn30200011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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
Taking care of elderly demented individuals, especially when they present behavioral changes, can be very exhaustive for both family and caregivers. Generally, this leads to changes in the family lifestyle, and the caregiver must deal with a range of problems. Information on this topic in Latin America, including Brazil, remains scarce. Objective To investigate the relationship between the presence of neuropsychiatric symptoms and the level of caregiver burden in a group of Brazilian elderly with dementia. Methods The Brazilian versions of the Zarit Caregiver Burden Interview (ZBI) and of the Neuropsychiatric Inventory (NPI) were administered to a total of 83 family-caregivers of patients with dementia followed at a university-affiliated outpatient clinic. Pearson's correlations were calculated to measure the level of association between the scores on both instruments. Results Among the caregivers, 83.1% were women, and had a mean age of 55.6±12.8 years. The ZBI scores ranged from 3 to 79 (mean=31.4). Patients' NPI scores ranged from 0 to 102 (mean=26.9), consistent with a significant degree of behavioral manifestations in most patients. A significant positive correlation was found between ZBI and NPI scores (r=0.402; p=0.000). Conclusion The presence and severity of behavioral manifestations assessed by the NPI were associated with a high level of caregiver burden in this sample of Brazilian elderly with dementia.
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Affiliation(s)
- Patrícia Paes Araujo Fialho
- MSc, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Anne Marise Koenig
- MSc, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Etelvina Lucas Dos Santos
- BSc, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Henrique Cerqueira Guimarães
- MD, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rogério Gomes Beato
- MD, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Viviane Amaral Carvalho
- BSc, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thais Helena Machado
- MSc, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- MD, PhD, Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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616
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Kaplin A, Carroll KA, Cheng J, Allie R, Lyketsos CG, Calabresi P, Rosenberg PB. IL-6 release by LPS-stimulated peripheral blood mononuclear cells as a potential biomarker in Alzheimer's disease. Int Psychogeriatr 2009; 21:413-4. [PMID: 19040786 DOI: 10.1017/S1041610208008107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: In Alzheimer's disease (AD), microglia are activated by amyloid-beta (Aβ) to release IL6 among other cytokines, which in turn may be neurotoxic. Prior studies suggest that the brain inflammatory response to various antigens can be modeled by measuring the release of IL6 from peripheral blood mononuclear cells stimulated by lipopolysaccharide (LPS). We sought to replicate these results and extend to an AD-specific stimulus (Aβ). METHOD: PBMCs were purified from 5 AD and 5 age-gender matched cognitively healthy controls and exposed to LPS at two concentrations (20 and 100 ng/ml) and Aβ1-42(20 ug/ml). IL6 release was measured with standard ELISA kits, and the ratio of “IL6 release” with and without LPS stimulation was reported as the “IL6 release ratio.” Correlations were performed with Pearson's r2. RESULTS: IL6 release ratios were increased in AD participants as compared to cognitively normal age-gender matched controls with LPS 100 ng/ml exposure at a trend level (p=.07). Aβ1-42 increased the IL6 release ratio at a trend level (P=.07) with LPS 20 ng/ml exposure. IL6 release ratio was significantly correlated with worse performance on a verbal category fluency test (p=.03, r2=.49)and higher scores on the Neuropsychiatric Inventory (p=.01, r2=.63). There were trend level correlations of Il6 release with worse ratings on the CDR and MMSE. CONCLUSIONS: The IL6 release ratio derived from peripheral blood has potential as a biomarker of AD disease severity, both for cognitive outcomes and neuropsychiatric symptoms of AD.
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617
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Mercuro G, Carpiniello B, Ruscazio M, Zoncu S, Montisci R, Rudas N, Cherchi A. Association between psychiatric disorders and Marfan's syndrome in a large Sardinian family with a high prevalence of cardiac abnormalities. Clin Cardiol 2009; 20:243-5. [PMID: 9068910 PMCID: PMC6655436 DOI: 10.1002/clc.4960200311] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Marfan's syndrome is an inherited disorder of connective tissue associated with characteristic abnormalities of the skeletal, ocular, and cardiovascular systems. Marked clinical variability and age dependency of all manifestations of Marfan's syndrome may render the unequivocal diagnosis difficult in mildly affected, young subjects. HYPOTHESIS The study and care of a 32-year-old woman with evidence of Marfan's syndrome, several cardiac abnormalities, and paranoid schizophrenia led to an investigation of her consenting relatives to verify the penetrance of Marfan's syndrome and the degree of comorbidity between the disease and psychiatric disorders. METHODS The patient and 12 subjects belonging to three generations of her family underwent cardiovascular, skeletal, ophthalmologic, and psychiatric examinations. Two-dimensional and Doppler echocardiography were performed. RESULTS One female index patient and six of her first-degree relatives were found to be affected by Marfan's syndrome. All seven patients were found to have mitral valve prolapse associated with other cardiac abnormalities. Four of these patients were affected by the following psychiatric disorders: generalized anxiety disorder, major depressive disorder, paranoid schizophrenia (two cases). Six more relatives without Marfan's syndrome showed mitral valve prolapse in association with other echocardiographic features. Two of these were found to be affected by a major depressive disorder. CONCLUSIONS The present data support the hypothesis that a psychiatric condition, associated with a significantly high frequency of cardiac involvement, may be part of the phenotype of Marfan's syndrome.
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Affiliation(s)
- G Mercuro
- Institute of Cardiology, University of Cagliari, Sardinia, Italy
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618
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Godinho C, Camozzato A, Kochhann R, Chaves MLF. Association of caregiver demographic variables with neuropsychiatric symptoms in Alzheimer's disease patients for distress on the Neuropsychiatric Inventory (NPI). Dement Neuropsychol 2008; 2:211-216. [PMID: 29213573 PMCID: PMC5619468 DOI: 10.1590/s1980-57642009dn20300009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/30/2022] Open
Abstract
Behavioral symptoms are frequently observed in Alzheimer’s disease patients and
are associated to higher distress for patients and caregivers, early
institutionalization, worst prognosis and increased care.
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Affiliation(s)
- Cláudia Godinho
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine
| | - Analuiza Camozzato
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
| | - Renata Kochhann
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
| | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre.,Medical Sciences Post-Graduation Course, UFRGS School of Medicine.,Internal Medicine Department, UFRGS School of Medicine
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619
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Abstract
Neuropsychiatric symptoms are well defined in behavioral variant frontotemporal dementia but are not as well studied in primary progressive aphasia. This study compared caregiver reported neuropsychiatric symptoms in these 2 forms of dementia at short and long disease duration. Patients with behavioral variant frontotemporal dementia had more symptoms than patients with primary progressive aphasia. However, when divided by duration of disease, patients with primary progressive aphasia with long duration had a similar number of symptoms to patients with behavioral variant frontotemporal dementia at either duration. Furthermore, this group of patients with primary progressive aphasia had more symptoms typical of behavioral variant frontotemporal dementia and less mood-related symptoms which were more common in patients with primary progressive aphasia with shorter duration. This study illustrates the emergence of neuropsychiatric symptoms as primary progressive aphasia progresses and highlights the increasing overlap with behavioral variant frontotemporal dementia because the disease affects areas outside of the language network.
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Affiliation(s)
- Sarah J. Banks
- Montreal Neurological Institute, Neuropsychology Institute, Montreal, Quebec
| | - Sandra Weintraub
- Montreal Neurological Institute, Neuropsychology Institute, Montreal, Quebec
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620
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Abstract
Neurobehavioural and psychiatric symptoms are common in a range of
neurodegenerative disorders with distinct profiles which are helpful in the
diagnosis and monitoring of these disorders. The Cambridge Behavioural Inventory
(CBI) has been shown to distinguish frontotemporal dementia (FTD), Alzheimer’s
disease (AD), Huntington’s disease (HD) and Parkinson’s disease (PD), but it is
lengthy.
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Affiliation(s)
- Helen J Wear
- BA - MRCP PhD, Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Catherine J Wedderburn
- BA - MRCP PhD, Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Eneida Mioshi
- FedMedSci, MSc OTR - Prince of Wales Medical Research Institute, Sydney, Australia
| | - Caroline H Williams-Gray
- BA - MRCP PhD, Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,MRCP PhD, Department of Neurology, Addenbrooke's Hospital, Cambridge, CB2 2QQ. John Hodges and Eneida Mioshi were based at the Department of Clinical Neurosciences at the time of the study
| | - Sarah L Mason
- BA - MRCP PhD, Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Roger A Barker
- BA - MRCP PhD, Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,MRCP PhD, Department of Neurology, Addenbrooke's Hospital, Cambridge, CB2 2QQ. John Hodges and Eneida Mioshi were based at the Department of Clinical Neurosciences at the time of the study
| | - John R Hodges
- FedMedSci, MSc OTR - Prince of Wales Medical Research Institute, Sydney, Australia
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621
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Abstract
Little is known about subjective perceptions of quality of life (QOL) in Huntington's disease (HD). The current study determined correlates of patient and caregiver QOL and assessed change over time. Participants were 22 patient-caregiver dyads, who rated QOL at baseline and 6 months later. Overall, patients' functional and cognitive impairment were significantly correlated with patient and caregiver QOL. Neuropsychiatric symptoms had differential impact on patient and caregiver QOL. Furthermore, when patients recalled their QOL about a previous time, their recall may have been negatively biased. Clinical implications of results are discussed. Future work is needed because subjective QOL is an important outcome measure in therapeutic trials.
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Affiliation(s)
- Rebecca E Ready
- Department of Psychology, University of Massachusetts, Amherst, Massachusetts 01003, USA.
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622
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Hinton L, Farias ST, Wegelin J. Neuropsychiatric symptoms are associated with disability in cognitively impaired Latino elderly with and without dementia: results from the Sacramento Area Latino study on Aging. Int J Geriatr Psychiatry 2008; 23:102-8. [PMID: 18058994 PMCID: PMC2872104 DOI: 10.1002/gps.1952] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [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] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the relationship between neuropsychiatric symptoms burden and disability in cognitively impaired older Latinos. METHODS Subjects in the cross-sectional study were 95 cognitively impaired (both demented and non-demented) non-institutionalized Latino elderly participating in an epidemiological cohort study and their family caregivers. Care recipient neuropsychiatric symptoms (Neuropsychiatric Inventory) and level of functional impairment (i.e. impairment in activities of daily living and instrumental activities of daily living) were assessed through interviews with family caregivers. RESULTS Both NPI total score and NPI depression subscale score were significantly associated with disability before and after controlling for potential confounding variables. The strength of the association between higher neuropsychiatric symptom levels and higher disability was similar for both the cognitively impaired not demented and demented groups. CONCLUSIONS Neuropsychiatric symptoms are associated with increased disability in a community sample of cognitively impaired Latino elderly. More effective identification and treatment of neuropsychiatric symptoms may improve functioning in older Latinos and reduce health disparities for this population.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Alzheimer's Disease Center, University of California, CA, USA.
| | | | - Jacob Wegelin
- Department of Biostatistics, Virginia Commonwealth University, USA
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623
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Moscoso MA, Marques RDCG, Ribeiz SRI, Dos Santos L, Bezerra DM, Jacob Filho W, Nitrini R, Bottino CMDC. Profile of caregivers of Alzheimer's disease patients attended at a reference center for cognitive disorders. Dement Neuropsychol 2007; 1:412-417. [PMID: 29213421 PMCID: PMC5619439 DOI: 10.1590/s1980-57642008dn10400015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/22/2022] Open
Abstract
This is a study on burden of caregivers of patients with Alzheimer's disease attended at a Reference Center for Cognitive Disorders. Objective To evaluate the profile and burden on caregivers of patients with Alzheimer's disease attended at a Reference Center for Cognitive Disorders. Methods We collected demographic information and data on the relationship with the patient from caregivers, and measured burden with the Zarit scale. The patients were evaluated with the following scales: the Cambridge Cognitive Test (CAMCOG); Mini Mental State Examination, the Neuropsychiatric Inventory for neuropsychiatry symptoms, and Functional Activities Questionnaire - FAQ for functional impairment. Results Of the 31 caregivers, 77.4% were female, predominantly, and daughters, having a mean age of 58.6 years, educational level of 8.1 years, 70% of caregivers co-resided with the patient and 71% did not work. The mean time as a caregiver was 3 years. Twenty-seven percent of the caregivers presented mild to severe burden. The variables presenting significant association with caregiver burden were scores on the NPI and CAMCOG. Conclusion The social demographic characteristics of the sample were similar to those of studies performed in other countries. The average time as a caregiver and the frequency of caregivers with mild to intense burden were lower than those reported in international studies. Neuropsychiatric symptoms and severity of cognitive decline were the main factors associated to burden in this sample of mostly mild to moderate demented AD patients. Further studies are necessary to verify whether the burden is indeed less intense in our milieu.
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Affiliation(s)
- Marco Antonio Moscoso
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,PROTER (Old Age Research Group), Institute of Psychiatry - Clinicas Hospital of the School of Medicine of the University of São Paulo
| | - Rita de Cássia Gomes Marques
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,PROTER (Old Age Research Group), Institute of Psychiatry - Clinicas Hospital of the School of Medicine of the University of São Paulo
| | - Salma Rose Imanari Ribeiz
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,PROTER (Old Age Research Group), Institute of Psychiatry - Clinicas Hospital of the School of Medicine of the University of São Paulo
| | - Lysandra Dos Santos
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,PROTER (Old Age Research Group), Institute of Psychiatry - Clinicas Hospital of the School of Medicine of the University of São Paulo
| | - Diana Moitinho Bezerra
- PROTER (Old Age Research Group), Institute of Psychiatry - Clinicas Hospital of the School of Medicine of the University of São Paulo
| | - Wilson Jacob Filho
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,Department of Internal Medicine, School of Medicine of the University of São Paulo
| | - Ricardo Nitrini
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,Department of Neurology, School of Medicine of the University of São Paulo
| | - Cássio Machado de Campos Bottino
- CEREDIC (Reference Center for Cognitive Disorders); Clinicas Hospital of the School of Medicine of the University of São Paulo.,PROTER (Old Age Research Group), Institute of Psychiatry - Clinicas Hospital of the School of Medicine of the University of São Paulo
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624
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Abstract
BACKGROUND Misrecognition of symptoms in the early stages of frontotemporal dementia (FTD) frequently contributes to diagnostic delay. Three frameworks have been proposed for the clinical identification of prodromal FTD: (1) cognitive profiling, (2) the presence of behavioral/psychiatric symptoms in the absence of memory complaints, and (3) a combined approach of cognitive, behavioral, and neuroimaging features. OBJECTIVE To evaluate current conceptual frameworks for the clinical recognition of prodromal FTD with current empirical evidence. METHOD We performed a comprehensive PsychINFO and MEDLINE database search to identify articles investigating the prodromal symptoms of FTD. CONCLUSIONS The 3 frameworks capture important aspects of the clinical picture of prodromal FTD but require further refinement. The prodromal stage of FTD is characterized by both cognitive and behavioral features. Diagnostic accuracy will likely be improved by considering a combination of cognitive and behavioral features, because some features overlap with prodromes for Alzheimer's disease and vascular dementia.
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Affiliation(s)
- Bradley J Hallam
- Division of Neurology, Geriatric Psychiatry Outreach Team, Vancouver Hospital, Vancouver, British Columbia.
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625
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Abstract
Patients with mild cognitive impairment and mild to moderate Alzheimer's disease can provide information about their quality of life. This study determined whether aggregating patient and informant quality-of-life reports on the Cornell-Brown Scale for Quality of Life in Dementia can provide a broader perspective on the quality of life relative to patient or informant reports separately. Aggregated Cornell-Brown Scale for Quality of Life in Dementia scores were hypothesized to correlate more strongly with both patient and informant perspectives of patient's memory, function, and neuropsychiatric symptoms than the unaggregated measures. Results indicated that aggregated Cornell-Brown Scale for Quality of Life in Dementia scores reflected a blend of patient and informant perspectives on patient function. This study contributes to a growing line of research that recommends integrating patient and informant perspectives to achieve the most complete assessment of quality of life.
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Affiliation(s)
- Rebecca E Ready
- Department of Psychology, University of Massachusetts, Amherst, MA 01003, USA.
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626
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Ortiz F, Fitten LJ, Cummings JL, Hwang S, Fonseca M. Neuropsychiatric and behavioral symptoms in a community sample of Hispanics with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2006; 21:263-73. [PMID: 16948291 PMCID: PMC10833247 DOI: 10.1177/1533317506289350] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [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
The purpose of this study was to characterize and compare neuropsychiatric symptoms in a sample of 367 community-dwelling subjects: 70 Hispanics and 230 non-Hispanic white patients with Alzheimer's disease, and 22 Hispanics and 45 non-Hispanic white healthy age-matched controls. Neuropsychiatric symptoms were common among all patients with Alzheimer's disease. In the Alzheimer's disease groups, Hispanic subjects presented to the initial assessment with more symptoms than non-Hispanic white subjects did. In comparison to the non-Hispanic white population, the proportion of Hispanics with neuropsychiatric and behavioral symptoms was higher. These findings have implications for differential sociocultural presentations of Alzheimer's disease among ethnic/racial groups.
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Affiliation(s)
- Freddy Ortiz
- The Neuropsychiatry Research Memory Clinic, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.
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627
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Abstract
The purpose of this research was to assess the frequency and severity of neuropsychiatric and behavioral symptoms and to examine the association between preexisting medical conditions and specific neuropsychiatric symptoms in demented individuals. We studied 211 demented subjects (87.7 percent male) who were participants in epidemiological studies of dementia. Using the Neuropsychiatric Inventory (NPI), we assessed the frequency and severity of neuropsychiatric symptoms. We collected medical history information during a structured telephone interview. Our analyses focused on determining prevalence of neuropsychiatric symptoms by dementia diagnosis and severity. We also examined the association of history of head injury, alcohol abuse, and stroke with development of neuropsychiatric symptoms. We found that neuropsychiatric symptoms were common, with approximately three-fourths of the subjects exhibiting at least one symptom during the preceding month. Apathy (39.3 percent), agitation (31.8 percent), and aberrant motor behavior (31.1 percent) were the most frequent symptoms. Frequency and severity of symptoms were similar for the all-dementia and Alzheimer's disease-only groups, neuropsychiatric symptoms varied by severity of dementia, but generally not in a consistent ordinal pattern. History of alcohol abuse, head injury, or stroke was associated with presence of specific neuropsychiatric symptoms in dementia. While psychiatric symptoms are common in dementia, they also vary by type and severity of dementia. The finding that certain medical conditions may increase risk for specific types of neuropsychiatric symptoms expands our knowledge of the natural history of dementia and should improve management of dementia in medically ill patients. Our results may also shed light on mechanisms that underlie neuropsychiatric symptoms.
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Affiliation(s)
- David C Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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