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Burke SL, Grudzien A, Li T, Abril M, Yin W, Tyrell TA, Barnes CP, Hanson K, DeKosky ST. Examining the relationship between anxiety and regional brain volumes in the National Alzheimer's Coordinating Center uniform, imaging, and biomarker datasets. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100201. [PMID: 38312309 PMCID: PMC10837066 DOI: 10.1016/j.cccb.2024.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
Anxiety has been associated with a greater risk of Alzheimer's disease (AD). Existing research has identified structural differences in regional brain tissue in participants with anxiety, but results have been inconsistent. We sought to determine the association between anxiety and regional brain volumes, and the moderation effect of APOE ε4. Using data from participants in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set, with complete imaging (MRI) and biomarker data (n = 1533), multiple linear regression estimated the adjusted effect of anxiety on 30 structural MRI regions. The moderation effect of APOE ε4 on the relation between structural MRI regions and anxiety was assessed as was the moderation effect of cognitive status. False discovery rate was used to adjust for multiple comparisons. After controlling for intracranial volume, age, sex, years of education, race, Hispanic ethnicity, and cognitive status, seven MRI regions demonstrated lower volumes among participants with anxiety: total cerebrum gray matter volume, right hippocampus volume, hippocampal volume (total), right and left frontal lobe cortical gray matter volume, and right and total temporal lobe cortical gray matter volume. Findings suggest that anxiety is associated with significant atrophy in multiple brain regions, with corresponding ventricular enlargement. Future research should investigate if anxiety-related changes to brain morphology contribute to greater AD risk.
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Affiliation(s)
- Shanna L. Burke
- School of Social Work, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 SW 8th St. AHC5 585, Miami 33199, FL, USA
- Community-Based Research Institute, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 SW 8th St., Miami 33199, FL, USA
| | - Adrienne Grudzien
- Community-Based Research Institute, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 SW 8th St., Miami 33199, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, Miami 33199, FL, USA
| | - Marlou Abril
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, Miami 33199, FL, USA
| | - Wupeng Yin
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, Miami 33199, FL, USA
| | - Tahirah A. Tyrell
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Christopher P. Barnes
- Clinical and Translational Science Institute, College of Medicine, University of Florida, PO Box 100212, 2405 SW Archer Road, Gainesville 32608, FL, USA
| | - Kevin Hanson
- Information Services, Division of Research Operations & Services, College of Medicine, University of Florida, PO Box 100212, 2405 SW Archer Road, Gainesville 32608, FL, USA
| | - Steven T. DeKosky
- McKnight Brain Institute, 1Florida Alzheimer's Disease Center, University of Florida, USA
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Avery J, Thomas D, Myshakivska O. The effect of Mild Cognitive Impairment (MCI) on psychological distress among older adults in Ukraine. BMC Geriatr 2023; 23:248. [PMID: 37098486 PMCID: PMC10131381 DOI: 10.1186/s12877-023-03906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/20/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVES Understanding the negative consequences of Mild Cognitive Impairment (MCI) in Ukraine among a population who have collectively experienced difficult life events, provided the impetus for the current study which analyzed whether the perception of psychological distress differed among older adults with two types of MCI (amnestic MCI [aMCI] & nonamnestic MCI [naMCI]) compared to their cognitively intact peers. METHOD A sample of 132 older adults were selected from an outpatient regional hospital in Lviv, Ukraine and assigned into either an MCI or non-MCI control group. A demographic survey, and the Symptom Questionnaire (SQ) were administered to both groups. RESULTS Results of an ANOVA comparing the SQ sub-scales between the Ukrainian MCI and control groups were analyzed. A multiple hierarchical regression analysis assessed the predictive value of MoCA scores on the SQ sub-scales. Compared to adults in the MCI group, adults in the control group reported significantly lower rates of anxiety, somatic, depressive symptoms, and total psychological distress. DISCUSSION While the level of cognitive impairment was a significant predictor for each sub-type of distress, the explained variance was minimal suggesting that other factors also played a role. Reference was made to a similar MCI sample in the U.S. which had lower SQ psychological distress scores than the Ukraine sample, further suggesting possible environmental effects on symptoms. The importance of depression and anxiety screening and treatment for older adults with MCI was also discussed.
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Affiliation(s)
- Jennifer Avery
- School of Nursing, Eastern Michigan University, Ypsilanti, MI, USA
| | - David Thomas
- School of Health Sciences, Eastern Michigan University, Ypsilanti, MI, 48197, USA.
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The Synergic Effect of AT(N) Profiles and Depression on the Risk of Conversion to Dementia in Patients with Mild Cognitive Impairment. Int J Mol Sci 2023; 24:ijms24021371. [PMID: 36674881 PMCID: PMC9865785 DOI: 10.3390/ijms24021371] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Few studies have addressed the impact of the association between Alzheimer's disease (AD) biomarkers and NPSs in the conversion to dementia in patients with mild cognitive impairment (MCI), and no studies have been conducted on the interaction effect of these two risk factors. AT(N) profiles were created using AD-core biomarkers quantified in cerebrospinal fluid (CSF) (normal, brain amyloidosis, suspected non-Alzheimer pathology (SNAP) and prodromal AD). NPSs were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). A total of 500 individuals with MCI were followed-up yearly in a memory unit. Cox regression analysis was used to determine risk of conversion, considering additive and multiplicative interactions between AT(N) profile and NPSs on the conversion to dementia. A total of 224 participants (44.8%) converted to dementia during the 2-year follow-up study. Pathologic AT(N) groups (brain amyloidosis, prodromal AD and SNAP) and the presence of depression and apathy were associated with a higher risk of conversion to dementia. The additive combination of the AT(N) profile with depression exacerbates the risk of conversion to dementia. A synergic effect of prodromal AD profile with depressive symptoms is evidenced, identifying the most exposed individuals to conversion among MCI patients.
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Warren SL, Hamza EA, Tindle R, Reid E, Whitfield P, Doumit A, Moustafa AA. Common Neuropsychiatric S ymptoms in Alzheimer's Disease, Mild Cognitive Impairment, and Subjective Memory Complaints: A Unified Framework. Curr Alzheimer Res 2023; 20:459-470. [PMID: 37873914 DOI: 10.2174/0115672050255489231012072014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/25/2023]
Abstract
The Alzheimer's disease (AD) continuum is a unique spectrum of cognitive impairment that typically involves the stages of subjective memory complaints (SMC), mild cognitive impairment (MCI), and AD dementia. Neuropsychiatric symptoms (NPS), such as apathy, anxiety, stress, and depression, are highly common throughout the AD continuum. However, there is a dearth of research on how these NPS vary across the AD continuum, especially SMC. There is also disagreement on the effects of specific NPS on each stage of the AD continuum due to their collinearity with other NPS, cognitive decline, and environmental factors (e.g., stress). In this article, we conduct a novel perspective review of the scientific literature to understand the presence of NPS across the AD continuum. Specifically, we review the effects of apathy, depression, anxiety, and stress in AD, MCI, and SMC. We then build on this knowledge by proposing two theories of NPS' occurrence across the AD continuum. Consequently, we highlight the current landscape, limitations (e.g., differing operationalization), and contentions surrounding the NPS literature. We also outline theories that could clear up contention and inspire future NPS research.
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Affiliation(s)
- Samuel L Warren
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
| | - Eid Abo Hamza
- Faculty of Education, Tanta University, Tanta, Egypt
- College of Education, Humanities & Social Sciences, Al Ain University, Al Ain, UAE
| | - Richard Tindle
- School of Psychology, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Edwina Reid
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Paige Whitfield
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Adam Doumit
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Ahmed A Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Ronat L, Hoang VT, Hanganu A. Establishing an individualized model of conversion from normal cognition to Alzheimer's disease after 4 years, based on cognitive, brain morphology and neuropsychiatric characteristics. Int J Geriatr Psychiatry 2022; 37. [PMID: 35445762 DOI: 10.1002/gps.5718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The impact of neuropsychiatric symptoms (NPS) on cognitive performance has been reported, and this impact was better defined in the aging population. Yet the potential of using the impact of NPS on brain and cognitive performance in a longitudinal setting, as prediction of conversion - have remained questionable. This study proposes to establish a predictive model of conversion to Alzheimer's disease (AD) and mild cognitive impairment (MCI) based on current cognitive performance, NPS and their associations with brain morphology. METHODS 156 participants with MCI from the Alzheimer's Disease Neuroimaging Initiative database cognitively stable after a 4-year follow-up were compared to 119 MCI participants who converted to AD. Each participant underwent a neuropsychological assessment evaluating verbal memory, language, executive and visuospatial functions, a neuropsychiatric inventory evaluation and a 3 Tesla MRI. The statistical analyses consisted of 1) baseline comparison between the groups; 2) analysis of covariance model (controlling demographic parameters including functional abilities) to specify the variables that distinguish the two subgroups and; 3) used the significant ANCOVA variables to construct a binary logistic regression model that generates a probability equation to convert to a lower cognitive performance state. RESULTS Results showed that MCI who converted to AD in comparison to stable MCI, exhibited a higher NPS prevalence, a lower cognitive performance and a higher number of involved brain structures. Functional abilities, memory performance and the sizes of inferior temporal, hippocampal and amygdala sizes were significant predictors of MCI to AD conversion. We also report two models of conversion that can be implemented on an individual basis for calculating the percentage risk of conversion after 4 years. CONCLUSION These analytical methods might be a good way to anticipate cognitive and brain declines.
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Affiliation(s)
- Lucas Ronat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
- Faculté de Médecine, Département de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Van-Tien Hoang
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Alexandru Hanganu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
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Babulal GM, Chen L, Doherty JM, Murphy SA, Johnson AM, Roe CM. Longitudinal Changes in Anger, Anxiety, and Fatigue Are Associated with Cerebrospinal Fluid Biomarkers of Alzheimer’s Disease. J Alzheimers Dis 2022; 87:141-148. [DOI: 10.3233/jad-215708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer’s disease (AD) studies in cognitively normal (CN) older adults aged≥65 suggest depression is associated with molecular biomarkers (imaging and cerebrospinal fluid [CSF]). This study used linear mixed models (covariance pattern model) to assess whether baseline CSF biomarkers (Aβ 42/Aβ 40, t-Tau/Aβ 42, p-Tau/Aβ 42) predicted changes in non-depressed mood states in CN older adults (N = 248), with an average of three follow-up years. Participants with higher levels of CSF biomarkers developed more anger, anxiety, and fatigue over time compared to those with more normal levels. Non-depressed mood states in preclinical AD may be a prodrome for neuropsychiatric symptoms in symptomatic AD.
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Affiliation(s)
- Ganesh M. Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Jason M. Doherty
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Samantha A. Murphy
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ann M. Johnson
- Center for Clinical Studies, Washington University in St. Louis, St. Louis, MO, USA
| | - Catherine M. Roe
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Roe Research LLC, St. Louis, MO, USA
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Arevalo-Rodriguez I, Smailagic N, Roqué-Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S. Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2021; 7:CD010783. [PMID: 34313331 PMCID: PMC8406467 DOI: 10.1002/14651858.cd010783.pub3] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. OBJECTIVES To determine the accuracy of the Mini Mental State Examination for the early detection of dementia in people with mild cognitive impairment SEARCH METHODS: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. SELECTION CRITERIA We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. DATA COLLECTION AND ANALYSIS We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. MAIN RESULTS In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. AUTHORS' CONCLUSIONS Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.
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Affiliation(s)
- Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | - Marta Roqué-Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Erick Sanchez-Perez
- Neurosciences, Hospital Infantil Universitario de San José-FUCS, Bogotá, Colombia
| | - Antri Giannakou
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Olga L Pedraza
- Neurosciences, Hospital Infantil Universitario de San José-FUCS, Bogotá, Colombia
| | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sarah Cullum
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Patel P, Masurkar AV. The Relationship of Anxiety with Alzheimer's Disease: A Narrative Review. Curr Alzheimer Res 2021; 18:359-371. [PMID: 34429045 DOI: 10.2174/1567205018666210823095603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is an increased effort to better understand neuropsychiatric symptoms of Alzheimer's Disease (AD) as an important feature of symptomatic burden as well as potential modifiable factors of the disease process. Anxiety is one of the most common neuropsychiatric symptoms in Alzheimer's Disease (AD). A growing body of work has emerged that addresses the epidemiology and biological correlations of anxiety in AD. METHODS Here, we review human studies in research and clinical cohorts that examined anxiety in AD. We focused on work related to prevalence across AD stages, correlation with established biomarkers, relationship with AD neuropathology and genetic risk factors, and impact on progression. RESULTS Anxiety is prominent in the early stages and increases across the spectrum of functional stages. Biomarker relationships are strongest at the level of FDG-PET and amyloid measured via PET or cerebrospinal fluid analysis. Neuropathologically, anxiety emerges with early Braak stage tau pathology. The presence of the apolipoprotein E e4 allele is associated with increased anxiety at all stages, most notably at mild cognitive impairment. Anxiety portended a faster progression at all predementia stages. CONCLUSION This body of work suggests a close biological relationship between anxiety and AD that begins in early stages and influences functional decline. As such, we discuss future work that would improve our understanding of this relationship and test the validity of anxiolytic treatment as disease modifying therapy for AD.
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Affiliation(s)
- Palak Patel
- Department of Neurology, School of Medicine, New York University, New York, NY, United States
| | - Arjun V Masurkar
- Department of Neurology, School of Medicine, New York University, New York, NY, United States
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Barak Y, Barson D, Davie G, Glue P, Paleacu D. Internalize at your peril: internalizing disorders as risk factors for dementia-cohort study. GeroScience 2020; 43:253-261. [PMID: 33067707 DOI: 10.1007/s11357-020-00285-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
Few studies examined comorbid anxiety and depression's independent association with dementia. We assessed internalizing disorders as risk factors for dementia to avoid pitfalls inherent in separating anxiety and depression. Retrospectively designed prospective comparative cohort study using New Zealand's (NZ) National Minimum Dataset of hospital discharges. Hazards ratios (HRs), estimated from parametric survival models, compared the time to incident dementia after a minimal latency interval of 10 years between those with and without prior diagnosis of an internalizing disorder. A total of 47,932 patients aged 50-54 years were discharged from a publicly funded hospital events in NZ between 1988 and 1992. Of these, 37,631 (79%) met eligibility criteria, and incident dementia was diagnosed in 1594. Rates of incident dementia were higher among patients with an earlier diagnosis of internalizing disorders (572 vs 303 per 100,000 person years at risk (PYAR)). After adjustment for age, sex, ethnicity, and region, those with internalizing disorders were estimated to have a higher risk of developing dementia than those without (adjusted HR = 1.57, 95% CI 1.17-2.10). Females with an earlier diagnosis of internalizing disorders were estimated to have almost twice the risk of developing dementia (adjusted HR 1.80, 95% CI 1.25-2.59). Internalizing disorders affect one in five adults globally. Our findings suggest a significant increase in risk of dementia more than 10 years after the diagnosis of internalizing disorder.
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Affiliation(s)
- Yoram Barak
- School of Medicine, Dept. of Psychological Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - David Barson
- School of Medicine, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- School of Medicine, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- School of Medicine, Dept. of Psychological Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Diana Paleacu
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Ma L. Depression, Anxiety, and Apathy in Mild Cognitive Impairment: Current Perspectives. Front Aging Neurosci 2020; 12:9. [PMID: 32082139 PMCID: PMC7002324 DOI: 10.3389/fnagi.2020.00009] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Mild cognitive impairment (MCI) is an important risk state for dementia, particularly Alzheimer's disease (AD). Depression, anxiety, and apathy are commonly observed neuropsychiatric features in MCI, which have been linked to cognitive and functional decline in daily activities, as well as disease progression. Accordingly, the study's objective is to review the prevalence, neuropsychological characteristics, and conversion rates to dementia between MCI patients with and without depression, anxiety, and apathy. Methods: A PubMed search and critical review were performed relating to studies of MCI, depression, anxiety, and apathy. Results: MCI patients have a high prevalence of depression/anxiety/apathy; furthermore, patients with MCI and concomitant depression/anxiety/apathy have more pronounced cognitive deficits and progress more often to dementia than MCI patients without depression/anxiety/apathy. Conclusions and Implications: Depression, anxiety, and apathy are common in MCI and represent possible risk factors for cognitive decline and progression to dementia. Further studies are needed to better understand the role and neurobiology of depression, anxiety, and apathy in MCI.
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Affiliation(s)
- Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, China National Clinical Research Center for Geriatric Medicine, Beijing, China
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Four-Week, Home-Based, Robot Cognitive Intervention for Patients with Mild Cognitive Impairment: a Pilot Randomized Controlled Trial. Dement Neurocogn Disord 2020; 19:96-107. [PMID: 32985149 PMCID: PMC7521954 DOI: 10.12779/dnd.2020.19.3.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose Previous studies suggest that cognitive intervention can mitigate the development of dementia in patients with mild cognitive impairment (MCI). However, the previous cognitive intervention was mostly provided as a group session, in which MCI patients sometimes had difficulty in regularly attending sessions or were reluctant to participate in group-based classes. Additionally, experienced instructors for traditional cognitive intervention may be unavailable in some chronic-care facilities or community centers. Considering these reasons, we have developed 5 programs for home-based cognitive intervention using a personal robot for MCI patients. In this preliminary study, we aimed to demonstrate the effects of our newly developed home-based cognitive intervention with robots on cognitive function in MCI patients. Methods We conducted a single-blind randomized controlled trial enrolling 46 MCI patients. Participants were randomized into 2 groups: the robot cognitive intervention (robot) (n=24) group and without cognitive intervention (control) (n=22) group. The interventions comprised 60-min sessions per day for 4 weeks. The primary outcome was the change in cognitive function measured using the Cambridge Neuropsychological Test Automated Battery. Results There were no significant baseline demographic or clinical differences between the robot and control groups. After the 4-week cognitive intervention, the robot group showed greater improvement in working memory than did the control group. Conclusions Our home-based cognitive intervention with a personal robot improved the working memory in MCI patients. Further studies with larger samples and longer study periods are required to demonstrate the effects of these programs in other cognitive domains in MCI patients.
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Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort. Infant Behav Dev 2019; 57:101336. [PMID: 31404801 DOI: 10.1016/j.infbeh.2019.101336] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Abstract
Pregnancy and the early post partum period are widely understood as a critical period for the infant's emotional development and the earliest influence shaping social interaction. The present study aims to understand the potential influence of both antenatal and postnatal maternal anxiety and depressive symptoms on socio-emotional outcomes in offspring aged 12 months. The study used longitudinal data from a prospective cohort study on Australian pregnant women and their children. Data were available for 282 mothers and their children. Maternal depressive and anxiety symptoms were measured in early pregnancy, trimester three of pregnancy, six and 12 months postpartum. Social and emotional development in children was measured using the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 12 months. Using growth curve analysis of 4 waves of repeated measurement to examine intercept and slope, we found that both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children's social and emotional development. In the final model anxiety accounted for 19% of the variance in child socio-emotional problems and depression 23% of variance. The results emphasise the importance of perinatal maternal mental health as a potential risk factor for child development. This carries important implications for policy development, such as the need to build early identification and early intervention models in to the current clinical practice for perinatal care, specifically, to develop targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy, and continuing monitoring of young children whose mothers have experienced perinatal mental health difficulties.
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Tan EY, Köhler S, Hamel RE, Muñoz-Sánchez JL, Verhey FR, Ramakers IH. Depressive Symptoms in Mild Cognitive Impairment and the Risk of Dementia: A Systematic Review and Comparative Meta-Analysis of Clinical and Community-Based Studies. J Alzheimers Dis 2019; 67:1319-1329. [DOI: 10.3233/jad-180513] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Y.L. Tan
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
- Geestelijk Gezondheidszorg Eindhoven en de Kempen (GGzE), The Netherlands
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | | | | | - Frans R.J. Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
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14
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Pehlivan Y, Orucoglu N, Pehlivan S, Kimyon G, Zengin O, Kucuk A, Sahin A, Tomas N, Oksuz MF, Kisacik B, Akar S, Onat AM, Dalkilic E. Patients' concerns regarding biological agents in rheumatology. Int J Rheum Dis 2018; 21:1219-1226. [PMID: 29879318 DOI: 10.1111/1756-185x.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The potential side effects of biological agents may increase the anxiety levels of patients and influence not only their desire to use these therapies but also their concordance to treatment. This study aimed to determine the level and prevalence of drug-related concern in patients treated with biological agents and to acquire additional information regarding the related causes. MATERIALS AND METHODS A total of 1134 patients who were using biological agents for at least 3 months with a diagnosis of rheumatic diseases were enrolled. General anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI). RESULTS The most common cause for drug-related concerns was the potential side effects of the drugs (59.5%). Among the potential side effects, cancer risk was the most common cause for concern (40.1%), followed by the risk of tuberculosis activation (30.7%). Anxiety levels were higher in patients who experienced side effects than in other patients, and this difference was statistically significant (P < 0.05). STAI trait and state scores were moderately correlated with anxiety levels related to the drug (P < 0.001). CONCLUSION Anxiety related to biological agents may significantly affect the patients' anxiety levels. Awareness regarding the patients' concerns and expectations related to the drug is important to ensure drug adherence and concordance to treatment.
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Affiliation(s)
- Yavuz Pehlivan
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
| | - Nurdan Orucoglu
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
| | - Seda Pehlivan
- Department of Nursing, Health Science Faculty, Uludag University, Bursa, Turkey
| | - Gezmis Kimyon
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Orhan Zengin
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Adem Kucuk
- Department of Rheumatology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Sahin
- Department of Rheumatology, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Nazmiye Tomas
- Department of Rheumatology, School of Medicine, İzmir Katip Celebi University, İzmir, Turkey
| | - Mustafa Ferhat Oksuz
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
| | - Bunyamin Kisacik
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Servet Akar
- Department of Rheumatology, School of Medicine, İzmir Katip Celebi University, İzmir, Turkey
| | - Ahmet Mesut Onat
- Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ediz Dalkilic
- Department of Rheumatology, School of Medicine, Uludag University, Bursa, Turkey
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15
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Mosca A, Sperduti S, Pop V, Ciavardelli D, Granzotto A, Punzi M, Stuppia L, Gatta V, Assogna F, Banaj N, Piras F, Piras F, Caltagirone C, Spalletta G, Sensi SL. Influence of APOE and RNF219 on Behavioral and Cognitive Features of Female Patients Affected by Mild Cognitive Impairment or Alzheimer's Disease. Front Aging Neurosci 2018; 10:92. [PMID: 29755337 PMCID: PMC5932379 DOI: 10.3389/fnagi.2018.00092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/19/2018] [Indexed: 01/20/2023] Open
Abstract
The risk for Alzheimer’s disease (AD) is associated with the presence of the 𝜀4 allele of Apolipoprotein E (APOE) gene and, recently, with a novel genetic variant of the RNF219 gene. This study aimed at evaluating interactions between APOE-𝜀4 and RNF219/G variants in the modulation of behavioral and cognitive features of two cohorts of patients suffering from mild cognitive impairment (MCI) or AD. We enrolled a total of 173 female MCI or AD patients (83 MCI; 90 AD). Subjects were screened with a comprehensive set of neuropsychological evaluations and genotyped for the APOE and RNF219 polymorphic variants. Analysis of covariance was performed to assess the main and interaction effects of APOE and RNF219 genotypes on the cognitive and behavioral scores. The analysis revealed that the simultaneous presence of APOE-𝜀4 and RNF219/G variants results in significant effects on specific neuropsychiatric scores in MCI and AD patients. In MCI patients, RNF219 and APOE variants worked together to impact the levels of anxiety negatively. Similarly, in AD patients, the RNF219 variants were found to be associated with increased anxiety levels. Our data indicate a novel synergistic activity APOE and RNF219 in the modulation of behavioral traits of female MCI and AD patients.
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Affiliation(s)
- Alessandra Mosca
- Department of Neuroscience, Imaging, and Clinical Science, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,Department of Neuroscience, Psychology, Drug Area and Child Health, University of Florence, Florence, Italy.,Molecular Neurology Unit, Center of Excellence on Aging and Translational Medicine, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Samantha Sperduti
- Department of Neuroscience, Imaging, and Clinical Science, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Viorela Pop
- Department of Neurology and Pharmacology, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Domenico Ciavardelli
- Molecular Neurology Unit, Center of Excellence on Aging and Translational Medicine, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,School of Human and Social Science, Kore University of Enna, Enna, Italy
| | - Alberto Granzotto
- Department of Neuroscience, Imaging, and Clinical Science, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,Molecular Neurology Unit, Center of Excellence on Aging and Translational Medicine, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Miriam Punzi
- Department of Neuroscience, Imaging, and Clinical Science, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,Molecular Neurology Unit, Center of Excellence on Aging and Translational Medicine, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Valentina Gatta
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Francesca Assogna
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nerisa Banaj
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federica Piras
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gianfranco Spalletta
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Science, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,Molecular Neurology Unit, Center of Excellence on Aging and Translational Medicine, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.,Department of Neurology and Pharmacology, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
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16
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Mortamais M, Abdennour M, Bergua V, Tzourio C, Berr C, Gabelle A, Akbaraly TN. Anxiety and 10-Year Risk of Incident Dementia-An Association Shaped by Depressive Symptoms: Results of the Prospective Three-City Study. Front Neurosci 2018; 12:248. [PMID: 29719498 PMCID: PMC5913372 DOI: 10.3389/fnins.2018.00248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Anxiety is common in patients with cognitive impairment and dementia. However, whether anxiety is a risk factor for dementia is still not known. We aimed to examine the association between trait anxiety at baseline and the 10-year risk of incident dementia to determine to which extent depressive symptoms influence this relationship in the general population. Methods: Data came from 5,234 community-dwelling participants from the Three-City prospective cohort study, aged 65 years at baseline and followed over 10 years. At baseline, anxiety trait was assessed using the Spielberger State-Trait Anxiety Inventory (STAI), and depressive symptoms using Center for Epidemiologic Studies-Depression Scale (CESD). Use of anxiolytic drugs was also considered. Diagnoses of dementia were made at baseline and every 2 years. To examine the relationship between anxiety exposures and risk of incident dementia, Cox proportional hazard regression models were performed. Results: Taking anxiolytic drugs or having high trait anxiety (STAI score ≥ 44) increased the risk of dementia assessed over 10 years of follow-up [Hazard Ratio (HR) = 1.39, 95%CI: 1.08–1.80, p = 0.01 and HR = 1.26, 95%CI: 1.01–1.57, p = 0.04, respectively], independently of a large panel of socio-demographic variables, health behaviors, cardio-metabolic disorders, and additional age-related disorders such as cardiovascular diseases, activity limitations, and cognitive deficit. However, the associations were substantially attenuated after further adjustment for depressive symptoms. Conclusion: Our findings suggest that depressive symptoms shape the association between anxiety trait and dementia. Further research is needed to replicate our findings and extrapolate our results to anxiety disorders.
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Affiliation(s)
- Marion Mortamais
- Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Meriem Abdennour
- Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Valérie Bergua
- University of Bordeaux, Institut National de la Santé et de la Recherche Médicale, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- University of Bordeaux, Institut National de la Santé et de la Recherche Médicale, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Claudine Berr
- Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Audrey Gabelle
- Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Memory Resources and Research Center, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France
| | - Tasnime N Akbaraly
- MMDN, Université de Montpellier, EPHE, Institut National de la Santé et de la Recherche Médicale, U1198, Montpellier, France.,Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Montpellier, France
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17
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Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment symptoms of depression, anxiety, irritability, and euphoria. Int Psychogeriatr 2018; 30:185-196. [PMID: 28899446 DOI: 10.1017/s1041610217001880] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. METHODS Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: "mild cognitive impairment," "dementia," "prodromal dementia," "preclinical dementia," "Alzheimer's," "depression," "dysphoria," "mania," "euphoria," "bipolar disorder," and "irritability." RESULTS Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. CONCLUSION Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
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18
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Bakkane Bendixen A, Hartberg CB, Selbæk G, Engedal K. Symptoms of Anxiety in Older Adults with Depression, Dementia, or Psychosis: A Principal Component Analysis of the Geriatric Anxiety Inventory. Dement Geriatr Cogn Disord 2018; 42:310-322. [PMID: 27811466 DOI: 10.1159/000452272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS The primary aim of this study was to examine anxiety symptoms as measured by the Geriatric Anxiety Inventory (GAI) in older patients with depression, dementia, or psychotic disorders. The secondary aim was to conduct a principal component analysis (PCA) of the GAI and to examine whether its subscales differ between the 3 disorders. METHODS We included data from 428 patients who were admitted to a department of geriatric psychiatry and examined according to a standardized protocol. The GAI was used to measure current anxiety symptoms. RESULTS The GAI symptoms occurred more frequently in the group with depression than in the other 2 groups. The PCA of the GAI with oblimin rotation resulted in a 2-component solution, labelled as "worries" (explained variance 46.3%, Cronbach's α 0.92) and "physical symptoms" (explained variance 7.1%, Cronbach's α 0.85). CONCLUSION The results indicate that in old age, anxiety is especially prevalent in depression. The 2-component solution indicates that the GAI measures 2 different aspects of anxiety with different symptomatology.
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19
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Li XX, Li Z. The impact of anxiety on the progression of mild cognitive impairment to dementia in Chinese and English data bases: a systematic review and meta-analysis. Int J Geriatr Psychiatry 2018; 33:131-140. [PMID: 28240415 DOI: 10.1002/gps.4694] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/01/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE It remains unclear whether or not anxiety increases the risk of dementia in people with mild cognitive impairment (MCI). The aim of this systematic review and meta-analysis was to investigate the risk of dementia among people with MCI and anxiety compared with those with MCI and no anxiety. METHODS The hazard ratio of conversion to dementia in people with anxiety and MCI was compared with those without anxiety and was calculated using a generic inverse variance method with fixed effect models. RESULTS Eleven studies from the English and Chinese databases were included, seven of which were included in the meta-analysis. The pooled hazard ratio of conversion to dementia was 1.18 95% CI [1.07, 1.31] (p = 0.002) in the group of MCI plus anxiety compared with those without anxiety. CONCLUSION The results suggest that anxiety increases the risk of progression to dementia in people with MCI. Future interventions targeting anxiety management in vulnerable people with MCI may reduce the risk of dementia. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xiao-Xue Li
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, China
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20
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Burke SL, O'Driscoll J, Alcide A, Li T. Moderating risk of Alzheimer's disease through the use of anxiolytic agents. Int J Geriatr Psychiatry 2017; 32:1312-1321. [PMID: 27805724 PMCID: PMC5441966 DOI: 10.1002/gps.4614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Anxiety diagnoses occur in 17.1% in people age 65 years and older. Individuals with anxiety may be at a higher risk of the development of probable Alzheimer's disease (AD). Previous literature has suggested that anxiolytic medications may exacerbate the risk of AD development. This study explored anxiolytic medication as a potential moderator of AD risk in older adults. METHODS A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was undertaken, analyzing observations from 12,083 participants with normal cognition at the first visit. Survival analysis was utilized to examine if anxiolytic medication use by those with anxiety and/or APOE ɛ4 moderates the hazard of AD and/or MCI development. RESULTS The hazard of probable AD (HR = 3.50, [2.77 - 4.44], p < .0001) or MCI (HR = 2.13, [1.85-2.44], p < .0001) development was statistically significant for those with anxiety. This hazard was no longer statistically significant when specific anxiolytics were used. ɛ4 carriers experienced a statistically significant hazard of AD (HR = 1.92, [1.52-2.41], p < .001) and MCI (HR = 1.17, [1.04-1.32], p < .05) development. This effect was moderated by the use of anxiolytics. DISCUSSION The results of this study suggest that anxiolytics may moderate the effect of anxiety on MCI and AD development, specifically indicating a neutralized hazard for those with ɛ4 carriers with anxiety. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Shanna L Burke
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, FL, USA
| | - Janice O'Driscoll
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, FL, USA
| | - Amary Alcide
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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21
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Vujović M, Sovilj M, Jeličić L, Stokić M, Plećaš D, Plešinac S, Nedeljković N. Correlation between maternal anxiety, reactivity of fetal cerebral circulation to auditory stimulation, and birth outcome in normotensive and gestational hypertensive women. Dev Psychobiol 2017; 60:15-29. [PMID: 29091282 DOI: 10.1002/dev.21589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/10/2017] [Indexed: 12/17/2022]
Abstract
This study investigated the correlation between maternal anxiety and blood flow changes through the fetal middle cerebral artery (MCA) after defined acoustic stimulation in 43 normotensive (C) and 40 gestational hypertensive (GH) subjects. Neonatal outcomes (gestational age at birth, Apgar score, birth weight) in the C and GH groups were analyzed. State (STAI-S) and trait (STAI-T) anxiety was assessed using Spielberger's questionnaire. The MCA blood flow was assessed once between 28 and 41 weeks of gestation using color Doppler ultrasound before and after application of defined acoustic stimulus. Relative size of the Pulsatility index (Pi) change (RePi) was calculated. The general hypotheses were: (1) women in GH group would have higher anxiety; (2) higher anxiety correlates with higher RePi change and poorer neonatal outcome; (3) fetuses from the GH group would have poorer neonatal outcome. Subjects from the GH group had higher STAI-T and RePi compared to the C group. A positive correlation between RePi and STAI-S, STAI-T, and systolic/diastolic blood pressure was found in both groups. There were more preterm deliveries in the GH group compared to the C group. A significant effect of STAI-T on body weight was observed in the C and GH group. There was a predictive effect of STAI-T and RePi on the C group, and STAI-S, STAI-T, diastolic blood pressure, and RePi on the GH group in terms of neonatal body weight. This study demonstrates an association between antenatal anxiety in GH women and increased fetal cerebral circulation in response to defined auditory stimulation.
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Affiliation(s)
- Marina Vujović
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Mirjana Sovilj
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Ljiljana Jeličić
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Miodrag Stokić
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Darko Plećaš
- Clinical Center of Serbia, Medical Faculty, University Clinic for Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Snežana Plešinac
- Clinical Center of Serbia, Medical Faculty, University Clinic for Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Nadežda Nedeljković
- Faculty of Biology, Department for General Physiology and Biophysics, University of Belgrade, Belgrade, Serbia
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22
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Chang MC. The effects of ultrasound-guided corticosteroid injection for the treatment of hemiplegic shoulder pain on depression and anxiety in patients with chronic stroke. Int J Neurosci 2017; 127:958-964. [PMID: 28076692 DOI: 10.1080/00207454.2017.1281274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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23
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Anxiety as a Predictor for Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis. Am J Geriatr Psychiatry 2016; 24:823-42. [PMID: 27591161 DOI: 10.1016/j.jagp.2016.05.015] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because anxiety is postulated as a risk factor for dementia, we performed a systematic review and meta-analysis to investigate whether anxiety predicts cognitive decline and/or dementia, taking the stage of cognitive decline as well as setting into account. METHODS A systematic literature search up to January 2015 was performed to identify all longitudinal studies on the association between anxiety and cognition. Data extraction and methodological quality assessment were conducted independently by two authors. Where possible, pooled relative risks were calculated to examine anxiety as a possible risk factor for cognitive decline cognitive impairment and dementia in community studies (objective 1), as well as for conversion to dementia patients referred to memory clinics (objective 2). RESULTS Twenty studies met inclusion criteria. Data on cognitive decline were too heterogeneous for meta-analysis. Anxiety predicted incident cognitive impairment (4 studies, relative risk [RR]: 1.77, 95% confidence interval [CI]: 1.38-2.26, z = 4.50, p < 0.001) and dementia (6 studies, RR: 1.57, 95% CI: 1.02-2.42, z = 2.05, p = 0.040) in the community, the latter driven by studies with a mean age of 80 years or above. Among clinical mild cognitive impairment samples, anxiety did not predict conversion to dementia (RR: 1.21, 95% CI: 0.90-1.63, z = 1.28, p = 0.200). CONCLUSIONS Anxiety is associated with an increased risk for cognitive impairment and dementia in the community. Stronger associations were driven by higher age, suggesting that it is a prodromal symptom. Causal biological pathways have also been described, which could explain the risk for incident cognitive impairment in the community. Future studies should include mediating mechanism when studying anxiety as a predictor for cognitive decline and/or dementia.
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Lauterbach EC. Repurposing psychiatric medicines to target activated microglia in anxious mild cognitive impairment and early Parkinson's disease. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2016; 5:29-51. [PMID: 27073741 PMCID: PMC4788730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 06/05/2023]
Abstract
Anxiety is common in the Mild Cognitive Impairment (MCI) stage of Alzheimer's disease (AD) and the pre-motor stages of Parkinson's disease (PD). A concomitant and possible cause of this anxiety is microglial activation, also considered a key promoter of neurodegeneration in MCI and early PD via inflammatory mechanisms and the generation of degenerative proinflammatory cytokines. Psychiatric disorders, prevalent in AD and PD, are often treated with psychiatric drugs (psychotropics), raising the question of whether psychotropics might therapeutically affect microglial activation, MCI, and PD. The literature of common psychotropics used in treating psychiatric disorders was reviewed for preclinical and clinical findings regarding microglial activation. Findings potentially compatible with reduced microglial activation or reduced microglial inflammogen release were evident for: antipsychotics including neuroleptics (chlorpromazine, thioridazine, loxapine) and atypicals (aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone); mood stabilizers (carbamazepine, valproate, lithium); antidepressants including tricyclics (amitriptyline, clomipramine, imipramine, nortriptyline), SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), venlafaxine, and bupropion; benzodiazepine anxiolytics (clonazepam, diazepam); cognitive enhancers (donepezil, galantamine, memantine); and other drugs (dextromethorphan, quinidine, amantadine). In contrast, pramipexole and methylphenidate might promote microglial activation. The most promising replicated findings of reduced microglial activation are for quetiapine, valproate, lithium, fluoxetine, donepezil, and memantine but further study is needed and translation of their microglial effects to human disease still requires investigation. In AD-relevant models, risperidone, valproate, lithium, fluoxetine, bupropion, donepezil, and memantine have therapeutic microglial effects in need of replication. Limited clinical data suggest some support for lithium and donepezil in reducing MCI progression, but other drugs have not been studied. In PD-relevant models, lamotrigine, valproate, fluoxetine, dextromethorphan, and amantadine have therapeutic microglial effects whereas methylphenidate induced microglial activation and pramipexole promoted NO release. Clinical data limited to pramipexole do not as of yet indicate faster progression of early PD while the other drugs remain to be investigated. These tantalizing psychotropic neuroprotective findings now invite replication and evidence in AD-and PD-specific models under chronic administration, followed by consideration for clinical trials in MCI and early stage PD. Psychiatric features in early disease may provide opportunities for clinical studies that also employ microglial PET biomarkers.
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Affiliation(s)
- Edward C Lauterbach
- Department of Psychiatry and Behavioral Sciences, Mercer University School of Medicine 655 First Street, Macon, Georgia, 31201, USA
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Abstract
PURPOSE OF REVIEW Stress exacerbates mental illnesses such as depression but also appears to increase risk of dementia, suggesting a common mechanism for development of stress-induced affective and cognitive impairment. The purpose of this review is to address the question of whether anxiety 'damages' the brain, and to identify potential mechanisms for the link between stress and neuropsychiatric illness. RECENT FINDINGS Anxiety disorders are associated with alterations in fear neurocircuitry such that 'bottom-up' processes in the amygdala which respond to threat are exaggerated, and regulation of these processes by the prefrontal cortex (PFC) and hippocampus is impaired. Chronic stress exposure similarly alters fear neurocircuitry by enhancing amygdalar functioning while causing structural degeneration in the PFC and hippocampus thereby inhibiting PFC/hippocampus control over the stress response. Pharmacological (e.g., antidepressant medications) and nonpharmacological interventions (cognitive-behavioral therapy, exercise) may reverse stress-induced damage in the brain. SUMMARY Pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus and the PFC, which may account for the increased risk of developing neuropsychiatric disorders, including depression and dementia. Longitudinal studies are needed to determine whether reversal of stress-induced brain changes by interventions such as cognitive-behavioral therapy can reduce risk of neuropsychiatric illness.
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Yoo I, Woo JM, Lee SH, Fava M, Mischoulon D, Papakostas GI, Kim EJ, Chung S, Ha JH, Jeon HJ. Influence of anxiety symptoms on improvement of neurocognitive functions in patients with major depressive disorder: A 12-week, multicenter, randomized trial of tianeptine versus escitalopram, the CAMPION study. J Affect Disord 2015; 185:24-30. [PMID: 26142691 DOI: 10.1016/j.jad.2015.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous research has reported evidence that patients with major depressive disorder (MDD) show anxiety symptoms and neurocognitive impairments. However, the influence of anxiety on neurocognitive function in MDD patients during antidepressant treatment is unclear. METHOD MDD patients (n=164) completed a 12-week, multicenter, randomized trial assigned in a 1:1 ratio to either tianeptine or escitalopram. Changes of anxiety symptoms were assessed by the Hamilton Anxiety Rating Scale (HAM-A), and the Hamilton Depression Rating Scale (HAM-D), self-rated subjective cognitive impairment on memory and concentration, the Mini-Mental Status Examination (MMSE), Continuous Performance Test (CPT), Verbal Learning Test (VLT), and Raven's Progressive Matrices (RPM) were assessed every 4 weeks. RESULTS During 12 weeks of treatment, decrease in the HAM-A score was significantly associated with improvement of subjective cognitive impairments on memory (p<0.001) and concentration (p<0.001), and objective measures on delayed memory (p=0.006) and reasoning ability (p=0.002), after adjusting for covariates such as baseline HAM-A scores, time, sex, age, education years and assigned medication using the Mixed effects and Generalized Estimated Equation model analysis. However, the other cognitive outcome variables, immediate memory, commission error, and MMSE, which showed significant improvement through 12-week study period, showed no significant association with improvement of anxiety. CONCLUSION Improvement of anxiety symptoms was significantly associated with improvement in subjective and objective neurocognitive functions such as delayed memory and reasoning ability in elderly MDD patients during antidepressant treatment, but not significantly associated with improvement of immediate memory and commission error. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01309776.
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Affiliation(s)
- Ikki Yoo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Min Woo
- Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Ilsan Paik Hospital, Inje University School of Medicine, Ilsan, Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - George I Papakostas
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Eui-Joong Kim
- Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Hyun Ha
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Abstract
Anxiety disorders are highly prevalent among the elderly and are associated with increased disability, poor quality of life, and cognitive impairment. Despite this high prevalence and associated morbidities, anxiety disorders in late life are underreported and understudied. In this article, we discuss the epidemiology, disease presentation, and current treatment of anxiety disorders in older adults. We also discuss limitations in the current understanding of such disorders in this population, as well as future research directions that may reveal the mechanisms and rationale for treatment regimens for anxiety disorders in late life. We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders.
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Tifratene K, Robert P, Metelkina A, Pradier C, Dartigues JF. Progression of mild cognitive impairment to dementia due to AD in clinical settings. Neurology 2015; 85:331-8. [PMID: 26136516 DOI: 10.1212/wnl.0000000000001788] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/26/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe the positive predictive value of mild cognitive impairment (MCI) and the factors associated with progression in routine practice. METHODS A retrospective cohort study was conducted from the French National Alzheimer Database. Among 446,439 patients cared for in the participating centers between January 2009 and January 2014, 45,386 (10.2%) were classified as having MCI and 23,676 had at least one follow-up visit. Annual progression rate was used to describe the progression of patients with MCI to dementia due to Alzheimer disease. Hazard ratios of dementia due to Alzheimer disease were estimated using Cox regression model. RESULTS Annual progression rate (95% confidence interval) was 13.7% person-years (py) (13.5%-13.9%) with higher rate for amnestic MCI (aMCI) (18.2% py [17.9%-18.5%]) than for nonamnestic MCI (naMCI) (9.5% py [9.3%-9.6%]). Separate regression models were performed for each MCI subtype. Higher education, older age, female sex, and lower Mini-Mental State Examination score were associated with an increased risk of progression for both subtypes. Use of anxiolytics (adjusted hazard ratio [95% confidence interval]: 0.77 [0.66-0.91]) was a protective factor for aMCI whereas antidepressant drugs (1.16 [1.04-1.29]) were associated with an increased risk. For naMCI, prescriptions of antidepressants (0.85 [0.74-0.98]) and antipsychotics (0.55 [0.32-0.93]) were protective for progression. CONCLUSIONS Under circumstances emulating routine clinical practice, the positive predictive value of an MCI diagnosis is in line with previous clinical studies and the external validity of the concept is strengthened. Distinguishing between aMCI and naMCI is particularly relevant.
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Affiliation(s)
- Karim Tifratene
- From the Department of Public Health (K.T.) and CMRR de Nice (P.R.), CHU de Nice and EA Cobtek, Université de Nice Sophia Antipolis, Nice; Laboratoire d'Informatique (A.M.), Signaux et Systèmes de Sophia-Antipolis (I3S), UMR 7271, UNS CNRS; Department of Public Health (C.P.), CHU de Nice; and ISPED (J.F.D.), Université de Bordeaux, INSERM U897, France.
| | - Philippe Robert
- From the Department of Public Health (K.T.) and CMRR de Nice (P.R.), CHU de Nice and EA Cobtek, Université de Nice Sophia Antipolis, Nice; Laboratoire d'Informatique (A.M.), Signaux et Systèmes de Sophia-Antipolis (I3S), UMR 7271, UNS CNRS; Department of Public Health (C.P.), CHU de Nice; and ISPED (J.F.D.), Université de Bordeaux, INSERM U897, France
| | - Asya Metelkina
- From the Department of Public Health (K.T.) and CMRR de Nice (P.R.), CHU de Nice and EA Cobtek, Université de Nice Sophia Antipolis, Nice; Laboratoire d'Informatique (A.M.), Signaux et Systèmes de Sophia-Antipolis (I3S), UMR 7271, UNS CNRS; Department of Public Health (C.P.), CHU de Nice; and ISPED (J.F.D.), Université de Bordeaux, INSERM U897, France
| | - Christian Pradier
- From the Department of Public Health (K.T.) and CMRR de Nice (P.R.), CHU de Nice and EA Cobtek, Université de Nice Sophia Antipolis, Nice; Laboratoire d'Informatique (A.M.), Signaux et Systèmes de Sophia-Antipolis (I3S), UMR 7271, UNS CNRS; Department of Public Health (C.P.), CHU de Nice; and ISPED (J.F.D.), Université de Bordeaux, INSERM U897, France
| | - Jean François Dartigues
- From the Department of Public Health (K.T.) and CMRR de Nice (P.R.), CHU de Nice and EA Cobtek, Université de Nice Sophia Antipolis, Nice; Laboratoire d'Informatique (A.M.), Signaux et Systèmes de Sophia-Antipolis (I3S), UMR 7271, UNS CNRS; Department of Public Health (C.P.), CHU de Nice; and ISPED (J.F.D.), Université de Bordeaux, INSERM U897, France
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Fernández-Blázquez M, Ávila-Villanueva M, López-Pina J, Zea-Sevilla M, Frades-Payo B. Psychometric properties of a new short version of the State-Trait Anxiety Inventory (STAI) for the assessment of anxiety in the elderly. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ramakers IH, Honings ST, Ponds RW, Aalten P, Köhler S, Verhey FR, Visser PJ. The Effect of Psychological Distress and Personality Traits on Cognitive Performances and the Risk of Dementia in Patients with Mild Cognitive Impairment. J Alzheimers Dis 2015; 46:805-12. [DOI: 10.3233/jad-142493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Inez H.G.B. Ramakers
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Steven T.H. Honings
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Rudolf W. Ponds
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
- Department of Neurology, Alzheimer Center VU Medical Center, Amsterdam, The Netherlands
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Mah L, Binns MA, Steffens DC. Anxiety symptoms in amnestic mild cognitive impairment are associated with medial temporal atrophy and predict conversion to Alzheimer disease. Am J Geriatr Psychiatry 2015; 23:466-76. [PMID: 25500120 PMCID: PMC4390420 DOI: 10.1016/j.jagp.2014.10.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 10/14/2014] [Accepted: 10/21/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To test the hypothesis that anxiety in amnestic mild cognitive impairment (aMCI) increases rates of conversion to Alzheimer disease (AD) and to identify potential neural mechanisms underlying such an association. METHODS Participants (N = 376) with aMCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were studied over a median period of 36 months. A Cox proportional-hazards model was used to assess the association between anxiety severity ratings on the Neuropsychiatric Inventory Questionnaire and AD risk. Other variables were depression, memory loss, and MRI-derived AD-related regions of interest (ROIs), including hippocampal, amygdalar, entorhinal cortical (EC) volumes, and EC thickness, In addition, a linear regression model was used to determine the effect of anxiety in aMCI on rates of atrophy within ROIs. RESULTS Anxiety severity increased rate of aMCI conversion to AD, after controlling for depression and cognitive decline. The association between anxiety and AD remained significant even with inclusion of ROI baseline values or atrophy rates as explanatory variables. Further, anxiety status predicted greater rates of decrease in EC volume. An association between anxiety and EC thickness missed significance. CONCLUSION Anxiety symptoms in aMCI predict conversion to AD, over and beyond the effects of depression, memory loss, or atrophy within AD neuroimaging biomarkers. These findings, together with the greater EC atrophy rate predicted by anxiety, are compatible with the hypothesis that anxiety is not a prodromal noncognitive feature of AD but may accelerate decline toward AD through direct or indirect effects on EC.
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Affiliation(s)
- Linda Mah
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada; Division of Geriatric Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Malcolm A Binns
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT
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Arevalo‐Rodriguez I, Smailagic N, Roqué i Figuls M, Ciapponi A, Sanchez‐Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S. Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2015; 2015:CD010783. [PMID: 25740785 PMCID: PMC6464748 DOI: 10.1002/14651858.cd010783.pub2] [Citation(s) in RCA: 304] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. OBJECTIVES To determine the diagnostic accuracy of the MMSE at various thresholds for detecting individuals with baseline MCI who would clinically convert to dementia in general, Alzheimer's disease dementia or other forms of dementia at follow-up. SEARCH METHODS We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. SELECTION CRITERIA We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. DATA COLLECTION AND ANALYSIS We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. MAIN RESULTS In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. AUTHORS' CONCLUSIONS Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.
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Affiliation(s)
- Ingrid Arevalo‐Rodriguez
- Fundación Universitaria de Ciencias de la Salud ‐ Hospital San Jose/ Hospital Infantil de San JoseDivision of ResearchCarrera 19 Nº 8a ‐ 32Bogotá D.C.Colombia11001
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaSpain08041
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health PolicyArgentine Cochrane Centre IECS ‐ Southern American Branch of the Iberoamerican Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresArgentinaC1414CPV
| | - Erick Sanchez‐Perez
- Hospital Infantil Universitario de San José‐FUCSNeurosciencesCra 52 67A‐51BogotáColombia11001000
| | - Antri Giannakou
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS82PS
| | - Olga L Pedraza
- Hospital Infantil Universitario de San José‐FUCSNeurosciencesCra 52 67A‐51BogotáColombia11001000
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret, 167Pavilion 18 (D‐13)BarcelonaSpain08025
| | - Sarah Cullum
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS82PS
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Banks SJ, Raman R, He F, Salmon DP, Ferris S, Aisen P, Cummings J. The Alzheimer's disease cooperative study prevention instrument project: longitudinal outcome of behavioral measures as predictors of cognitive decline. Dement Geriatr Cogn Dis Extra 2014; 4:509-16. [PMID: 25685141 PMCID: PMC4307008 DOI: 10.1159/000357775] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Methods The Alzheimer's Disease Cooperative Study Prevention Instrument Project is a longitudinal study that recruited 644 cognitively healthy older subjects (aged between 75 and 93 years, 58% women) at baseline and evaluated their cognitive change over 4 years. The study was structured like a clinical trial to anticipate a prevention trial and to determine the performance of novel trial instruments in a longitudinal non-interventional trial framework. Behavioral symptoms were assessed at baseline. Results The existence of participant-reported behavioral symptoms at baseline predicted conversion to Clinical Dementia Rating scale score ≥0.5 over the 4-year period. Conclusions The results imply that early anxiety and depression may be harbingers of future cognitive decline, and that patients exhibiting such symptoms, even in the absence of co-occurring cognitive symptoms, should be closely followed over time.
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Affiliation(s)
- Sarah Jane Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
| | - Rema Raman
- University of California, San Diego, Calif., USA
| | - Feng He
- University of California, San Diego, Calif., USA
| | | | - Steven Ferris
- New York University Langone Medical Center, New York, N.Y., USA
| | - Paul Aisen
- University of California, San Diego, Calif., USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
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de Bruijn RFAG, Direk N, Mirza SS, Hofman A, Koudstaal PJ, Tiemeier H, Ikram MA. Anxiety is not associated with the risk of dementia or cognitive decline: the Rotterdam Study. Am J Geriatr Psychiatry 2014; 22:1382-90. [PMID: 24745561 DOI: 10.1016/j.jagp.2014.03.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/07/2014] [Accepted: 03/05/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Anxiety and depression frequently co-occur in the elderly and in patients with dementia. Prior research has shown that depression is related to the risk of dementia, but the effect of anxiety on dementia remains unclear. We studied whether anxiety symptoms and anxiety disorders are associated with the risk of dementia and cognition. METHODS We studied 2,708 nondemented participants from the prospective, population-based Rotterdam Study who underwent the Hospital Anxiety and Depression Scale (HADS) (sample I, baseline 1993-1995) and 3,069 nondemented participants who underwent screening for anxiety disorders (sample II, baseline 2002-2004). In 1993-1995, anxiety symptoms were assessed using the HADS. In 2002-2004, anxiety disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In both study samples, participants were continuously monitored for dementia until January 1, 2011. Cognition was tested in 2002-2004 and at a follow-up visit in 2009-2011 in sample II only. RESULTS In sample I, 358 persons developed dementia, and in sample II, 248 persons developed dementia. We did not find an association with the risk of dementia for anxiety symptoms (hazard ratio 1.05, 95% confidence interval: 0.77-1.43, Wald statistic 0.08, p = 0.77, df = 1) or for anxiety disorders (hazard ratio 0.92, 95% confidence interval: 0.58-1.45, Wald statistic 0.14, p = 0.71, df = 1). We could demonstrate an association of anxiety disorders with poor cognition cross-sectionally, but this attenuated after additional adjustments. CONCLUSION Our findings do not offer evidence for an association between anxiety symptoms or anxiety disorders with the risk of dementia or with cognition. This suggests that anxiety is not a risk factor nor a prodrome of dementia in an elderly, community-dwelling population.
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Affiliation(s)
- Renée F A G de Bruijn
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands
| | - Nese Direk
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Saira Saeed Mirza
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands.
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Diefenbach GJ, Bragdon LB, Blank K. Geriatric anxiety inventory: factor structure and associations with cognitive status. Am J Geriatr Psychiatry 2014; 22:1418-26. [PMID: 23954040 DOI: 10.1016/j.jagp.2013.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 04/09/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The factor structure and clinical correlates of the Geriatric Anxiety Inventory were determined within a sample of patients with cognitive impairment. METHODS Using a cross-sectional design, data were collected within an outpatient Memory Disorders Center. Clinical participants were diagnosed with either mild dementia (N = 45) or cognitive impairment, no dementia (N = 55). A comparison group of participants without subjective memory complaints (N = 50) was also included. The Geriatric Anxiety Inventory was administered and scored as both the 20-item version and 5-item short form. Measures of cognitive status, depressive symptoms, and functioning were also completed. RESULTS Clinical participants reported more severe anxiety than did participants in the comparison group; however, the two patient groups did not differ. Principal components analysis revealed a four-factor structure of the Geriatric Anxiety Inventory. Item endorsement on factors characterized by excessive worry and difficulty making decisions were associated with a nearly twofold (odds ratio [OR]: 1.86) and nearly sixfold (OR: 5.70) odds of having cognitive impairment, respectively. The short-form version was composed of a single factor, and item endorsement was associated with a twofold increased odds of having cognitive impairment (OR: 2.02). CONCLUSION Psychometric properties of the Geriatric Anxiety Inventory are acceptable among patients with cognitive impairment. Anxiety symptoms were common, and symptoms characterized by excessive worry and difficulty making decisions demonstrated the strongest associations with cognitive status.
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Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT; Yale University School of Medicine, New Haven, CT.
| | - Laura B Bragdon
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT
| | - Karen Blank
- Memory Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT; University of Connecticut Health Science Center, Farmington, CT
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Association entre l’anxiété et le déclin cognitif chez les personnes âgées vivant dans la communauté. Can J Aging 2014; 33:296-306. [DOI: 10.1017/s0714980814000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTThe present study was conducted to determine whether anxiety among community-dwelling elders is associated with cognitive decline over a period of one year as well as to verify whether there are sex differences in the association between anxiety and cognitive decline. Participants (n=1942) were community-dwelling adults aged 65–96 years assessed at study entry (T0) and one year later (T1). Anxiety was identified with a semi-structured interview and cognitive functioning was assessed using the Mini-Mental State Examination. Results revealed that the presence of a clinically significant anxiety disorder did not predict cognitive decline in men and women. Subclinical anxiety symptoms predicted cognitive decline in women only. Moreover, for men, the presence of symptoms from at least two anxiety disorders predicted cognitive decline. For women, cognitive decline was predicted by the presence of symptoms from one anxiety disorder only. Overall, the results illustrate the role of anxiety in cognitive decline in community-dwelling older adults.
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Moon Y, Kim HJ, Choi H, Oh SI, Han SH. Validity of the Korean version of the fear of Alzheimer's disease scale for the assessment of anticipatory dementia. J Korean Med Sci 2014; 29:411-5. [PMID: 24616592 PMCID: PMC3945138 DOI: 10.3346/jkms.2014.29.3.411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/19/2013] [Indexed: 11/20/2022] Open
Abstract
Anticipatory dementia is related to anxiety, which is a clinical predictor of early conversion to Alzheimer's disease. The Fear of Alzheimer's Disease Scale (FADS) is a reliable and valid instrument to address anticipatory dementia. The aim of the present investigation was to develop the Korean version of the Fear of Alzheimer's Disease Scale (K-FADS) and to verify its reliability and validity. We developed the K-FADS to consist of 30 items with total scores ranging from 0 to 120, as in the original FADS. One hundred eight healthy volunteer participants, drawn from 3 different university hospitals, were evaluated. The K-FADS revealed good reliability (Cronbach α=0.96) and good validity as compared to the Korean version of the State-Trait Anxiety Inventory Form (r=0.242, P=0.013). Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.98 (95% confidence interval, 0.96-0.99). Our results show that the K-FADS is a suitable and valuable scale to assess anticipatory dementia in elderly Koreans.
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Affiliation(s)
- Yeonsil Moon
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Hee-Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Hojin Choi
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
| | - Seong-il Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
- Center for Geriatric Neuroscience Research, Institute of Biomedical Science, Konkuk Medical Science Research Center, Konkuk University, Seoul, Korea
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Fernández-Blázquez MA, Ávila-Villanueva M, López-Pina JA, Zea-Sevilla MA, Frades-Payo B. Psychometric properties of a new short version of the State-Trait Anxiety Inventory (STAI) for the assessment of anxiety in the elderly. Neurologia 2014; 30:352-8. [PMID: 24484757 DOI: 10.1016/j.nrl.2013.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/10/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Anxiety has negative effects on the cognitive performance and psychosocial adjustment of elderly people. Given the high prevalence of anxiety symptoms in patients suffering from cognitive impairment, it has been suggested that these symptoms may be an early marker of dementia. The State-Trait Anxiety Inventory (STAI) is one of the most widely-used scales for evaluating anxiety in elderly people. However, inasmuch as the STAI may be difficult to apply to older people, having a short form of it would be desirable. METHODS The participants comprised 489 community-dwelling individuals aged 68 years and over. All of them were volunteers in a longitudinal study for early detection of Alzheimer' Disease (Proyecto Vallecas). The full sample was divided in two homogeneous subgroups: Group A, used to reduce the number of items and response options, and Group B, the group used to determine the psychometric properties of the new short form (STAIr). RESULTS A dichotomous Rasch model was used to obtain the STAIr. No statistically significant differences for STAIr scores were found with respect to sociodemographic variables. Psychometric properties and normative data were obtained for the new short version. CONCLUSIONS The STAIr is composed of 13 items and data fits the model well. Since it is short and easy to apply to elderly people, STAIr will be very useful in clinical and research settings.
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Affiliation(s)
- M A Fernández-Blázquez
- Unidad de Investigación Proyecto Alzheimer, Fundación CIEN, Instituto de Salud Carlos III, Centro Alzheimer Fundación Reina Sofía, Madrid, España; Servicio de Neurología, Hospital Sanitas La Moraleja, Madrid, España.
| | - M Ávila-Villanueva
- Unidad de Investigación Proyecto Alzheimer, Fundación CIEN, Instituto de Salud Carlos III, Centro Alzheimer Fundación Reina Sofía, Madrid, España
| | - J A López-Pina
- Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Murcia, España
| | - M A Zea-Sevilla
- Unidad de Investigación Proyecto Alzheimer, Fundación CIEN, Instituto de Salud Carlos III, Centro Alzheimer Fundación Reina Sofía, Madrid, España
| | - B Frades-Payo
- Unidad de Investigación Proyecto Alzheimer, Fundación CIEN, Instituto de Salud Carlos III, Centro Alzheimer Fundación Reina Sofía, Madrid, España
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Abstract
SummaryThis systematic review, with meta-analyses conducted where data were available, aimed to investigate the prevalence of symptoms of depression and anxiety in mild cognitive impairment (MCI), and to establish how symptoms of depression and anxiety relate to the progression from no cognitive impairment to MCI, and from MCI to dementia. Sixty studies were included in the review. Meta-analyses indicated that symptoms of depression and anxiety were more prevalent in people with MCI than in people with normal cognitive function, and increased the risk of progression from no cognitive impairment to MCI. There were mixed results regarding the effect of such symptoms on progression from MCI to dementia. The findings highlight the need for more research in this area, which can inform attempts to slow or halt the progression of cognitive impairment in later life, with resulting benefits for quality of life.
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Ramakers IHGB, Verhey FRJ, Scheltens P, Hampel H, Soininen H, Aalten P, Rikkert MO, Verbeek MM, Spiru L, Blennow K, Trojanowski JQ, Shaw LM, Visser PJ. Anxiety is related to Alzheimer cerebrospinal fluid markers in subjects with mild cognitive impairment. Psychol Med 2013; 43:911-920. [PMID: 22954311 PMCID: PMC4104501 DOI: 10.1017/s0033291712001870] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anxiety, apathy and depression are common in subjects with mild cognitive impairment (MCI) and may herald Alzheimer's disease (AD). We investigated whether these symptoms correlated with cerebrospinal fluid (CSF) markers for AD in subjects with MCI. Method Subjects with MCI (n=268) were selected from the 'Development of screening guidelines and criteria for pre-dementia Alzheimer's disease' (DESCRIPA) and Alzheimer's Disease Neuroimaging Initiative (ADNI) studies. We measured amyloid β(1-42) protein (Aβ42) and total tau (t-tau) in CSF. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory. RESULTS Depressive symptoms were reported by 55 subjects (21%), anxiety by 35 subjects (13%) and apathy by 49 subjects (18%). The presence of anxiety was associated with abnormal CSF Aβ42 [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6-3.3] and t-tau (OR 2.6, 95% CI 1.9-3.6) concentrations and with the combination of abnormal concentrations of both Aβ42 and t-tau (OR 3.1, 95% CI 2.0-4.7). The presence of agitation and irritability was associated with abnormal concentrations of Aβ42 (agitation: OR 1.6, 95% CI 1.1-2.3; irritability: OR 2.2, 95% CI 1.5-3.3). Symptoms of depression and apathy were not related to any of the CSF markers. CONCLUSIONS In subjects with MCI, symptoms of anxiety, agitation and irritability may reflect underlying AD pathology, whereas symptoms of depression and apathy do not.
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Affiliation(s)
- I H G B Ramakers
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands.
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Norton J, Ancelin ML, Stewart R, Berr C, Ritchie K, Carrière I. Anxiety symptoms and disorder predict activity limitations in the elderly. J Affect Disord 2012; 141:276-85. [PMID: 22560597 DOI: 10.1016/j.jad.2012.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND In the elderly, little attention has been paid to anxiety both on a symptom dimension and as a disorder, as an independent risk factor for the incidence of activity limitations. METHODS In a community-dwelling cohort of 1581 persons aged 65+, the association between trait anxiety symptoms (Spielberger Trait, third highest tertile) and baseline DSM-IV anxiety disorder, and 7-year incident activity limitations was determined using mixed logistic regression models. Repeated measures of activity limitations included, by increased severity level: social restriction (neighbourhood and house confined), mobility (Rosow and Breslau scale) and limitations in instrumental activities of daily living (IADL). RESULTS Of the sample, 14.2% had an anxiety disorder at baseline. Adjusting for baseline socio-demographic and health variables, depression (past and current), antidepressant and anxiolytic drugs, baseline anxiety disorder was associated with an increased risk of incident IADL limitation (OR (95% CI): 1.84 (1.01-3.39), p=0.048) and trait anxiety with increased incidence of social restriction (OR (95% CI): 2.41 (1.42-4.09), p=0.001). Associations remained significant in participants free of depressive symptoms at baseline (OR (95% CI): 2.92 (1.41-6.05), p=0.004; OR (95% CI): 3.21 (1.31-7.89), p=0.011, respectively). LIMITATIONS Activity limitations were self-reported and may have been over-reported in participants with anxiety. CONCLUSION Both trait anxiety symptomatology and anxiety disorder were independently associated with increased incidence of activity limitations with a gradient of severity: trait anxiety associated with incident social restriction and anxiety disorder with more severe IADL limitations, suggesting that anxiety is a predictor of activity limitations in the elderly independently of depression comorbidity.
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Affiliation(s)
- Joanna Norton
- Inserm, U1061, Montpellier, F-34093, France; University Montpellier 1, Montpellier, F-34000, France.
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Potvin O, Lorrain D, Forget H, Dubé M, Grenier S, Préville M, Hudon C. Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults. Sleep 2012; 35:491-9. [PMID: 22467987 DOI: 10.5665/sleep.1732] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine in cognitively intact older men and women the associations between subjective sleep quality and 1-yr incident cognitive impairment. DESIGN Prospective cohort study. SETTING General community. PARTICIPANTS 1,664 cognitively intact individuals age 65 to 96 years. MEASUREMENTS AND RESULTS Sleep quality at baseline was measured using the Pittsburgh Sleep Quality Index (PSQI). Cognitive functioning was assessed at baseline and 12 months later using the Mini-Mental State Examination (MMSE). Incident general cognitive impairment was defined according to a follow-up MMSE score below the 15(th) percentile according to normative data and of at least 2 points below baseline. General cognitive impairments were also separated into amnestic and nonamnestic subtypes according to MMSE delayed recall performance. Associations between sleep quality indicators at baseline and incident cognitive impairment were assessed by odds ratio (OR) adjusted for age, education, baseline MMSE score, psychotropic drug use, anxiety, depressive episodes, cardiovascular conditions, and chronic diseases. Results revealed that global PSQI score was significantly linked with incident cognitive impairment (OR 1.17, 95% confidence interval (CI) 1.05-1.30) in men, but not in women. In women, sleep disturbance score (OR 2.62, 95% CI 1.41-4.86) and long sleep duration (≥ 9 hr; OR 3.70, 95% CI 1.49-9.17) were associated with nonamnestic and amnestic incident cognitive impairment, respectively. In men, short sleep duration (≤ 5 hr; OR 4.95, 95% CI 1.72-14.27) and habitual sleep efficiency score (OR 1.94, 95% CI 1.42-2.66) were associated with amnestic and general incident cognitive impairment, respectively. CONCLUSIONS Sleep quality in older adults should receive particular attention by clinicians because poor sleep quality can be an early sign of cognitive decline.
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Potvin O, Hudon C, Dion M, Grenier S, Préville M. Anxiety disorders, depressive episodes and cognitive impairment no dementia in community-dwelling older men and women. Int J Geriatr Psychiatry 2011; 26:1080-8. [PMID: 21905102 DOI: 10.1002/gps.2647] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/14/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anxiety symptoms are highly prevalent in elders with mild cognitive disorders, but little is known about the associations of specific anxiety disorders to mild cognitive disorders. OBJECTIVE To identify the clinical and subclinical anxiety disorders associated with cognitive impairment no dementia (CIND) and to determine whether these associations differ depending on sex and concomitant depressive episodes. METHOD Participants constituted a random sample (n = 2414) of community-dwelling adults aged 65-96 years. The following clinical and subclinical DSM-IV anxiety disorders were identified with a semi-structured interview: specific phobia, social phobia, agoraphobia, panic disorder, obsessive-compulsive, and generalized anxiety disorder (GAD). Major depressive episodes or minor depression (MDE/MD) were also determined based on the DSM-IV criteria. CIND cases were defined based on Mini-Mental State Examination (MMSE) cut-offs (15th percentile) stratified for age, education, and sex. Potentially confounding variables (age, education, MDE/MD, chronic diseases, and psychotropic drug use) were statistically controlled. RESULTS In men, after adjusting for confounding variables, CIND was associated with subclinical GAD (odds ratio (OR): 4.93, 95% confidence interval: 1.84-13.23). Further analyses showed that in men, CIND was related to clinical/subclinical GAD whether MDE/MD was present (7.05, 1.88-26.43) or absent (9.33, 3.24-26.83). In women, CIND was not linked to any clinical or subclinical anxiety disorder. CONCLUSIONS These results suggest that in community-dwelling elders, GAD is the main anxiety disorder associated with poor global cognitive functioning. Moreover, this association is modified by sex, but not by the presence of depressive episodes.
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Affiliation(s)
- Olivier Potvin
- Centre de Recherche de l'Hôpital Charles LeMoyne, Longueuil, Québec, Canada.
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Potvin O, Forget H, Grenier S, Préville M, Hudon C. Anxiety, Depression, and 1-Year Incident Cognitive Impairment in Community-Dwelling Older Adults. J Am Geriatr Soc 2011; 59:1421-8. [DOI: 10.1111/j.1532-5415.2011.03521.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
OBJECTIVE To identify the components of the neuroticism trait most responsible for its association with cognitive decline and dementia in old age. DESIGN Longitudinal clinical-pathologic cohort study. SETTING Chicago metropolitan area. PARTICIPANTS A total of 785 older persons without dementia completed standard self-report measures of six components of neuroticism and then had annual clinical evaluations for a mean of 3.4 years and brain autopsy in the event of death. MEASUREMENTS Incidence of clinically diagnosed Alzheimer disease (AD), change in global and specific cognitive functions, and postmortem measures of plaques and tangles, cerebral infarction, and Lewy bodies. RESULTS During follow-up, 94 individuals developed AD. Higher levels of anxiety and vulnerability to stress were associated with increased risk of AD and more rapid decline in global cognition, with no effects for the other four trait components. In analyses of specific cognitive systems, neuroticism subscales were related to decline in episodic memory, working memory, and perceptual speed, but not in semantic memory or visuospatial ability. No component of neuroticism was related to the neuropathologic lesions most commonly associated with late-life dementia. CONCLUSIONS Neuroticism's association with late-life dementia mainly reflects vulnerability to stress and anxiety and their correlation with decline in the ability to process and retain new information.
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Gallagher D, Coen R, Kilroy D, Belinski K, Bruce I, Coakley D, Walsh B, Cunningham C, Lawlor BA. Anxiety and behavioural disturbance as markers of prodromal Alzheimer's disease in patients with mild cognitive impairment. Int J Geriatr Psychiatry 2011; 26:166-72. [PMID: 21229599 DOI: 10.1002/gps.2509] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression and anxiety have been reported to be independently predictive of conversion to Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI). Anxiety symptoms have been less well studied and findings in this regard have been inconsistent. The objectives of this study are to determine which symptoms among a range of neuropsychiatric symptoms known to commonly occur in patients with MCI are predictive of later conversion to AD. We also wish to determine whether these symptoms track existing measures of declining cognitive and functional status or may be considered distinct and sensitive biomarkers of evolving Alzheimer's pathology. METHODS One hundred and sixty-one patients with MCI were identified from consecutive referrals to a memory clinic. Univariate, multivariate and cox regression analyses were conducted. RESULTS Seventy-six per cent of all patients had at least one neuropsychiatric symptom at baseline of which anxiety (52%), affective disturbance (37%) and aggression (32%) were the most common. Increasing symptom frequency was observed with increasing clinical severity. Anticipatory anxiety and activity disturbances were significantly associated with earlier conversion to AD although this association did not remain significant following adjustment for cognitive status at baseline. CONCLUSION Neuropsychiatric symptoms and anxiety symptoms in particular are common in patients with MCI. In this sample anxiety for upcoming events and purposeless activity frequently co-occurred and were significant clinical predictors of earlier conversion to AD. However, these findings were not independent of cognitive status at baseline and therefore may be markers of severity rather than independent predictors of disease progression.
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Affiliation(s)
- Damien Gallagher
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland.
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Current world literature. Curr Opin Psychiatry 2011; 24:78-87. [PMID: 21116133 DOI: 10.1097/yco.0b013e3283423055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Prevalence of neuropsychiatric symptoms in chinese older persons with mild cognitive impairment-a population-based study. Am J Geriatr Psychiatry 2010; 18:948-54. [PMID: 20808089 DOI: 10.1097/jgp.0b013e3181d69467] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To estimate the point prevalence and correlates of neuropsychiatric (NP) symptoms among older adults with mild cognitive impairment (MCI) and normal cognition (NC) in a Chinese community. DESIGN Cross-sectional study derived from a population-based prevalence study of MCI and dementia. SETTING AND PARTICIPANTS This survey was conducted in Hong Kong from 2005 to 2006. Seven hundred eighty-eight community-dwelling older adults (450 NC and 338 MCI) were recruited. Cognitive and NP data were obtained. RESULTS The point prevalence of at least one NP symptom in NC and MCI were 29% and 36.7%, respectively (logistic regression controlled for age and education, odds ratio = 1.38, 95% confidence interval [CI]: 1.01-1.89, Wald χ = 4.10, df = 1, p = 0.04). Agitation (1.8% versus 5.1%), apathy (7.6% versus 15.2%), and irritability (4.2% versus 8%) were more prevalent in subjects with MCI (p <0.05). Logistic regression analyses showed that apathy score was a significant factor associated with the status of NC or MCI (logistic regression, apathy, p = 0.031, Exp(B) = 1.23, 95% CI: 1.02-1.47; Hosmer and Lemeshow test, χ = 8.6, df = 8, p = 0.38, R = 0.23). CONCLUSIONS The authors reported the findings of one of the first population-based studies estimating the point prevalence of NP symptoms in Asian older adults with MCI. Taking into account of its prevalence and magnitude of effects, apathy is a clinically significant symptom in MCI. Its predictive value for conversion to dementia warrants further evaluation.
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