401
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Rozum WJ, Cooley B, Vernon E, Matyi J, Tschanz JT. Neuropsychiatric symptoms in severe dementia: Associations with specific cognitive domains the Cache County Dementia Progression Study. Int J Geriatr Psychiatry 2019; 34:1087-1094. [PMID: 30945374 PMCID: PMC6812503 DOI: 10.1002/gps.5112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/26/2018] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the prevalence of neuropsychiatric symptoms (NPS) and cognitive correlates in severe dementia. METHODS A population-based sample of 56 individuals with severe dementia (85.7% Alzheimer's type; 67.9% female) were assessed with the Severe Cognitive Impairment Profile (SCIP) and the Neuropsychiatric Inventory (NPI). Descriptive statistics displayed the frequency of NPS and bivariate and multiple regression analyses examined the associations between cognitive domains on the SCIP and NPS total, domain, and cluster scores. RESULTS NPS were common in severe dementia with 98% of the sample exhibiting at least one symptom. Most common were delusions, apathy, agitation/aggression, and aberrant motor behavior, affecting 50% or more of participants. SCIP comportment was significantly associated with NPI total score and apathy (r = -.350 and -.292, respectively). All SCIP domains except for arithmetic, visuospatial, comportment, and motor behavior were significantly associated with agitation/aggression (r = -.285 to -.350). These associations remained in individual multiple regression models. CONCLUSION In severe dementia, impairment in specific cognitive domains was associated with more severe NPS. Environmental manipulations to reduce processing demands in persons with severe dementia may be a useful strategy to target agitation and aggressive behaviors.
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Affiliation(s)
| | | | | | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University;,Center for Epidemiologic Studies, Utah State University
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402
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Tiel C, Sudo FK, Calmon AB. Neuropsychiatric symptoms and executive function impairments in Alzheimer's disease and vascular dementia: The role of subcortical circuits. Dement Neuropsychol 2019; 13:293-298. [PMID: 31555401 PMCID: PMC6753905 DOI: 10.1590/1980-57642018dn13-030005] [Citation(s) in RCA: 16] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) in dementia are prevalent, under-recognized and little studied regarding their pathophysiological aspects. The pathophysiological mechanism, as well as the possible role of vascular lesions in the genesis of these symptoms, are still matters of debate. OBJECTIVE to describe and compare the prevalence and severity of NPS in subjects with Alzheimer's disease (AD) and vascular dementia (VaD). METHODS a cross-sectional study involving 82 outpatients, divided into two groups (AD × VaD), was conducted. Patients were submitted to the Cambridge Cognitive Test (CAMCOG), the Clock Drawing Test (CLOX 1 and 2), the Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating (CDR) scale. Neuroimaging was scored using the de Leon and Fazekas scales. RESULTS 90.8% of the patients had at least one neuropsychiatric symptom. There were statistical differences on the CLOX test and in the apathy symptoms between AD and VaD groups. Apathy and disinhibition proved more prevalent in patients with higher vascular load. CONCLUSION apathy and impaired executive function may reflect vascular damage in subcortical circuits in dementia patients.
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Affiliation(s)
- Chan Tiel
- Universidade de VassourasMedical SchoolVassourasRJBrazilUniversidade de Vassouras (UV), Medical School, Vassouras, Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de JaneiroDepartment of NeurologyRio de JaneiroRJBrazilDepartment of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
| | - Felipe Kenji Sudo
- Instituto D’Or de Ensino e PesquisaMemory ClinicRio de JaneiroRJBrazilMemory Clinic, Instituto D’Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil.
| | - Ana Beatriz Calmon
- Universidade de VassourasMedical SchoolVassourasRJBrazilUniversidade de Vassouras (UV), Medical School, Vassouras, Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de JaneiroDepartment of NeurologyRio de JaneiroRJBrazilDepartment of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
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403
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Abstract
Objectives: To evaluate the cognitive, neuropsychiatric, and quality of life outcomes of computer-based cognitive training and social interaction on people with mild to moderate dementia. Methods: Ten individuals with dementia were recruited to complete a cognitive training regimen. They were randomly assigned to a high social interaction (HSI) group (n = 5) and low social interaction (LSI) group (n = 5). Eight of the original 10 participants completed the cognitive training and were evaluated on cognitive abilities, neuropsychiatric symptoms (NPS), and quality of life (QoL). Results: Mean scores for the HSI group increased on cognitive assessments, where mean scores for the LSI group saw decline, or stability. There was an overall reduction in the frequency and severity of NPS presentation in both the HSI and LSI group. Mixed results were found for mean changes in QoL. Discussion: These results support the idea of social interaction influencing cognitive outcomes, cognitive training influencing NPS, and both social interaction and cognitive training influencing QoL. The findings illustrate the feasibility and importance of incorporating social activity to computerized cognitive training for people with dementia. Clinical Implications: Cognitive training that incorporates social interaction may be a promising intervention for individuals with dementia experiencing NPS.
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Affiliation(s)
- Hillary J Rouse
- a School of Aging Studies , University of South Florida , Tampa , FL , USA
| | - Brent J Small
- a School of Aging Studies , University of South Florida , Tampa , FL , USA
| | - Mark E Faust
- b Department of Psychological Science , University of North Carolina at Charlotte , Charlotte , NC , USA
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404
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Rockwood K, Sanon Aigbogun M, Stanley J, Wong H, Dunn T, Chapman CAT, Howlett SE, Miguelez M, McGarrigle L, Baker RA. The Symptoms Targeted for Monitoring in a Web-Based Tracking Tool by Caregivers of People With Dementia and Agitation: Cross-Sectional Study. J Med Internet Res 2019; 21:e13360. [PMID: 31254339 PMCID: PMC6625216 DOI: 10.2196/13360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In people with dementia, neuropsychiatric symptoms (NPSs), especially agitation, are associated with worse quality of life and caregiver burden. As NPSs may vary with illness severity, knowledge of how people with dementia and their caregivers describe and rate the importance of agitation symptoms can improve the understanding of the clinical meaningfulness of the manifestations of agitation. The internet provides new opportunities to better understand patient experiences, as patients and caregivers increasingly look to Web-based platforms as a means of managing symptoms. OBJECTIVE The aim of this study was to examine Web-based reports from a dementia symptom website to better understand the symptoms of agitation and explore how they are being targeted for monitoring by caregivers of people with dementia. METHODS The Dementia Guide website hosts a Web-based database used by caregivers (97%) and people with dementia (3%). From its 61 dementia symptoms, users can select relevant symptoms that they deem important to monitor or track the effects of treatment. We employed a staging algorithm to determine if individuals had mild cognitive impairment (MCI) or mild, moderate, or severe dementia. Agitation was defined using terms consistent with the International Psychogeriatrics Association's provisional consensus definition. We compared the proportion of people with NPSs and agitation across stages of dementia severity and studied how many agitation-defining descriptors were selected, and how often they occurred, by stage. RESULTS As of March 2017, 4121 people had used the tracking tool, of whom 2577 provided sufficient data to allow disease severity staging. NPSs were tracked by 2127/2577 (82.54%) and agitation by 1898/2577 (73.65%). The proportion in whom agitation was tracked increased with increasing cognitive impairment: 68.5% (491/717) in people with MCI, and 72.50% (754/1040), 73.3% (378/516), and 90.5% (275/304) in mild, moderate, and severe dementia, respectively (χ23=54.9; P<.001). The number of NPS and agitation descriptors selected also increased with severity (median number of NPSs=1, 2, 2, and 3 for MCI, mild, moderate, and severe dementia, respectively, Kruskal-Wallis H Test H3=250.47; P<.001; median number of agitation descriptors=1, 2, 3, and 4, H3=146.11; P<.001). CONCLUSIONS NPSs and agitation are common targets for tracking over the course of dementia and appear more frequently with increasing disease severity. These common and distressing symptoms represent clinically meaningful targets in treating people with dementia.
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Affiliation(s)
- Kenneth Rockwood
- Geriatric Medicine Research Unit, Halifax, NS, Canada.,DGI Clinical Inc, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | - Susan E Howlett
- DGI Clinical Inc, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Maia Miguelez
- Otsuka Canada Pharmaceutical Inc, Saint-Laurent, QC, Canada
| | - Lisa McGarrigle
- Geriatric Medicine Research Unit, Halifax, NS, Canada.,DGI Clinical Inc, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ross A Baker
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
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405
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Dekker AD, Sacco S, Carfi A, Benejam B, Vermeiren Y, Beugelsdijk G, Schippers M, Hassefras L, Eleveld J, Grefelman S, Fopma R, Bomer-Veenboer M, Boti M, Oosterling GDE, Scholten E, Tollenaere M, Checkley L, Strydom A, Van Goethem G, Onder G, Blesa R, Zu Eulenburg C, Coppus AMW, Rebillat AS, Fortea J, De Deyn PP. The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome. J Alzheimers Dis 2019; 63:797-819. [PMID: 29689719 PMCID: PMC5929348 DOI: 10.3233/jad-170920] [Citation(s) in RCA: 29] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.
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Affiliation(s)
- Alain D Dekker
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | | | - Angelo Carfi
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Bessy Benejam
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | - Yannick Vermeiren
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Gonny Beugelsdijk
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Mieke Schippers
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Lyanne Hassefras
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - José Eleveld
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Sharina Grefelman
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Roelie Fopma
- Talant, Center for Intellectual Disabilities, Heerenveen, The Netherlands
| | | | - Mariángeles Boti
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | | | - Esther Scholten
- Elver, Center for Intellectual Disabilities, Nieuw-Wehl, The Netherlands
| | - Marleen Tollenaere
- Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Laura Checkley
- Division of Psychiatry, University College London, London, UK
| | - André Strydom
- Division of Psychiatry, University College London, London, UK
| | - Gert Van Goethem
- Het GielsBos, Center for Intellectual Disabilities, Gierle, Belgium.,Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Graziano Onder
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Rafael Blesa
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christine Zu Eulenburg
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonia M W Coppus
- Dichterbij, Center for Intellectual Disabilities, Gennep, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Juan Fortea
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain.,Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
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406
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Abstract
Introduction: Cognitive impairment and behavioral disturbances are common findings in Parkinson's disease (PD). Despite initially being considered late complications of the disease, it is currently accepted that almost all PD patients will exhibit cognitive and behavioral abnormalities from the early and even the premotor stages of the disease. Areas covered: The present review focuses on the cognitive profile of PD, the clinical picture of PD-MCI and dementia in PD (PDD) and the recommended methods for cognitive assessment in this population. The authors also describe the more representative neuropsychiatric alterations and provide an overview of the recommended methods of assessment. Expert opinion: Cognitive and behavioral symptoms are inherent to PD, appear in a vast majority of patients at some point during disease progression and have an enormous impact on health-related quality of life of patients and caregivers. Validated methods of cognitive and behavioral assessment are currently developed and must be used in research and clinical settings.
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Affiliation(s)
- Saul Martinez-Horta
- a Movement Disorders Unit, Neurology Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,b Biomedical Research Institute (IIB-Sant Pau) , Barcelona , Spain.,c Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) , Madrid , Spain.,d Autonomous University of Barcelona , Barcelona , Spain
| | - Andrea Horta-Barba
- a Movement Disorders Unit, Neurology Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,b Biomedical Research Institute (IIB-Sant Pau) , Barcelona , Spain.,c Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) , Madrid , Spain
| | - Jaime Kulisevsky
- a Movement Disorders Unit, Neurology Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,b Biomedical Research Institute (IIB-Sant Pau) , Barcelona , Spain.,c Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) , Madrid , Spain.,d Autonomous University of Barcelona , Barcelona , Spain
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407
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Esang M, Goldstein S, Dhami R. The Role of Physical Examinations in Psychiatry as Illustrated in a Case of Neuroleptic Malignant Syndrome Versus Viral Encephalitis: A Case Report and Literature Review. Cureus 2019; 11:e4840. [PMID: 31410323 PMCID: PMC6684120 DOI: 10.7759/cureus.4840] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although a standard psychiatric evaluation includes a physical examination, there are no guidelines on the components of a comprehensive physical examination during psychiatric patient encounters. The mental status examination is frequently considered the psychiatric physical examination equivalent. We report a 59-year-old male inpatient on a medical unit who had hyperthermia, an altered mental status, muscle rigidity, and elevated white blood cell count and creatine phosphokinase level. He had been taking risperidone 1 mg orally every 12 hours for two months. His primary treatment team suspected Neuroleptic Malignant Syndrome (NMS), but the consulting psychiatrist detected equivocal findings on physical examination and recommended a broader differential diagnosis. Further investigations revealed the possibility of an infection. The patient was positive for immunoglobulin G (IgG) antibodies to HSV-1 and HSV-2 on cerebrospinal fluid analysis. He was then treated for Herpes Simplex Encephalitis (HSE) with an oral course of acyclovir. Although NMS was low in the diagnostic ranking, given the possibility of an atypical form and the lethality of this condition if untreated, he also received intravenous lorazepam at 2 mg every six hours. He experienced full resolution of his symptoms and was stable for discharge. HSE and NMS are two examples of neuropsychiatric disorders with similar presenting symptoms. HSE frequently presents with predominantly psychiatric symptoms, such as paranoia, hallucinations, and an altered mental status. Consequently, it is typically not the first diagnosis that comes to mind, especially when these symptoms occur in a patient already being treated by a psychiatrist. Confirmation bias is the tendency for an individual to focus on the information that aligns with one’s preconceptions and to ignore information that defies it. Due to this bias, physicians may attribute all symptoms of a known psychiatric patient to a psychiatric cause, instead of considering an organic etiology. In this case, the evaluation by the psychiatrist was crucial in guiding the treatment team to a diagnosis of HSE. This is important since a delayed treatment of HSE can be fatal. The literature review reveals a general consensus among psychiatrists on the value of physical examinations in patient care. In spite of this, the majority of psychiatrists seldom perform physical examinations due to concerns over skill atrophy and the potential that doing so may change the therapeutic dynamic. Others have disputed these claims and have argued that physical examinations in a psychiatric setting will not only strengthen the perception of a psychiatrist as a physician by the patient but will also allow for better care of psychiatrically ill patients. Psychiatrists should remember that they are oftentimes the sole healthcare provider for psychiatric patients and that these patients may not have the access to primary care physicians and may lack the ability to explain their symptoms or advocate for themselves. Therefore, incorporating an emphasis on performing physical examinations during psychiatry residency training and in continuing medical education programs for psychiatrists is essential.
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Affiliation(s)
- Michael Esang
- Psychiatry and Behavioral Sciences, Nassau University Medical Center, East Meadow, USA
| | - Sabina Goldstein
- Miscellaneous, American University of the Caribbean, Cupecoy, SXM
| | - Ravina Dhami
- Miscellaneous, American University of the Caribbean, Cupecoy, SXM
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408
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Gerridzen IJ, Joling KJ, Depla MF, Veenhuizen RB, Verschuur EM, Twisk JW, Hertogh CM. Awareness and its relationships with neuropsychiatric symptoms in people with Korsakoff syndrome or other alcohol-related cognitive disorders living in specialized nursing homes. Int J Geriatr Psychiatry 2019; 34:836-845. [PMID: 30854733 PMCID: PMC6593674 DOI: 10.1002/gps.5093] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 03/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Impaired awareness of functional deficits is often observed in people with Korsakoff syndrome (KS) and may result in refusal of care, although this area has been understudied. This study aimed to investigate levels of impaired awareness and their relationships with neuropsychiatric symptoms (NPS) in people with KS residing in specialized nursing homes. METHODS A cross-sectional, observational study was conducted among 215 residents with KS or other alcohol-related cognitive disorders. Awareness was measured with the Patient Competency Rating Scale (PCRS). NPS and subsyndromes were measured with the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Adjusted multilevel regression analyses were performed to examine the relationships between the level of awareness and NPS. RESULTS The mean level of impaired awareness was 39.3 (SD = 19.9) indicating moderate impairment. Twenty-nine percent of the residents had no or mildly impaired awareness; 37% were moderately impaired, and 34% were severely impaired. Residents with moderately impaired awareness showed more severe apathy than residents with no or mildly impaired awareness (difference 1.23; 95% CI 1.02-1.48; p = 0.03). No associations were found between the level of awareness and other NPI outcomes. Cognitive functioning seems to have the strongest impact on the association between level of awareness and NPS in KS residents. CONCLUSIONS Impaired awareness of functional deficits is highly common in KS residents; however, apart from apathy, is not significantly related with NPS. Additional research should further examine, which interventions are effective in dealing with impaired awareness in these people, particularly when apathy is present.
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Affiliation(s)
- Ineke J. Gerridzen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands,Nursing home MarkenhofAtlantBeekbergenThe Netherlands
| | - Karlijn J. Joling
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
| | - Marja F. Depla
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
| | - Ruth B. Veenhuizen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
| | | | - Jos W.R. Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands
| | - Cees M.P.M. Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
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409
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Vik-Mo AO, Bencze J, Ballard C, Hortobágyi T, Aarsland D. Advanced cerebral amyloid angiopathy and small vessel disease are associated with psychosis in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2019; 90:728-730. [PMID: 30054314 DOI: 10.1136/jnnp-2018-318445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Audun Osland Vik-Mo
- Department of Clinical Science, University of Bergen, Bergen, Norway .,Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - János Bencze
- Division of Neuropathology, Institute of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Tibor Hortobágyi
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, University of Debrecen, Debrecen, Hungary.,Institute of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Dag Aarsland
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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410
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Appelhof B, Bakker C, de Vugt ME, van Duinen-van den IJssel JCL, Zwijsen SA, Smalbrugge M, Teerenstra S, Verhey FRJ, Zuidema SU, Koopmans RTCM. Effects of a Multidisciplinary Intervention on the Presence of Neuropsychiatric Symptoms and Psychotropic Drug Use in Nursing Home Residents WithYoung-Onset Dementia: Behavior and Evolution of Young-Onset Dementia Part 2 (BEYOND-II) Study. Am J Geriatr Psychiatry 2019; 27:581-589. [PMID: 30799167 DOI: 10.1016/j.jagp.2018.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/25/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The effect of an intervention on neuropsychiatric symptoms (NPS), particularly agitation and aggression, and psychotropic drug use (PDU) in institutionalized people with young-onset dementia (YOD) was evaluated. METHODS A randomized controlled trial was conducted using a stepped wedge design. Thirteen YOD special care units were randomly assigned to three groups, which received the intervention at different time points. Four assessments took place every 6 months during a period of 18 months. Two hundred seventy-four people with YOD who resided in YOD special care units participated, of whom 131 took part in all assessments. The intervention consisted of an educational program combined with a care program, which structured the multidisciplinary process of managing NPS. The care program included the following five steps: evaluation of psychotropic drug prescription, detection, analysis, treatment, and evaluation of treatment of NPS. The Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version were used to assess NPS. Data on PDU were retrieved from residents' medical files. Multilevel models were used to evaluate the effect of the intervention, which accounted for clustering of measurements in clients within units. RESULTS No significant differences were found in agitation, aggression, other NPS, or PDU after crossing over to the intervention condition. CONCLUSION We found no evidence that the intervention for management of NPS in nursing home residents with YOD was more effective in reducing agitation, aggression, other NPS, or PDU compared with care as usual.
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Affiliation(s)
- Britt Appelhof
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Knowledge Center for Specialized Care (BA), Landrijt Archipel, Eindhoven, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; Send correspondence and reprint requests to Britt Appelhof, M.Sc., Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands..
| | - Christian Bakker
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; Center for Specialized Care in Young-Onset Dementia (CB), Florence Mariahoeve, The Hague
| | - Marjolein E de Vugt
- Alzheimer Center Limburg (MEV, FRJV), School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeannette C L van Duinen-van den IJssel
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands
| | - Sandra A Zwijsen
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research Institute (SAZ, MS), VU University Medical Center, Amsterdam
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research Institute (SAZ, MS), VU University Medical Center, Amsterdam
| | - Steven Teerenstra
- Department of Health Evidence (ST), Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg (MEV, FRJV), School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine (SUZ), University Medical Center Groningen, Groningen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; De Waalboog "Joachim en Anna" Center for Specialized Geriatric Care (RTCMK), Nijmegen, The Netherlands
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411
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Sugarman MA, Alosco ML, Tripodis Y, Steinberg EG, Stern RA. Neuropsychiatric Symptoms and the Diagnostic Stability of Mild Cognitive Impairment. J Alzheimers Dis 2019; 62:1841-1855. [PMID: 29614641 DOI: 10.3233/jad-170527] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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
BACKGROUND Mild cognitive impairment (MCI) is an intermediate diagnosis between normal cognition (NC) and dementia, including Alzheimer's disease (AD) dementia. However, MCI is heterogeneous; many individuals subsequently revert to NC while others remain stable at MCI for several years. Identifying factors associated with this diagnostic instability could assist in defining clinical populations and determining cognitive prognoses. OBJECTIVE The current study examined whether neuropsychiatric symptoms could partially account for the temporal instability in cognitive diagnoses. METHOD The sample included 6,763 participants from the National Alzheimer's Coordinating Center Uniform Data Set. All participants had NC at baseline, completed at least two follow-up visits (mean duration: 5.5 years), and had no recent neurological conditions. Generalized linear models estimated by generalized estimating equations examined associations between changes in cognitive diagnoses and symptoms on the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Geriatric Depression Scale (GDS-15). RESULTS 1,121 participants converted from NC to MCI; 324 reverted back to NC and 242 progressed to AD dementia. Higher symptoms on the GDS-15 and circumscribed symptom domains on the NPI-Q were associated with conversion from NC to MCI and a decreased likelihood of reversion from MCI to NC. Individuals with higher symptoms on NPI-Q Hyperactivity and Mood items were more likely to progress to AD dementia. DISCUSSION The temporal instability of MCI can be partially explained by neuropsychiatric symptoms. Individuals with higher levels of specific symptoms are more likely to progress to AD dementia and less likely to revert to NC. Identification and treatment of these symptoms might support cognitive functioning in older adults.
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Affiliation(s)
- Michael A Sugarman
- Boston University Alzheimer's Disease Center, Boston, MA, USA.,Department of Psychology, Bedford Veterans Affairs Medical Center, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Center, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | | | - Robert A Stern
- Boston University Alzheimer's Disease Center, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
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412
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Krashia P, Nobili A, D'Amelio M. Unifying Hypothesis of Dopamine Neuron Loss in Neurodegenerative Diseases: Focusing on Alzheimer's Disease. Front Mol Neurosci 2019; 12:123. [PMID: 31156387 PMCID: PMC6534044 DOI: 10.3389/fnmol.2019.00123] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/25/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Paraskevi Krashia
- Laboratory of Molecular Neurosciences, Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Unit of Molecular Neurosciences, Department of Medicine, University Campus-Biomedico, Rome, Italy
| | - Annalisa Nobili
- Laboratory of Molecular Neurosciences, Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Unit of Molecular Neurosciences, Department of Medicine, University Campus-Biomedico, Rome, Italy
| | - Marcello D'Amelio
- Laboratory of Molecular Neurosciences, Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Unit of Molecular Neurosciences, Department of Medicine, University Campus-Biomedico, Rome, Italy
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413
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Abstract
Vocally disruptive behavior (VDB) is a common and particularly difficult symptom to manage in dementia. VDB is usually considered collectively with agitation and aggression as a component of behavioral and psychological symptoms in dementia and is therefore poorly understood as an individual symptom. A review of the literature is described where VDB as a challenging behavior has been individually examined as a symptom. A case of VDB occurring in patient with dementia is described where the patient's repetitive vocalizations responded to treatment with pregabalin. This has not been previously reported in the literature. The prevalence of VDB, the factors associated with it and the current management guidelines for clinicians are outlined with a review of the drug treatment strategies for VDB. Pregabalin with its unique pharmacological profile and excellent tolerability should be considered as a possible treatment for VDB where drug treatment is indicated.
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414
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Habiger TF, Achterberg WP, Flo E, Husebo BS. Psychosis symptoms in nursing home residents with and without dementia-Cross-sectional analyses from the COSMOS study. Int J Geriatr Psychiatry 2019; 34:683-691. [PMID: 30706561 DOI: 10.1002/gps.5067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/21/2018] [Accepted: 01/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the characteristics of nursing home residents with psychosis and the association with potential underlying factors, such as pain, sleep disturbances, and antipsychotic medication. METHOD Five hundred forty-five residents with and without dementia from 67 Norwegian nursing home units were included in the cross-sectional analyses. Psychosis was the main outcome measure in our study; other outcome measures include quality of life (QoL), activities of daily living (ADL) function, cognitive function, pain, and antipsychotic medication. RESULTS One hundred twelve residents had one or more symptoms of psychosis, and compared with residents without psychosis, they had lower QoL (p < 0.001), ADL function (p = 0.003), and cognitive functioning (p = 0.001). Adjusted logistic regression analyses showed that psychosis was associated with the prevalence of pain (OR: 3.19; 95% CI, 1.94-5.24), sleep disturbances (OR: 4.51; 95% CI, 2.91-6.99), and total number of medication (OR: 1.10; 95% CI, 1.03-1.17). Residents with psychosis but without antipsychotic medication had better QoL (p = 0.005) compared with residents receiving any antipsychotics. CONCLUSION Psychosis in NH residents is associated with pain, sleep disturbances, and number of medications. Residents with psychosis have poor QoL, although better QoL was observed among those who did not use antipsychotic medication.
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Affiliation(s)
- Torstein F Habiger
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Wilco P Achterberg
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, Netherlands
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
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415
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Appelhof B, Bakker C, Van Duinen-van Den IJssel JCL, Zwijsen SA, Smalbrugge M, Verhey FRJ, de Vugt ME, Zuidema SU, Koopmans RTCM. Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia. Aging Ment Health 2019; 23:581-586. [PMID: 29424552 DOI: 10.1080/13607863.2018.1428935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aims of the current study are (1) to explore the differences in neuropsychiatric symptoms (NPS) between young-onset dementia (YOD) and late-onset dementia (LOD), and (2) to investigate whether the possible differences can be attributed to differences in dementia subtype, gender, psychotropic drug use (PDU), or dementia severity. METHOD Three hundred and eighty-six nursing home (NH) residents with YOD and 350 with LOD were included. Multilevel modeling was used to compare NPS between the groups . Furthermore, dementia subtype, gender, PDU, and dementia severity were added to the crude multilevel models to investigate whether the possible differences in NPS could be attributed to these characteristics. RESULTS Higher levels of apathy were found in NH residents with YOD. After the characteristics were added to the models, also lower levels of verbally agitated behaviors were found in YOD . CONCLUSION We recommend that special attention be paid to interventions targeting apathy in YOD. Although no differences in other NPS were found, the PDU rates were higher in YOD, suggesting that the threshold for the use of PDU in the management of NPS is lower. This underscores the need for appropriate attention to non-pharmacological interventions for the management of NPS in YOD.
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Affiliation(s)
- Britt Appelhof
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,b Archipel, Landrijt , Knowledge Center For Specialized Care , Eindhoven , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands
| | - Christian Bakker
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands.,d Florence, Mariahoeve , Center for Specialized Care in Young-Onset Dementia , The Hague , the Netherlands
| | - Jeannette C L Van Duinen-van Den IJssel
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands
| | - Sandra A Zwijsen
- e Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research , VU Medical Centre , Amsterdam , the Netherlands
| | - Martin Smalbrugge
- e Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research , VU Medical Centre , Amsterdam , the Netherlands
| | - Frans R J Verhey
- f School For Mental Health and Neuroscience , Alzheimer Center Limburg , Maastricht University Medical Center , Maastricht , the Netherlands
| | - Marjolein E de Vugt
- f School For Mental Health and Neuroscience , Alzheimer Center Limburg , Maastricht University Medical Center , Maastricht , the Netherlands
| | - Sytse U Zuidema
- g Department of General Practice , University of Groningen , University Medical Center Groningen , Groningen , the Netherlands
| | - Raymond T C M Koopmans
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands.,h De Waalboog 'Joachim en Anna' , Center for Specialized Geriatric Care , Nijmegen , the Netherlands
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416
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Huang XQ, Zhang H, Chen S. Neuropsychiatric Symptoms, Parenting Stress and Social Support in Chinese Mothers of Children with Autism Spectrum Disorder. Curr Med Sci 2019; 39:291-7. [PMID: 31016524 DOI: 10.1007/s11596-019-2033-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/10/2018] [Indexed: 01/03/2023]
Abstract
Although little is known about the current situation regarding autism spectrum disorder (ASD) in mainland China, psychiatric disorders are common among Chinese mothers of preschool children with ASD. Previous studies showed ASD child's behavioral symptoms, maternal anxiety, and maternal depressive symptoms were associated with overall parenting stress in northern China. In the present study, we retrospectively analyzed medical records at the hospital related to neuropsychiatric symptoms, parenting stress and social support in mothers of children with ASD from southern China. A total of 80 mothers of children with ASD were screened. Among them, 34 mothers were in low-functioning ASD group (L-ASD group) and 46 mothers were in high-functioning ASD group (H-ASD group). Identification of the ASD cases was confirmed with a Revised Autism Diagnostic Inventory. Neuropsychiatric symptoms, parenting stress and social support were measured by neuropsychiatric inventory (NPI), parenting stress index short form (PSI-SF), and multi-dimensional scale of perceived social support (MSPSS). Total mean score of the NPI in the L-ASD group was significantly higher than that in the H-ASD group (P<0.01). The subscale scores of NPI, including depression, anxiety, apathy, irritability, agitation, night time behavior disturbances and change in appetite were significantly higher in the L-ASD group than those in the H-ASD group (P<0.01 or P<0.05). Meanwhile, the total PSI-SF scores and the scores of parental distress (PD), parental-child dysfunctional interaction (PCDI) and difficult child (DC) in the L-ASD group were significantly higher than those in the H-ASD group (P<0.01 or P<0.05). The total score of MSPSS was also higher in the L-ASD group than in the H-ASD group (P<0.01). This study goes further to show the neuropsychiatric symptoms and parenting stress are significantly higher in mothers of children with ASD, and more social supports are needed for mothers of children with ASD from southern China, especially for mothers of children with low-functioning ASD.
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417
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Kim SJ, Jung NY, Kim YJ, Park SB, Kim K, Kim Y, Jang H, Kim SE, Cho SH, Kim JP, Jung YH, Woo SY, Kim SW, Lockhart SN, Kim EJ, Kim HJ, Lee JM, Chin J, Na DL, Seo SW. Clinical Effects of Frontal Behavioral Impairment: Cortical Thickness and Cognitive Decline in Individuals with Subjective Cognitive Decline and Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2019; 69:213-225. [PMID: 30958372 DOI: 10.3233/jad-190007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frontal behavioral impairment (FrBI) is commonly observed in various degenerative diseases and refers to various behavioral symptoms. OBJECTIVE We investigated the effects of the presence of FrBI on cortical thickness, and the longitudinal neuropsychological changes in people in the predementia stage. METHODS A total of 794 individuals completed neuropsychological tests and the Frontal Behavioral Inventory (FBI) Questionnaire, and underwent magnetic resonance (MR) scanning. Participants were analyzed and grouped into non-FrBI (FBI = 0) or FrBI (FBI≥1). Cortical thickness was measured on MR images using a surface-based method. RESULTS In total, 281 people with subjective cognitive decline (SCD) and 513 with amnestic mild cognitive impairment (aMCI) were assessed for FrBI. Relative to people without FrBI, those with FrBI presented reduced cortical thickness in the frontal, anterior temporal and lateral parietal regions (p < 0.05, FDR corrected). People with FrBI developed Alzheimer's disease, rather than behavioral variant frontotemporal dementia, as observed over seven years. Mixed effects models reported that people with FrBI have greater cognitive decline than those with non-FrBI in multiple domains, including language, memory, and executive functions (p < 0.05, FDR corrected). Furthermore, while negative FrBI symptoms (e.g., deficit behaviors) were associated with greater declines in multiple domains, positive FrBI symptoms (e.g., disinhibition symptoms) were related to declines in visuospatial function and verbal memory. Finally, the occurrence of both types of symptoms correlated with multi-domain cognitive decline. CONCLUSIONS FrBI predicted worse clinical outcomes, including reduced cortical thickness and cognitive decline, which are not necessarily specific to frontal dysfunction.
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Affiliation(s)
- Seung Joo Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Departments of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Medical Research Institute, Yangsan, South Korea
| | - Young Ju Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong Beom Park
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - KoWoon Kim
- Department of Neurology, Chonbuk National University Hospital, Chun-Ju, South Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Si Eun Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Soo Hyun Cho
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jun Pyo Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Hee Jung
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sook-Young Woo
- Biostatistics team, Samsung Biomedical Research Institute, Seoul, South Korea
| | - Seon Woo Kim
- Biostatistics team, Samsung Biomedical Research Institute, Seoul, South Korea
| | - Samuel N Lockhart
- Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, South Korea
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Juhee Chin
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duk L Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
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418
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Tseng CF, Lee SH, Hsieh TC, Lee RP. Smart Restored by Learning Exercise Alleviates the Deterioration of Cognitive Function in Older Adults with Dementia-A Quasi-Experimental Research. Int J Environ Res Public Health 2019; 16:ijerph16071270. [PMID: 30970666 PMCID: PMC6480400 DOI: 10.3390/ijerph16071270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 11/16/2022]
Abstract
Maintaining cognitive function is essential for older adults with dementia. The purpose of this study was to investigate the effectiveness of Smart Restored by Learning Exercise (SRLE) on cognitive functions, neuropsychiatric symptoms, and frontal lobe functions in elderly people with dementia. A total of 68 older adults with dementia participated in this study. A quasi-experimental design was used, and convenience sampling and assignment approaches were adopted to select the participants for experimental and control groups. The experimental group engaged in SRLE for 6 months. The control group received routine care without SRLE. The participants’ cognitive function, neuropsychiatric symptoms, and frontal lobe function at baseline were evaluated using the Mini-Mental State Examination (MMSE), Neuropsychiatry Inventory (NPI), and Frontal Assessment Battery (FAB), respectively, in month 3 and month 6. The Group by Time interaction was statistically significant for MMSE and FAB scores, which indicated the different group effects between months 3 and 6. The results also showed that the improvement of MMSE, NPI, and FAB scores in the SRLE group were significantly better than the control group (t = −5.99~4.90, p < 0.001) at both months 3 and 6. In conclusion, long-term facilities may provide residents with SRLE every day to prevent a decline in the residents’ levels of cognitive function.
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Affiliation(s)
- Chi-Fen Tseng
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan.
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970, Taiwan.
| | - Shao-Huai Lee
- Department of Family Studies and Child Development, Shih Chien University, Taipei 10462, Taiwan.
- Taiwan Smart Restored by Learning Exercise Development Association, Taipei 10696, Taiwan.
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan.
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan.
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419
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Vernon EK, Cooley B, Rozum W, Rattinger GB, Behrens S, Matyi J, Fauth E, Lyketsos CG, Tschanz JT. Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia. Am J Geriatr Psychiatry 2019; 27:349-359. [PMID: 30616905 PMCID: PMC6812501 DOI: 10.1016/j.jagp.2018.11.010] [Citation(s) in RCA: 16] [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: 08/01/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs. METHODS Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002-2012). RESULTS In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed -0.32 points per year for the psychosis cluster, -0.11 points per year for agitation/aggression, and -0.67 overall for the affective cluster. CONCLUSION Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.
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Affiliation(s)
- Elizabeth K Vernon
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Bryce Cooley
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - William Rozum
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Gail B Rattinger
- Department of Health Outcomes and Administrative Sciences (GBR), School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY
| | - Stephanie Behrens
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Joshua Matyi
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Elizabeth Fauth
- Department of Human Development and Family Studies (EF), Utah State University, Logan, UT
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences (CGL), Johns Hopkins University, Baltimore
| | - JoAnn T Tschanz
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT; Center for Epidemiological Studies (JTT), Utah State University, Logan, UT.
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420
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Abstract
Addison’s disease (AD), also known as primary adrenal insufficiency, is a rare autoimmune disorder affecting males and females equally. The most common cause of AD is autoimmune adrenalitis and other causes include metastatic cancers, tuberculosis and acquired immunodeficiency syndrome. AD presents with a wide variety of signs and symptoms and thus, making a diagnosis challenging. The common symptoms of this disease include weakness and fatigability, orthostatic hypotension, nausea, vomiting, diarrhea, anorexia and weight loss. Addison’s disease often presented with other autoimmune disorders, such as autoimmune polyglandular syndrome. We herein report a case of a patient who presented in a hospital emergency department, with Addisonian crisis and predominant neuropsychiatric manifestation. On review of the patient's history, combined with biochemical testing, a diagnosis of Addison’s disease was established. This type of presentation is relatively uncommon.
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Affiliation(s)
- Maham Munawar
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Choudhary A Hasan
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Syed W Rizvi
- Internal Medicine, University of Medicine and Dentistry of New Jersey, Newark, USA
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421
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Yao ML, Zhang H, Xu Y, Zhang SM, Gao YZ, Shu M, Zhang JJ. Neuropsychiatric Symptoms and Cognitive Impairment in Chinese Patients with Parkinson's Disease in Han and Hui Ethnicity. Curr Med Sci 2019; 39:122-126. [PMID: 30868501 DOI: 10.1007/s11596-019-2009-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 01/12/2018] [Revised: 10/09/2018] [Indexed: 12/29/2022]
Abstract
Neuropsychiatric symptoms are common in patients with Parkinson's disease (PD) and they are likely to outweigh the motor symptoms and become a major factor affecting the quality of life of PD patients. However, the studies focusing on the non-motor symptoms in Chinese PD patients from different ethnicity are scarce. The aim of this retrospective study was to investigate neuropsychiatric symptoms and cognitive impairment in Chinese PD patients from Han and Hui populations from central China. Seventy-two Han Chinese PD patients (Han PD group) and 71 age-and sex-matched Hui Chinese PD patients (Hui PD group) were enrolled from Zhongnan Hospital of Wuhan University between Sept. 2011 and Aug. 2014 in the study. The neuropsychiatric symptoms and cognitive impairment were assessed using Neuropsychiatric Inventory (NPI) and Mini Mental State Examination (MMSE). We found that the proportion of depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were higher in the Han PD group than in the Hui PD group (P<0.05 or P<0.01). But the proportion of delusion, hallucination, agitation, disinhibition, aberrant motor behavior and change in appetite were not significantly different between the Han PD group and the Hui PD group (P>0.05). The total mean scores of the MMSE from patients in the Han PD group were similar to those in the Hui PD group (P>0.05). However, the subscale scores of recall domain and language domain in the Han PD group were significantly different from those in the Hui PD group (P<0.05). No significant difference was noted in the orientation, memory and calculation domains between the two PD groups (P>0.05). This study first showed the recall domain and language domain were different between the Han PD patients and the Hui PD patients. Depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were less presented in the Hui PD patients. All these differences may be related to the different ethnicity, which would be helpful for clinical physicians to recognize the different non-motor symptoms in Chinese PD patients with different ethnicity.
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Affiliation(s)
- Mei-Ling Yao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Yan Xu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Sheng-Ming Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong-Zhe Gao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Min Shu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jun-Jian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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422
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Ozaki T, Katsumata Y, Arai A. Association between changes in the use of psychotropic drugs and behavioural and psychological symptoms of dementia over 1 year among long-term care facility residents. Psychogeriatrics 2019; 19:126-134. [PMID: 30338614 DOI: 10.1111/psyg.12374] [Citation(s) in RCA: 7] [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] [Received: 03/22/2018] [Revised: 07/11/2018] [Accepted: 08/13/2018] [Indexed: 01/14/2023]
Abstract
AIM Pharmacological treatments are often used in treating the behavioural and psychological symptoms of dementia (BPSD) in nursing homes, despite the fact that non-pharmacological treatments are recommended as a first-line treatment and can provide a suitable alternative. Because the course of BPSD is known to fluctuate depending on individual symptoms over time, the frequencies of drug use and BPSD, as well as their association, should be observed over a longer period. We investigated the association between the changes in psychotropic drug (PD) use and BPSD, focusing on the number of symptoms, severity, and care burden over 1 year among long-term care facility residents. METHODS A 1-year follow-up study was conducted among older residents with dementia or similar symptoms (n = 312 at baseline; n = 237 at follow-up) by using a care staff questionnaire in 10 long-term care facilities in Hokkaido, Japan. Medication use was determined based on prescription information. The brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD. RESULTS Among residents followed up for 1 year, new users of PD-particularly anxiolytics and hypnotics-had a significantly increased number and severity of BPSD, compared with non-PD users. Continuing PDs was also related to increased severity over the year. Among residents with any persistent BPSD for 1 year, new use of PDs-particularly anxiolytics and hypnotics-was significantly associated with an increased care burden of BPSD, compared with the non-use of PDs. The discontinuation of PDs was significantly associated with a decreased care burden, compared with the non-use of PDs. CONCLUSIONS Our study suggests that PDs, particularly anxiolytics and hypnotics, may be prescribed carefully in response to exacerbation of BPSD in terms of the number of symptoms, severity, and care burden in long-term care facilities. Continuous monitoring of PDs use and BPSD is important to effectively address BPSD.
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Affiliation(s)
- Takashi Ozaki
- School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuriko Katsumata
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Asuna Arai
- Department of Health Care Policy, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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423
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Abstract
UNLABELLED ABSTRACTBackground:Neuropsychiatric symptoms (NPI) of dementia are important determinants of caregiver burden, while caregiver coping styles and competences can relieve burden. Caregivers differ in coping with the demands made on them and in experienced burden. What changes in caregivers explain recovery from burden, and which caregiver characteristics predict recovery from burden over time, and does treatment make a difference? METHODS This study into recovery from burden was a secondary analysis of data collected in a formerly conducted randomized controlled trial (RCT) on the integrated reactivation and rehabilitation (IRR) programme in a psychiatric-skilled nursing home, compared to usual care (UC; i.e. day care, assisted living arrangements, and nursing home wards). For this secondary analysis, longitudinal data on persons with dementia and caregivers were used from baseline (T1), end of treatment (T2), and at nine months (T3). RESULTS Caregivers with an improved sense of competence (SCS) who care for persons with dementia with a decreased severity of NPI have the highest chance of recovering from burden (CSI). Caregivers with a tendency to feel involved with others and sympathize with others (affiliation, ICL-R) have a slightly lower probability of improvement with respect to their sense of competence in the short term. The number of improved caregivers was higher in IRR than UC. CONCLUSION Recovery depends on both an improved sense of competence and a decreased severity of NPI. Combined interventions that address both NPI and focus on enhancing caregiver's sense of competence have added value when it comes to decreasing caregiver burden.
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424
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Mallo SC, Ismail Z, Pereiro AX, Facal D, Lojo-Seoane C, Campos-Magdaleno M, Juncos-Rabadán O. Assessing mild behavioral impairment with the mild behavioral impairment checklist in people with subjective cognitive decline. Int Psychogeriatr 2019; 31:231-9. [PMID: 30017017 DOI: 10.1017/S1041610218000698] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 11/05/2022]
Abstract
UNLABELLED ABSTRACTObjectives:To estimate the prevalence of Mild Behavioral Impairment (MBI) in people with Subjective Cognitive Decline (SCD), and validate the Mild Behavioral Impairment Checklist (MBI-C) with respect to score distribution, sensitivity, specificity, and utility for MBI diagnosis, as well as correlation with other neuropsychological tests. DESIGN Correlational study with a convenience sampling. Descriptive, logistic regression, ROC curve, and bivariate correlations analyses were performed. SETTING Primary care health centers. PARTICIPANTS 127 patients with SCD. MEASUREMENTS An extensive evaluation, including Questionnaire for Subjective Memory Complaints, Mini-Mental State Examination, Cambridge Cognitive Assessment-Revised, Neuropsychiatric Inventory-Questionnaire (NPI-Q), the Geriatric Depression Scale-15 items (GDS-15), the Lawton and Brody Index and the MBI-C, which was administered by phone to participants' informants. RESULTS MBI prevalence was 5.8% in those with SCD. The total MBI-C scoring was low and differentiated people with MBI at a cut-off point of 8.5 (optimizing sensitivity and specificity). MBI-C total scoring correlated positively with NPI-Q, Questionnaire for Subjective Cognitive Complaints (QSCC) from the informant and GDS-15. CONCLUSIONS The phone administration of the MBI-C is useful for detecting MBI in people with SCD. The prevalence of MBI in SCD was low. The MBI-C detected subtle Neuropsychiatric symptoms (NPS) that were correlated with scores on the NPI-Q, depressive symptomatology (GDS-15), and memory performance perceived by their relatives (QSCC). Next steps are to determine the predictive utility of MBI in SCD, and its relation to incident cognitive decline over time.
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425
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Wilkins JM, Goldstein EK, Forester BP. Characteristics of Hospice Referrals From an Inpatient Geriatric Psychiatry Unit. Am J Geriatr Psychiatry 2019; 27:162-166. [PMID: 30583918 DOI: 10.1016/j.jagp.2018.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 09/19/2018] [Revised: 11/17/2018] [Accepted: 11/22/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Geriatric psychiatrists who treat neuropsychiatric symptoms of dementia are in the unique position of offering palliation to people with terminal illness in whom neuropsychiatric symptoms may be indicators of the illness's end stage (e.g., feeding problems). Little is known, however, about the characteristics of hospice referrals from inpatient geriatric psychiatry units. METHODS This was a retrospective chart review of patients with dementia admitted to an inpatient geriatric psychiatry unit and referred to hospice on discharge. RESULTS Patients were referred to hospice because of feeding problems, with oral intake insufficient to sustain life. Most patients (78%) died within 31 days of discharge, and all patients (100%) died within 6 months of discharge. CONCLUSION The results from this study support a symptom-based approach to hospice referral for people with dementia, as opposed to prognostic estimation, where certain symptom clusters may indicate a more rapidly progressing course.
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Affiliation(s)
- James M Wilkins
- Division of Geriatric Psychiatry (JMW, EKG, BPF), McLean Hospital, Belmont, MA; Department of Psychiatry (JMW, BPF), Harvard Medical School, Boston.
| | | | - Brent P Forester
- Division of Geriatric Psychiatry (JMW, EKG, BPF), McLean Hospital, Belmont, MA; Department of Psychiatry (JMW, BPF), Harvard Medical School, Boston
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426
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Lim L, Zhang A, Lim L, Choong TM, Silva E, Ng A, Kandiah N. High Caregiver Burden in Young Onset Dementia: What Factors Need Attention? J Alzheimers Dis 2019; 61:537-543. [PMID: 29171995 DOI: 10.3233/jad-170409] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is an increase in prevalence of young onset dementia (YOD). The specific problems among YOD patients and levels of caregiver burden (CB) in this group warrants further evaluation. OBJECTIVE To evaluate and compare level of CB in YOD and late onset dementia (LOD). Also, we sought to understand the specific factors, such as neuropsychiatric symptoms, that may affect the levels of caregiver burden in the YOD group. METHODS Patient-caregiver dyads with YOD and LOD were recruited from a tertiary neurology center. Levels of CB between YOD and LOD were compared among 183 patient-caregiver dyads. CB was quantified using the Zarit Burden Inventory (ZBI). Neuropsychological evaluations as well as the Neuropsychiatric Inventory were performed. Factors that influenced level of CB in YOD group was investigated with regression analyses. RESULTS There were 57 YOD and 126 LOD dyads. Caregivers of YOD subjects reported significantly higher levels of burden compared to caregivers of LOD subjects (ZBI: 17.3 versus 13.94; p = 0.015). 52.6% of YOD caregivers reported a high caregiver burden. When compared to caregivers of LOD, the odds of a caregiver of YOD reporting high caregiver burden was 2.34 (95% CI: 1.22-4.49: p = 0.010). YOD dyads with a high caregiver burden had significantly higher neuropsychiatric inventory scores. Risk factors for high caregiver burden in YOD included family history of dementia and behavioral symptoms including disinhibited behavior, delusions, and apathy. CONCLUSION Targeted support for caregivers of patients with YOD is needed to address the higher CB in this group.
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Affiliation(s)
- Linda Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Angeline Zhang
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Eveline Silva
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Adeline Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS, Graduate Medical School, Singapore
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427
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Sköldunger A, Wimo A, Sjögren K, Björk S, Backman A, Sandman PO, Edvardsson D. Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: Results from the U-Age program (SWENIS study). Int J Geriatr Psychiatry 2019; 34:130-136. [PMID: 30246433 DOI: 10.1002/gps.5000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/12/2018] [Accepted: 09/08/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes. METHODS Data were collected in 2014 from a Swedish national sample of nursing home residents (n = 4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association. RESULTS We found that cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23 hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25 hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359 685 SEK, and in severely cognitive impaired resident, the cost was 825 081 SEK. CONCLUSION Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations.
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Affiliation(s)
- Anders Sköldunger
- Department of Nursing, Umeå University, Umeå, Sweden.,Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Per-Olof Sandman
- Department of Nursing, Umeå University, Umeå, Sweden.,Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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428
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Yoro-Zohoun I, Nubukpo P, Houinato D, Mbelesso P, Ndamba-Bandzouzi B, Clément JP, Dartigues JF, Preux PM, Guerchet M. Neuropsychiatric symptoms among older adults living in two countries in Central Africa (EPIDEMCA study). Int J Geriatr Psychiatry 2019; 34:169-178. [PMID: 30255569 DOI: 10.1002/gps.5006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 04/05/2018] [Accepted: 09/08/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Our study aimed at estimating the prevalence of neuropsychiatric symptoms and investigating associated factors among older adults living in two countries in Central Africa (Central African Republic [CAR] and Republic of Congo [ROC]). METHODS The EPIDEMCA multicentre population-based study was carried out in rural and urban areas of CAR and ROC between 2011 and 2012 among people aged 65 and over. After cognitive screening using the Community Screening Interview for Dementia, participants with low performances underwent neurological examination including the brief version of the Neuropsychiatric Inventory Questionnaire (NPI-Q). Multivariate logistic regression analyses were performed to identify factors independently associated with neuropsychiatric symptoms in this population. RESULTS NPI-Q data were available for 532 participants. Overall, 333 elderly people (63.7%) reported at least one neuropsychiatric symptom. The prevalence of neuropsychiatric symptoms was 89.9% (95% CI, 84.6-95.1) in participants with dementia, 73.4% (95% CI, 65.1-81.7) in participants with mild cognitive impairment (MCI), and 48.7% (95% CI, 42.9-54.6) in participants with no MCI nor dementia after neurological examination (P < 0.0001). The most common symptoms were depression, anxiety, and irritability. Participants living in Gamboma, with normal hearing and with friends in the community, were less likely to present neuropsychiatric symptoms. Physical disability, difficulties in eating, female sex, and dementia were significantly associated with neuropsychiatric symptoms. CONCLUSION Neuropsychiatric symptoms are common among older people with neurocognitive disorders in CAR and ROC. Our results confirm those from previous studies in Nigeria and Tanzania. Nevertheless, knowledge of these symptoms remains limited in sub-Saharan Africa, hampering their appropriate management.
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Affiliation(s)
- Inès Yoro-Zohoun
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Philippe Nubukpo
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- CHU Esquirol, Addictology Department, Limoges, France
| | - Dismand Houinato
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Pascal Mbelesso
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | | | - Jean-Pierre Clément
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- CHU Esquirol Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
| | | | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- Department of Medical Information and Evaluation, Clinical Research and Biostatistic Unit, Limoges University Hospital, Limoges, France
| | - Maëlenn Guerchet
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, London, UK
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429
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Garcia-Segura ME, Fischer CE, Schweizer TA, Munoz DG. APOE ɛ4/ɛ4 Is Associated with Aberrant Motor Behavior Through Both Lewy Body and Cerebral Amyloid Angiopathy Pathology in High Alzheimer's Disease Pathological Load. J Alzheimers Dis 2019; 72:1077-1087. [PMID: 31744003 PMCID: PMC9680058 DOI: 10.3233/jad-190643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/01/2023]
Abstract
BACKGROUND Aberrant motor behavior (AMB) is a neuropsychiatric symptom (NPS) prevalent in Alzheimer's disease (AD), known to cause great distress to both patients and caregivers. Apolipoprotein E4 (APOE4) is the most important genetic predictor of AD, and it has been associated with high NPS prevalence. OBJECTIVE To investigate the neuropathological substrates and risk factors associated with AMB in AD patients. METHODS Cases with Braak stage I-II and CERAD 0-1 were classified as Low AD (LAD), while Braak stage III-IV and CERAD 2 were grouped as Intermediate AD (IAD). Cases with Braak stage V-VI and CERAD 3 were classified as High AD (HAD) in accordance with NIA-Reagan criteria. All cases were stratified by APOE genotype, yielding No ɛ4 & ɛ4 and ɛ4/ɛ4 groups depending on ɛ4 copy number within APOE. Presence of AMB was assessed using NPI-Q. RESULTS AND CONCLUSION AMB increased in parallel with CERAD and Braak & Braak scores. Hypercholesterolemia, but no other cardiovascular risk factors, was associated with AMB in HAD. AMB prevalence in HAD was significantly increased in the presence of two APOEɛ4 alleles as compared to No ɛ4 & ɛ4. The relationship between homozygous APOE4 and AMB was strongly associated with the presence of both Lewy bodies and cerebral amyloid angiopathy pathologies in both sexes.
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Affiliation(s)
- Monica Emili Garcia-Segura
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, St. Michaels Hospital, Toronto, ON, Canada
| | - David G. Munoz
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Division of Pathology, St. Michaels Hospital, Toronto, ON, Canada
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430
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De Vito A, Calamia M, Weitzner DS, Bernstein J. Examining differences in neuropsychiatric symptom factor trajectories in empirically derived mild cognitive impairment subtypes. Int J Geriatr Psychiatry 2018; 33:1627-1634. [PMID: 30276884 PMCID: PMC8785654 DOI: 10.1002/gps.4963] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/22/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine neuropsychiatric symptom (NPS) factor severity progression over time in empirically derived (ED) mild cognitive impairment (MCI) subtypes. METHODS Participants in the Alzheimer's Disease Neuroimaging Initiative study diagnosed with MCI by Alzheimer's Disease Neuroimaging Initiative protocol using conventional clinical (CC) criteria (n = 788) were reclassified using cluster analysis as amnestic, dysnomic, dysexecutive MCI, or cluster-derived normal (CC-Normal) using empirical criteria. Cognitively normal (CN) participants (n = 207) were also identified. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was administered from baseline through 48-month follow-up. Exploratory factor analysis was completed to determine the NPI-Q factor structure at 6-month follow-up. Multilevel modeling was used to determine NPI-Q symptom severity factor and apathy symptom progression over time by cognitive subtype. RESULTS The exploratory factor analysis revealed that the NPI-Q consisted of 2 factors: hyperactivity/agitation and mood symptoms. Using clinical and empirical criteria, all MCI groups were identified as having more severe hyperactivity/agitation symptoms than CN participants. However, only the amnestic MCI group identified using empirical criteria showed an increase in symptom severity over time relative to CN participants. Mood factor and apathy symptoms were found to be more severe in dysexecutive and amnestic groups in both models. Similarly, both models identified a significant worsening of mood and apathy symptoms over time for dysexecutive and amnestic groups relative to CN participants. CONCLUSIONS This study provides further support that empirical criteria aid in examining the progression of clinical characteristics associated with MCI. Further, it helps to identify which MCI subtypes may be at higher risk for NPS progression.
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Affiliation(s)
- Alyssa De Vito
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
| | - Matthew Calamia
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
| | - Daniel S. Weitzner
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
| | - John Bernstein
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
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431
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Kohnen RF, Gerritsen DL, Smals OM, Lavrijsen JCM, Koopmans RTCM. Prevalence of neuropsychiatric symptoms and psychotropic drug use in patients with acquired brain injury in long-term care: a systematic review. Brain Inj 2018; 32:1591-1600. [PMID: 30373405 DOI: 10.1080/02699052.2018.1538537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 10/28/2022]
Abstract
OBJECTIVE Little is known about the prevalence of neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) in patients below the age of 65 years with acquired brain injury (ABI) in long-term care. The objective of this study was to review the literature about the prevalence of NPS and PDU. METHODS A systematic literature search of English, Dutch and German articles in Pubmed, EMBASE, PsycINFO and CINAHL was performed with the use of MeSH and free-text terms. RESULTS Six articles met the inclusion criteria. The place of residence was mainly a nursing home and most studies were conducted in a population of patients with traumatic brain injury. Sample sizes varied from 40 to 26,472 residents and NPS were assessed with different assessment instruments. Depressive symptoms were most common with a prevalence ranging from 13.9% to 39.3%. Two studies reported PDU in which tranquillizers (59%) were the most prevalent psychotropic drugs followed by anticonvulsants (35%) and antidepressants (26-34%). CONCLUSIONS Patients with ABI experience lifelong consequences, regardless the cause of ABI, that have a high impact on them and their surroundings. More insight into the magnitude of NPS and PDU, through prevalence studies, is necessary to achieve suitable provision of care for these patients.
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Affiliation(s)
- Roy F Kohnen
- a Vivent , Mariaoord , Rosmalen , the Netherlands.,b Department of Primary and Community Care , Radboud University, Medical Centre , Nijmegen , the Netherlands
| | - Debby L Gerritsen
- b Department of Primary and Community Care , Radboud University, Medical Centre , Nijmegen , the Netherlands
| | - Odile M Smals
- a Vivent , Mariaoord , Rosmalen , the Netherlands.,b Department of Primary and Community Care , Radboud University, Medical Centre , Nijmegen , the Netherlands
| | - Jan C M Lavrijsen
- b Department of Primary and Community Care , Radboud University, Medical Centre , Nijmegen , the Netherlands
| | - Raymond T C M Koopmans
- b Department of Primary and Community Care , Radboud University, Medical Centre , Nijmegen , the Netherlands.,c De Waalboog , Centre for Specialized Geriatric Care"Joachim en Anna" , Nijmegen , the Netherlands
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432
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Roitto HM, Kautiainen H, Öhman H, Savikko N, Strandberg TE, Raivio M, Laakkonen ML, Pitkälä KH. Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer's Disease - Does Exercise Modify the Risk? J Am Geriatr Soc 2018; 66:2377-2381. [PMID: 30320427 DOI: 10.1111/jgs.15614] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/13/2018] [Accepted: 08/18/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore how neuropsychiatric symptoms (NPS) are associated with number of falls and how exercise modifies the risk of falling in community-dwelling people with Alzheimer's disease (AD) and NPS. DESIGN Secondary analysis of a randomized controlled trial. SETTING Community. PARTICIPANTS Community-dwelling individuals with AD (N=210) who completed the Neuropsychiatric Inventory (NPI) (N = 179). INTERVENTION Participants were randomized into 3 groups: group-based exercise (4-hour sessions with approximately 1 hour of training) and tailored home-based exercise (1 hour of training) twice a week for 1 year and a control group receiving usual community care. In this secondary analysis, we merged the home-based and group-based exercise groups and compared this group with the control group. MEASUREMENTS NPS were measured using the NPI at baseline, and spousal caregivers recorded falls in daily fall diaries during 1 year of follow-up. RESULTS The number of falls increased linearly with NPI score in the control group. Fall rates were 1.48 (95% confidence interval (CI)=1.26-1.73) per person-year in the intervention group and 2.87 (95% CI=2.43-3.35) in the control group. Adjusted for age, sex, Mini-Mental State Examination (MMSE) score, and Short Physical Performance Battery (SPPB) score, incidence rate ratio (IRR) was 0.48 (95% Cl=0.39-0.60, p < .001). Main effects for fall rate were significant for group (p < .001) and NPI total (p < .02); the interaction effect was also significant (p = .009) (adjusted for sex, age, MMSE score, SPPB score, and psychotropic medication use). CONCLUSION Exercise may decrease the risk of falling in community-dwelling individuals with AD and NPS. Future exercise trials should confirm this finding in participants with significant NPS. TRIAL REGISTRATION ACTRN12608000037303. J Am Geriatr Soc 66:2377-2381, 2018.
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Affiliation(s)
- Hanna-Maria Roitto
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Hannareeta Öhman
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Niina Savikko
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Home Care, City of Espoo, Espoo, Finland
| | - Timo E Strandberg
- Department of Medicine, University of Helsinki, Helsinki, Finland.,Geriatric Clinic, Helsinki University Hospital, Helsinki, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Minna Raivio
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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433
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Pitkänen A, Alanen HM, Kampman O, Leinonen E. Outcome of neuropsychiatric symptoms and daily functioning of patients with dementia treated on an acute psychogeriatric ward. Nord J Psychiatry 2018; 72:521-525. [PMID: 30445895 DOI: 10.1080/08039488.2018.1532021] [Citation(s) in RCA: 3] [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: 12/17/2022]
Abstract
BACKGROUND Dementia is associated with progressive deterioration in multiple cognitive domains, functional impairment and neuropsychiatric symptoms (NPS). AIMS The aim of this study was to explore the factors associated with the outcome of NPS and daily functioning in patients with dementia during acute psychogeriatric hospitalization. MATERIALS AND METHOD The data (n = 175) were collected between 2009 and 2013 in naturalistic settings on one acute psychogeriatric ward at one university hospital in Finland. Behavioural symptoms were assessed using the Neuropsychiatric Inventory (NPI) and activities of daily living using the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL). RESULTS During the hospital stay (45 days ±30.4) NPI total score decreased from 33.9 to 18.2 (p < .001). Daily functioning score decreased from 31.7 to 20.9 (p < .001). The number of patients taking antipsychotics (96-130, p = .004) and anxiolytics (54-102, p < .001) increased from admission to discharge. Overall mean dosage (mg/day) of antipsychotics (from 40.2 to 72.0 in chlorpromazine equivalents, p < .00) and anxiolytics (from 3.43 to 7.47 in diazepam equivalents, p < .001) also increased. Higher antipsychotic dosage at discharge was a significant predictor for large NPI score change (p = .002) indicating better symptom reduction. Neither higher antipsychotic dosage or anxiolytic dosage at discharge were significant predictors for ADL score change. CONCLUSIONS Neuropsychiatric symptoms improved while deterioration was found in daily functioning from admission to discharge. Higher antipsychotic dosage at discharge was a predictor for larger NPI score change indicating better symptom reduction. Preventing threatening ADL decline during hospital stay is especially important.
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Affiliation(s)
- Anneli Pitkänen
- a Administration Centre , Tampere University Hospital , Tampere , Finland
| | - Hanna-Mari Alanen
- b Department of Psychiatry , Tampere University Hospital , Pitkäniemi , Finland
| | - Olli Kampman
- c School of Medicine , University of Tampere , Tampere , Finland.,d Department of Psychiatry , Seinäjoki Hospital District , Seinäjoki , Finland
| | - Esa Leinonen
- b Department of Psychiatry , Tampere University Hospital , Pitkäniemi , Finland.,c School of Medicine , University of Tampere , Tampere , Finland
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434
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Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Colloby SJ, Lloyd J, Petrides G, McKeith IG, Thomas AJ. Neuropsychiatric symptoms and cognitive profile in mild cognitive impairment with Lewy bodies. Psychol Med 2018; 48:2384-2390. [PMID: 29362011 DOI: 10.1017/s0033291717003956] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND The accurate clinical characterisation of mild cognitive impairment (MCI) is becoming increasingly important. The aim of this study was to compare the neuropsychiatric symptoms and cognitive profile of MCI with Lewy bodies (MCI-LB) with Alzheimer's disease MCI (MCI-AD). METHODS Participants were ⩾60 years old with MCI. Each had a thorough clinical and neuropsychological assessment and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single photon emission computed tomography FP-CIT SPECT). MCI-LB was diagnosed if two or more diagnostic features of dementia with Lewy bodies were present (visual hallucinations, cognitive fluctuations, motor parkinsonism, rapid eye movement sleep behaviour disorder or positive FP-CIT SPECT). A Lewy body Neuropsychiatric Supportive Symptom Count (LBNSSC) was calculated based on the presence or absence of the supportive neuropsychiatric symptoms defined by the 2017 DLB diagnostic criteria: non-visual hallucinations, delusions, anxiety, depression and apathy. RESULTS MCI-LB (n = 41) had a higher LBNSSC than MCI-AD (n = 24; 1.8 ± 1.1 v. 0.7 ± 0.9, p = 0.001). 67% of MCI-LB had two or more of those symptoms, compared with 16% of MCI-AD (Likelihood ratio = 4.2, p < 0.001). MCI-LB subjects scored lower on tests of attention, visuospatial function and verbal fluency. However, cognitive test scores alone did not accurately differentiate MCI-LB from MCI-AD. CONCLUSIONS MCI-LB is associated with neuropsychiatric symptoms and a cognitive profile similar to established DLB. This supports the concept of identifying MCI-LB based on the presence of core diagnostic features of DLB and abnormal FP-CIT SPECT imaging. The presence of supportive neuropsychiatric clinical features identified in the 2017 DLB diagnostic criteria was helpful in differentiating between MCI-LB and MCI-AD.
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Affiliation(s)
- Paul C Donaghy
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - John-Paul Taylor
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - John T O'Brien
- Department of Psychiatry,University of Cambridge,Cambridge,UK
| | - Nicola Barnett
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Kirsty Olsen
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Sean J Colloby
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Jim Lloyd
- Nuclear Medicine Department,Newcastle upon Tyne Hospitals NHS Foundation Trust,Newcastle upon Tyne,UK
| | - George Petrides
- Nuclear Medicine Department,Newcastle upon Tyne Hospitals NHS Foundation Trust,Newcastle upon Tyne,UK
| | - Ian G McKeith
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Alan J Thomas
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
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435
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Stankevich Y, Lueken U, Balzer-Geldsetzer M, Dodel R, Gräber-Sultan S, Berg D, Liepelt-Scarfone I, Hilker-Roggendorf R, Kalbe E, Kaut O, Mollenhauer B, Reetz K, Schäffer E, Schmidt N, Schulz JB, Spottke A, Witt K, Linse K, Storch A, Riedel O. Psychometric Properties of an Abbreviated Version of the Apathy Evaluation Scale for Parkinson Disease (AES-12PD). Am J Geriatr Psychiatry 2018; 26:1079-1090. [PMID: 30082208 DOI: 10.1016/j.jagp.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 12/04/2017] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Apathy is a frequent symptom in Parkinson's disease (PD), substantially aggravating the course of PD. Regarding the accumulating evidence of the key role of apathy in PD, time-efficient assessments are useful for fostering progress in research and treatment. The Apathy Evaluation Scale (AES) is widely used for the assessment of apathy across different nosologies. OBJECTIVE To facilitate the application of the AES in PD, we reduced the AES to two-thirds its length and validated this abbreviated version. DESIGN Data sets of 339 PD patients of the DEMPARK/LANDSCAPE study without dementia and depression were randomly split into two samples. Data of sample 1 were used to develop a brief version of the AES (AES-12PD). A cross-validation was conducted in sample 2 and in a subsample of 42 PD patients with comorbid dementia and depressive symptomatology. Receiver operating characteristic analysis was applied to determine the optimal cutoff of the AES-12PD as an indicator of apathy. RESULTS The AES-12PD featured high internal consistency that was better compared to the AES. The abbreviated scale was well differentiated from motor impairment and cognitive deficits. The AES-12PD cutoff of 27/28 was the optimal cutoff for apathy in PD patients without dementia and depression. The cutoff of 25/26 indicated apathy in PD patients with comorbid dementia and depression. CONCLUSION Results confirm a high internal consistency and good discriminant validity of the AES-12PD. The AES-12PD represents a reliable tool for the efficient assessment of apathy that can be applied in PD patients with and without dementia and depression.
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Affiliation(s)
- Yuliya Stankevich
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany.
| | - Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin
| | - Monika Balzer-Geldsetzer
- Department of Neurology, Phillips University Marburg, Marburg, Germany; Chair of Geriatrics, University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Essen, Germany
| | - Richard Dodel
- Department of Neurology, Phillips University Marburg, Marburg, Germany; Chair of Geriatrics, University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Essen, Germany
| | - Susanne Gräber-Sultan
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Universität Tübingen, and German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Campus Kiel, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Universität Tübingen, and German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne
| | - Oliver Kaut
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany; Klinik für Neurologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Eva Schäffer
- Department of Neurology, University Hospital Campus Kiel, Kiel, Germany
| | - Nele Schmidt
- Department of Neurology, University Hospital Campus Kiel, Kiel, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Annika Spottke
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Karsten Witt
- Department of Neurology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Linse
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, and German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Oliver Riedel
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany; Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
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436
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Vik-Mo AO, Giil LM, Ballard C, Aarsland D. Course of neuropsychiatric symptoms in dementia: 5-year longitudinal study. Int J Geriatr Psychiatry 2018; 33:1361-1369. [PMID: 29979473 DOI: 10.1002/gps.4933] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [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] [Received: 12/14/2017] [Accepted: 05/31/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPS) in dementia are frequent and challenging for patients, carers, and the health care system, but few long-term studies exist. We analyse the longitudinal course of NPS in patients with mild dementia. METHODS A longitudinal cohort study of 223 patients with mild dementia and annual assessments using the Neuropsychiatric Inventory (NPI) for 5 years. RESULTS A total 1043 NPI assessments, representing 97% of all possible measurements of living cohort members, were analysed. Neuropsychiatric symptoms were common at baseline, and only a moderate increase in total NPS score from 15 to 17 with no increase in the proportion with high NPI total scores. Ninety seven percent scored ≥16, and 49% scored ≥36 on NPI total score at least once during follow-up. Individual NPS fluctuated and often reappeared. The most common symptoms ever reported was apathy (83%), depression (63%), appetite (63%), and aberrant motor behavior (60%). Cognitive decline was associated with higher NPI total score and several NPI items, but only the frequency of apathy increased significantly with time. Lewy body dementia was associated with higher NPI total score and psychotic symptoms. Alzheimer's disease was associated with increase in apathy. CONCLUSIONS Severe NPS are already common at time of dementia diagnosis, and the increase in overall severity over 5 years was moderate. Individual symptoms tend to fluctuate over time within patients and correspond to states rather than traits. These findings highlight the need to focus on, and plan for, NPS as part of dementia pathway, and are relevant for clinical trial design.
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Affiliation(s)
- Audun Osland Vik-Mo
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Dag Aarsland
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
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437
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Martyr A, Nelis SM, Quinn C, Wu YT, Lamont RA, Henderson C, Clarke R, Hindle JV, Thom JM, Jones IR, Morris RG, Rusted JM, Victor CR, Clare L. Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia. Psychol Med 2018; 48:2130-2139. [PMID: 29734962 DOI: 10.1017/s0033291718000405] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [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: 01/08/2023]
Abstract
Current policy emphasises the importance of 'living well' with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1-0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
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Affiliation(s)
| | | | | | - Yu-Tzu Wu
- School of Psychology, University of Exeter,EX4 4QG,UK
| | - Ruth A Lamont
- School of Psychology, University of Exeter,EX4 4QG,UK
| | - Catherine Henderson
- Personal Social Services Research Unit,London School of Economics and Political Science,WC2A 2AE,UK
| | - Rachel Clarke
- School of Psychology, University of Sussex,BN1 9RH,UK
| | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales,NSW 2052,Australia
| | - Ian Rees Jones
- Wales Institute of Social and Economic Research, Data and Methods, Cardiff University,CF10 3BB,UK
| | - Robin G Morris
- Department of Psychology,King's College London Institute of Psychiatry, Psychology and Neuroscience,London, SE5 8AF,UK
| | | | | | - Linda Clare
- School of Psychology, University of Exeter,EX4 4QG,UK
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438
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Gilmore-Bykovskyi A, Block L, Johnson R, Goris ED. Symptoms of apathy and passivity in dementia: A simultaneous concept analysis. J Clin Nurs 2018; 28:410-419. [PMID: 30184283 DOI: 10.1111/jocn.14663] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/09/2018] [Accepted: 08/30/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The objective of this analysis was to clarify the concepts of apathy and passivity in the context of dementia by identifying distinguishing and overlapping attributes for both concepts simultaneously. BACKGROUND Apathy is among the most common and persistent symptoms in dementia. The concept of apathy is often used interchangeably with passivity. Understanding similarities and differences between these concepts is of critical importance in clarifying clinical diagnostic criteria, developing consistent measurement in research and translating research evidence into nursing practice. DESIGN A systematic literature search of multiple databases identified relevant articles for review. A modified combination of Haase et al.'s simultaneous concept analysis method and Morses' principle-based concept analysis using qualitative content and thematic analysis procedures was applied to identify overlapping and distinguishing attributes. METHODS A search of PubMed, CINAHL and PsycINFO databases identified 176 articles meeting inclusion criteria. The concepts of apathy and passivity were characterised using a standardised manual to identify attributes of definitions (conceptual and operational), related conditions, functional, behavioural and neurobiological correlates, antecedents and consequences. Thematic analysis identified common themes across each category which were tabulated and entered into comparative matrices to identify overlapping and distinguishing features. RESULTS There is considerable overlap across attributes of apathy and passivity. Apathy is distinguished as a clinical syndrome characterised by loss of motivation not due to emotional distress or cognitive impairment. Passivity is distinguished as a lack of interaction between the individual and environment in the context of cognitive impairment. CONCLUSION In contrast to passivity, apathy is a more robustly defined concept focused on motivational limitations within the individual associated with specific neuroanatomical deficits. RELEVANCE TO CLINICAL PRACTICE The identification of key distinguishing features of apathy and passivity in dementia is a critical first step in ensuring consistent measurement of each concept.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin.,Department of Medicine, Division of Geriatrics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin.,Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin
| | - Laura Block
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
| | - Rachel Johnson
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
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439
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Levada OA, Troyan AS, Cherednichenko NV. Specific Cognitive-Psychopathological Phenotypes in Patients With Early Stages of Subcortical Vascular Neurocognitive Disorders: A Hospital-Based Case-Control Study. J Geriatr Psychiatry Neurol 2018; 31:256-264. [PMID: 30037284 DOI: 10.1177/0891988718790418] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of subcortical vascular neurocognitive disorders' (ScVNCDs) is currently based on neuropsychological and neuroimaging approaches; nevertheless, clinical features, apart from cognitive impairments (CI), may provide additional information about ScVNCD phenotypes. We aimed to determine whether CI and neuropsychiatric symptoms (NPS) form such clinical phenotypes in the mild and early stage of major ScVNCD. METHODS Our sample included 88 cognitively normal elderly individuals, 100 patients with mild ScVNCD, and 60 patients with early major ScVNCD. All participants had neuropsychological, neuropsychiatric, neurological, and functional evaluations. The prevalence of NPS was based on the neuropsychiatric inventory. The statistical analyses included parametric and nonparametric tests and multivariate regression. RESULTS The severity of executive dysfunction increased through stages of ScVNCD progression ( P < .0001). The NPS with significant predictive value for mild ScVNCD membership was depression (odds ratio [OR] = 7.4), whereas for early major ScVNCD were depression (OR = 5.5) and apathy (OR = 7.6). Those distinguishing NPS and impairments of executive tests' performance significantly correlated ( P < .05) in patients with mild/major ScVNCD. CONCLUSION Significant correlation between pathognomonic cognitive and NPS in compared groups suggest that dysexecutive-depressive syndrome can be the main phenotype in mild ScVNCD, while dysexecutive-depressive-apathetic syndrome in the early stage of major ScVNCD. Obtained cognitive-psychopathological phenotypes may allow a better comprehension of the ScVNCD pathophysiology and improve the diagnostic and therapeutic approach.
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Affiliation(s)
- Oleg A Levada
- 1 State Institution, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
| | - Alexandra S Troyan
- 1 State Institution, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
| | - Nataliya V Cherednichenko
- 1 State Institution, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
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440
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Whitfield DR, Francis PT, Ballard C, Williams G. Associations between ZnT3, tau pathology, agitation, and delusions in dementia. Int J Geriatr Psychiatry 2018; 33:1146-1152. [PMID: 29856089 DOI: 10.1002/gps.4908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 11/07/2017] [Accepted: 04/13/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms such as agitation and delusions occur frequently in Lewy body dementia and Alzheimer's disease and represent significant burden and unmet treatment need. The underlying aetiology remains poorly understood. METHODS We used a multidimensional linear model to look for associations between measurements of agitation, delusions, amyloid, tau and α-synuclein pathology, and synaptic proteins (ZnT3, PSD95, synaptophysin, and β-III-tubulin) across multiple brain regions in post-mortem tissue from a cohort of 130 Lewy body dementia and Alzheimer's disease patients and non-demented controls. RESULTS We found both agitations and delusions to be significantly associated with increased tau pathology and decreased levels of ZnT3. ZnT3 packages Zn2+ into synaptic vesicles to be released as a long-term modulator of synaptic activity. CONCLUSIONS Our finding adds to the evidence that zinc modulating compounds are of interest for treatment or symptomatic relief in these dementias.
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Affiliation(s)
- David R Whitfield
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,University of Exeter Medical School, Exeter, UK
| | - Paul T Francis
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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441
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Loi SM, Eratne D, Kelso W, Velakoulis D, Looi JC. Alzheimer disease: Non-pharmacological and pharmacological management of cognition and neuropsychiatric symptoms. Australas Psychiatry 2018; 26:358-365. [PMID: 29671334 DOI: 10.1177/1039856218766123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This clinical update review focuses on the management of cognition and the neuropsychiatric features of Alzheimer's disease (AD) and highlights current issues regarding pharmacological and non-pharmacological treatment, putative therapeutics and recent relevant research findings in this area. CONCLUSIONS AD is a neurodegenerative progressive condition characterised by cognitive impairment and functional decline. Most people with AD will demonstrate neuropsychiatric features, better known as behavioural and psychological symptoms of dementia (BPSD). Early recognition and treatment of BPSD are essential, as these cause considerable distress and carer burden. While there are many disease-modifying therapies for the cognitive symptoms still in the research stage, only symptomatic treatments are currently available for these and the BPSD.
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Affiliation(s)
- Samantha M Loi
- Neuropsychiatrist, Department of Psychiatry, University of Melbourne and NorthWestern Mental Health, Parkville, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatrist, Melbourne Neuropsychiatry Centre, University of Melbourne and NorthWestern Mental Health, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychologist, Melbourne Neuropsychiatry Centre, University of Melbourne and NorthWestern Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatrist, Melbourne Neuropsychiatry Centre, University of Melbourne and NorthWestern Mental Health, Parkville, VIC, Australia
| | - Jeffrey Cl Looi
- Neuropsychiatrist, Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, VIC, and; Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACT, Australia
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442
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry, MetroHealth, Cleveland, OH, 44109, USA
| | - Juan J Young
- Department of Psychiatry, MetroHealth, Cleveland, OH, 44109, USA
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443
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Connors MH, Quinto L, McKeith I, Brodaty H, Allan L, Bamford C, Thomas A, Taylor JP, O'Brien JT. Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychol Med 2018; 48:1749-1758. [PMID: 29143692 PMCID: PMC6088773 DOI: 10.1017/s0033291717003257] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 05/19/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
Lewy body dementia (consisting of dementia with Lewy bodies and Parkinson's disease dementia) is a common neurodegenerative disease characterised by visual hallucinations, fluctuating attention, motor disturbances, falls, and sensitivity to antipsychotics. This combination of features presents challenges for pharmacological management. Given this, we sought to review evidence for non-pharmacological interventions with patients with Lewy body dementia and their carers. Bibliographic databases were searched using a wide range of search terms and no restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 21 studies including two randomised controlled trials with available subgroup data, seven case series, and 12 case studies. Most studies reported beneficial effects of the interventions used, though the only sizeable study was on dysphagia, showing a benefit of honey-thickened liquids. Given the heterogeneity of interventions and poor quality of the studies overall, no quantitative synthesis was possible. Overall, identified studies suggested possible benefits of non-pharmacological interventions in Lewy body dementia, but the small sample sizes and low quality of studies mean no definite recommendations can be offered. Our findings underscore the clear and urgent need for future research on this topic.
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Affiliation(s)
- Michael H. Connors
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Lena Quinto
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Louise Allan
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - John T. O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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444
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Abstract
OBJECTIVES This clinical update review focuses on the management of the neuropsychiatric manifestations of Huntington's disease (HD). The review highlights current issues regarding pharmacological and non-pharmacological treatment, putative therapeutics and recent relevant research findings in this area. CONCLUSIONS Neuropsychiatric symptoms may precede the classic motor clinical symptoms of HD (prodromal HD) by decades and cause significant functional impairment. Early recognition and comprehensive non-pharmacological, usually in combination with pharmacological, treatment is essential.
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Affiliation(s)
- Samantha M Loi
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Department of Psychiatry, University of Melbourne & NorthWestern Mental Health, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne & NorthWestern Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne & NorthWestern Mental Health, Parkville, VIC, Australia
| | - Jeffrey Cl Looi
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, VIC, and; Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia
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445
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Arthur PB, Gitlin LN, Kairalla JA, Mann WC. Relationship between the number of behavioral symptoms in dementia and caregiver distress: what is the tipping point? Int Psychogeriatr 2018; 30:1099-107. [PMID: 29143722 DOI: 10.1017/S104161021700237X] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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
UNLABELLED ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise. METHODS Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. RESULTS Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). CONCLUSIONS Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
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446
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Abstract
OBJECTIVES To provide a clinical update for general psychiatrists on the assessment and diagnosis of Alzheimer's disease (AD), highlighting current issues regarding epidemiology, risk factors and pathophysiology from recent relevant research findings. CONCLUSIONS Psychiatrists can apply their skills and training in the diagnosis of AD, which is based upon a comprehensive assessment comprising history, investigations, and cognitive and functional assessment, guided by accepted diagnostic criteria.
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Affiliation(s)
- Dhamidhu Eratne
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne, and; NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Department of Psychiatry, University of Melbourne, and; NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne, and; NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne, and; NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatrist, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne, and; NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Jeffrey Cl Looi
- Clinical Associate Professor, Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, and; Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, and; Associate Professor and Acting Head, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia
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447
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Chen P, Guarino PD, Dysken MW, Pallaki M, Asthana S, Llorente MD, Love S, Vertrees JE, Schellenberg GD, Sano M. Neuropsychiatric Symptoms and Caregiver Burden in Individuals With Alzheimer's Disease: The TEAM-AD VA Cooperative Study. J Geriatr Psychiatry Neurol 2018; 31:177-185. [PMID: 29966477 DOI: 10.1177/0891988718783897] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the prevalence of neuropsychiatric symptoms (NPS) in mild-to-moderate Alzheimer disease (AD) and their association with caregiver burden. METHODS Secondary analyses of baseline data from the Trial of Vitamin E and Memantine in Alzheimer's Disease (TEAM-AD) (N=613). Neuropsychiatric Inventory were used to measure severity of NPS and caregiver activity survey to measure caregiver burden. RESULTS A total of 87% of patients displayed at least 1 NPS; 70% displayed clinically meaningful NPS. The most common symptoms were apathy (47%), irritability (44%), agitation (42%), and depression (40%). Those with moderate AD had more severe NPS than those with mild AD ( P = .03). Neuropsychiatric symptoms were significantly associated with caregiver time after adjusting for age, education, cognitive function, and comorbidity ( P-value < .0001) with every point increase in NPS associated with a 10-minute increase in caregiver time. CONCLUSION Neuropsychiatric symptoms were prevalent in both mild and moderate AD, even in patients receiving treatment with an acetylcholinesterase inhibitors, and were more severe in moderate AD and associated with greater caregiver time.
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Affiliation(s)
- Peijun Chen
- 1 Department of Psychiatry, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 2 Department of Psychiatry, Geriatric Psychiatry Division, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peter D Guarino
- 3 Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- 4 Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Maurice W Dysken
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Muralidhar Pallaki
- 7 Department of Medicine, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 8 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sanjay Asthana
- 9 William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- 10 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maria D Llorente
- 11 Washington DC VA Medical Center, Washington, DC, USA
- 12 Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Susan Love
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Julia E Vertrees
- 13 VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Gerard D Schellenberg
- 14 Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mary Sano
- 15 Bronx Veterans Medical Research Center, New York, NY, USA
- 16 Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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448
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Kim J, Schweizer TA, Fischer CE, Munoz DG. Psychosis in "Cognitively Asymptomatic" Elderly Subjects is Associated With Neuritic Plaque Load, Not Neurofibrillary Tangles. Alzheimer Dis Assoc Disord 2018; 32:185-189. [PMID: 29553944 PMCID: PMC6107422 DOI: 10.1097/wad.0000000000000250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/24/2022]
Abstract
INTRODUCTION Despite having severe Alzheimer disease pathology, some individuals remain cognitively asymptomatic (cASYM). To explore noncognitive manifestations in these cASYM individuals, we aim to investigate the prevalence and pathologic substrates of psychosis. METHODS Data were obtained from the National Alzheimer's Coordinating Center. The Neuropsychiatric Inventory Questionnaire, quick version was used to evaluate presence of psychosis. Subjects with Mini-Mental Status Examination score of ≥24 with frequent neuritic plaques (NPs) were defined as NPcASYM, and those with Braak and Braak stage of neurofibrillary tangles of V/VI were defined as NTcASYM (both groups collectively designated cASYM). Logistic regression analysis was used to examine the association between NP and neurofibrillary tangle severity and psychosis accounting for potential confounders. RESULTS We identified 667 subjects with Mini-Mental Status Examination score of ≥24, of which 137 were NPcASYM and 96 were NTcASYM. NPcASYM were at significantly higher risk of having psychosis compared with those with moderate or sparse/no NP (odds ratio, 2.47; 95% confidence interval, 1.54-3.96). NTcASYM were also at higher risk compared with those with Braak and Braak stage I to IV, but the association explained by the effect of Lewy body pathology and microinfarcts. DISCUSSION The load of NP may be an important substrate of psychosis in individuals who show no gross cognitive symptoms.
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Affiliation(s)
- Julia Kim
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON, Canada M5B 1T8
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada, M5S 1A8
| | - Tom A. Schweizer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON, Canada M5B 1T8
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada, M5S 1A8
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada, M5S 1A8
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada, M5S 1A8
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada, M5B 1W8
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON, Canada M5B 1T8
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada, M5S 1A8
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada, M5S 1A8
| | - David G. Munoz
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON, Canada M5B 1T8
- Department of Laboratory Medicine and Pathobiology, University of Toronto
- Division of Pathology, St. Michael’s Hospital, Toronto, ON, Canada
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449
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Schroeder RW, Martin PK, Marsh C, Carr S, Richardson T, Kaur J, Rusk J, Jiwanlal S. An Individualized Music-Based Intervention for Acute Neuropsychiatric Symptoms in Hospitalized Older Adults With Cognitive Impairment: A Prospective, Controlled, Nonrandomized Trial. Gerontol Geriatr Med 2018; 4:2333721418783121. [PMID: 29977982 PMCID: PMC6024267 DOI: 10.1177/2333721418783121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/19/2018] [Revised: 05/03/2018] [Accepted: 05/21/2018] [Indexed: 11/28/2022] Open
Abstract
Background: Neuropsychiatric symptoms are common features of dementia, and these occur in three fourths of patients on psychogeriatric inpatient units. These symptoms have traditionally been treated with pharmacological agents, but many medications are as likely to harm patients with dementia as to help them. As a result, nonpharmacological interventions are increasingly being investigated as ways to reduce these symptoms. Objective: The current study evaluated the impact of an individualized music-based intervention on agitation, negative mood, positive mood, compliance with care, need for one-on-one nursing staff intervention, and need for PRN medication. Method: Participants in this study were older adults who were admitted to a geriatric behavioral inpatient unit for acute agitation or behavioral disturbance. Twenty patients were in a treatment as usual group and 21 were in the individualized music group. Results: Agitation, negative mood, and positive mood all benefited from the music-based intervention, with resulting large effect sizes. Resisting care level also significantly benefited from the intervention, with a resulting medium effect size. Conclusion: These findings indicate that an easily implemented and reproducible music-based intervention, which is well tolerated and without adverse side effects, can be an effective way to reduce neuropsychiatric symptoms associated with dementia on a hospital unit.
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Affiliation(s)
| | | | - Connie Marsh
- University of Kansas School of Medicine-Wichita, USA
| | - Susan Carr
- University of Kansas School of Medicine-Wichita, USA
| | | | - Jasmine Kaur
- University of Kansas School of Medicine-Wichita, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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450
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Ham S, Kim TK, Hong H, Kim YS, Tang YP, Im HI. Big Data Analysis of Genes Associated With Neuropsychiatric Disorders in an Alzheimer's Disease Animal Model. Front Neurosci 2018; 12:407. [PMID: 29962931 PMCID: PMC6013555 DOI: 10.3389/fnins.2018.00407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 10/16/2017] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease is a neurodegenerative disease characterized by the impairment of cognitive function and loss of memory, affecting millions of individuals worldwide. With the dramatic increase in the prevalence of Alzheimer's disease, it is expected to impose extensive public health and economic burden. However, this burden is particularly heavy on the caregivers of Alzheimer's disease patients eliciting neuropsychiatric symptoms that include mood swings, hallucinations, and depression. Interestingly, these neuropsychiatric symptoms are shared across symptoms of bipolar disorder, schizophrenia, and major depression disorder. Despite the similarities in symptomatology, comorbidities of Alzheimer's disease and these neuropsychiatric disorders have not been studied in the Alzheimer's disease model. Here, we explore the comprehensive changes in gene expression of genes that are associated with bipolar disorder, schizophrenia, and major depression disorder through the microarray of an Alzheimer's disease animal model, the forebrain specific PSEN double knockout mouse. To analyze the genes related with these three neuropsychiatric disorders within the scope of our microarray data, we used selected 1207 of a total of 45,037 genes that satisfied our selection criteria. These genes were selected on the basis of 14 Gene Ontology terms significantly relevant with the three disorders which were identified by previous research conducted by the Psychiatric Genomics Consortium. Our study revealed that the forebrain specific deletion of Alzheimer's disease genes can significantly alter neuropsychiatric disorder associated genes. Most importantly, most of these significantly altered genes were found to be involved with schizophrenia. Taken together, we suggest that the synaptic dysfunction by mutation of Alzheimer's disease genes can lead to the manifestation of not only memory loss and impairments in cognition, but also neuropsychiatric symptoms.
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Affiliation(s)
- Suji Ham
- Convergence Research Center for Diagnosis, Treatment and Care System of Dementia, Korea Institute of Science and Technology (KIST), Seoul, South Korea.,Division of Bio-Medical Science & Technology, KIST School, University of Science and Technology, Seoul, South Korea
| | - Tae K Kim
- Convergence Research Center for Diagnosis, Treatment and Care System of Dementia, Korea Institute of Science and Technology (KIST), Seoul, South Korea.,Department of Biology, Boston University, Boston, MA, United States
| | - Heeok Hong
- Department of Medical Science, Graduate School of Medicine, Konkuk University, Seoul, South Korea
| | - Yong S Kim
- Department of Pharmacology, Seoul National University College of Medicine, Seoul National University, Seoul, South Korea
| | - Ya-Ping Tang
- Neuroscience Center of Excellence, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
| | - Heh-In Im
- Convergence Research Center for Diagnosis, Treatment and Care System of Dementia, Korea Institute of Science and Technology (KIST), Seoul, South Korea.,Division of Bio-Medical Science & Technology, KIST School, University of Science and Technology, Seoul, South Korea.,Center for Neuroscience, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
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