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Akhgarjand C, Vahabi Z, Shab-Bidar S, Anoushirvani A, Djafarian K. The effects of probiotic supplements on oxidative stress and inflammation in subjects with mild and moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled study. Inflammopharmacology 2024; 32:1413-1420. [PMID: 38319476 DOI: 10.1007/s10787-023-01427-2] [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: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024]
Abstract
Through modulating effects on the gut-brain axis, probiotics are an effective adjuvant treatment for Alzheimer's disease (AD), one of our century's most important medical care challenges (Agahi et al. Front Neurol 9:662, 2018). This trial aimed to examine the effects of two different single-strain probiotics on oxidative stress and inflammation in patients with mild and moderate AD. This was a 12-week placebo-controlled, double-blind, randomized clinical trial performed on 90 patients with AD. Eligible patients were randomly assigned to two different interventions (Lacticaseibacillus rhamnosus HA-114 (7.5 × 109) or Bifidobacterium longum R0175 (7.5 × 109)) and a placebo group, supplemented twice daily. We used mixed-effect models to examine the probiotic's independent effects on clinical results. Significant improvements in serum inflammatory and oxidative stress markers were observed at the end of the trial (P < 0.05). Probiotic supplementation for 12 weeks had beneficial effects on oxidative stress, inflammation, quality of life, and physical activity in patients with mild and moderate AD.
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Affiliation(s)
- Camellia Akhgarjand
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Cognitive Neurology and Neuropsychiatry Division, Psychiatry Department, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Geriatric Department, Ziaeeian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliarash Anoushirvani
- Department of Internal Medicine, School of Medicine, Firoozgar General Hospital, Iran University of Medical Science, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Crump C, Sieh W, Vickrey BG, Edwards AC, Sundquist J, Sundquist K. Risk of depression in persons with Alzheimer's disease: A national cohort study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12584. [PMID: 38623385 PMCID: PMC11016814 DOI: 10.1002/dad2.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Depression is a risk factor and possible prodromal symptom of Alzheimer's disease (AD), but little is known about subsequent risk of developing depression in persons with AD. METHODS National matched cohort study was conducted of all 129,410 persons diagnosed with AD and 390,088 with all-cause dementia during 1998-2017 in Sweden, and 3,900,880 age- and sex-matched controls without dementia, who had no prior depression. Cox regression was used to compute hazard ratios (HRs) for major depression through 2018. RESULTS Cumulative incidence of major depression was 13% in persons with AD and 3% in controls. Adjusting for sociodemographic factors and comorbidities, risk of major depression was greater than two-fold higher in women with AD (HR, 2.21; 95% confidence interval [CI], 2.11-2.32) or men with AD (2.68; 2.52-2.85), compared with controls. Similar results were found for all-cause dementia. DISCUSSION Persons diagnosed with AD or related dementias need close follow-up for timely detection and treatment of depression. Highlights In a large cohort, women and men with AD had >2-fold subsequent risk of depression.Risks were highest in the first year (>3-fold) but remained elevated ≥3 years later.Risk of depression was highest in persons aged ≥85 years at AD diagnosis.Persons with AD need close follow-up for detection and treatment of depression.
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Affiliation(s)
- Casey Crump
- Departments of Family and Community Medicine and of EpidemiologyThe University of Texas Health Science CenterHoustonTexasUSA
| | - Weiva Sieh
- Department of EpidemiologyThe University of Texas M. D. Anderson Cancer CenterHoustonTexasUSA
| | - Barbara G. Vickrey
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alexis C. Edwards
- Department of PsychiatryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jan Sundquist
- Department of Clinical SciencesCenter for Primary Health Care ResearchLund UniversityMalmöSweden
| | - Kristina Sundquist
- Department of Clinical SciencesCenter for Primary Health Care ResearchLund UniversityMalmöSweden
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Armstrong MJ, LaBarre B, Sovich K, Maixner SM, Paulson HL, Manning C, Fields JA, Lunde A, Forsberg L, Boeve BF, Galvin JE, Taylor AS, Li Z. Patient- and proxy-reported quality of life in advanced dementia with Lewy bodies. Alzheimers Dement 2024; 20:2719-2730. [PMID: 38400528 PMCID: PMC11032544 DOI: 10.1002/alz.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Little is known regarding quality of life (QoL) in dementia with Lewy bodies (DLB), particularly in advanced stages. METHODS Dyads of individuals with moderate-advanced DLB and their primary caregivers were recruited from specialty clinics, advocacy organizations, and research registries. The study collected demographics, disease-related measures, and measures of patient/caregiver experiences. RESULTS The Quality of Life in Alzheimer's Disease (QoL-AD) was completed by the person with DLB and the caregiver (proxy) in 61 dyads; 85 dyads had only a proxy-completed QoL-AD. Patient- and proxy-reported scores were moderately correlated (r = 0.57, P < 0.0001). Worse patient-reported QoL correlated with daytime sleepiness, autonomic symptom burden, and behavioral symptoms. Proxy ratings correlated with dementia severity, daytime sleepiness, behavioral symptoms, dependence in activities of daily living, and caregiver experience measures. DISCUSSION Patient- and proxy-reported quality of life (QoL) should be assessed separately in advanced DLB. Some symptoms associated with QoL have available therapeutic options. Research is needed regarding strategies to optimally improve QoL in DLB. HIGHLIGHTS Patient and proxy quality of life (QoL) ratings had moderate correlation in advanced dementia with Lewy bodies. Daytime sleepiness affected patient- and proxy-reported QoL. Behavioral symptoms affected patient- and proxy-reported QoL. Autonomic symptom burden affected patient-reported QoL. Dementia severity, dependence, and caregiver experiences affected proxy ratings.
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Affiliation(s)
- Melissa J. Armstrong
- Department of NeurologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
- Norman Fixel Institute for Neurological DiseasesGainesvilleFloridaUSA
| | - Brian LaBarre
- Department of BiostatisticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Kaitlin Sovich
- Department of NeurologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Susan M. Maixner
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - Henry L. Paulson
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Carol Manning
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Angela Lunde
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Leah Forsberg
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - James E. Galvin
- Comprehensive Center for Brain HealthDepartment of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | - Zhigang Li
- Department of BiostatisticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
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Chekani F. Authors' Response to the Letter to the Editor Entitled: How Can We Interpret Insomnia as a "Risk Factor" on Behavioral Symptom. J Am Med Dir Assoc 2024; 25:554. [PMID: 38182122 DOI: 10.1016/j.jamda.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
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Curyto K, Wray LO, Sullivan JL, McConnell ES, Jedele JM, Minor L, Karel MJ. Implementation Lessons Learned: Distress Behaviors in Dementia Intervention in Veterans Health Administration. THE GERONTOLOGIST 2024; 64:gnad060. [PMID: 37262319 DOI: 10.1093/geront/gnad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence-based practices to manage distress behaviors in dementia (DBD) are not consistently implemented despite demonstrated effectiveness. The Veterans Health Administration (VA) trained teams to implement Staff Training in Assisted Living Residences (STAR)-VA, an intervention to manage DBD in VA nursing home settings, or Community Living Centers (CLCs). This paper summarizes multiyear formative evaluation results including challenges, adaptations, and lessons learned to support sustained integration into usual care across CLCs nationwide. RESEARCH DESIGN AND METHODS STAR was selected as an evidence-based practice for DBD, adapted for and piloted in VA (STAR-VA), and implemented through a train-the-trainer program from 2013 to 2018. Training and consultation were provided to 92 CLC teams. Evaluation before and after training and consultation included descriptive statistics of measures of clinical impact and survey feedback from site teams regarding self-confidence, engagement, resource quality, and content analysis of implementation facilitators and challenges. RESULTS STAR-VA training and consultation increased staff confidence and resulted in significant decreases in DBD, depression, anxiety, and agitation for Veterans engaged in the intervention. Implementation outcomes demonstrated feasibility and identified facilitators and barriers. Key findings were interpreted using implementation frameworks and informed subsequent modifications to sustain implementation. DISCUSSION AND IMPLICATIONS STAR-VA successfully prepared teams to manage DBD and resulted in improved outcomes. Lessons learned include importance of behavioral health-nursing partnerships, continuous engagement, iterative feedback and adaptations, and sustainment planning. Evaluation of sustainment factors has informed selection of implementation strategies to address sustainment barriers. Lessons learned have implications for integrating team-based practices into system-level practice.
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Affiliation(s)
- Kim Curyto
- Center for Integrated Healthcare, VA Western NY Healthcare System, Batavia, New York, USA
| | - Laura O Wray
- Center for Integrated Healthcare, Office of Mental Health and Suicide Prevention, VA Central Office, Buffalo, New York, USA
- Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports (LTSS COIN), Capt. Jonathan H. Harwood Jr Center for Research, VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Health Service, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Eleanor S McConnell
- Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Jenefer M Jedele
- Blue Cross and Blue Shield of North Carolina, Durham, North Carolina, USA
| | - Lisa Minor
- Facility Based Care, Geriatrics and Extended Care (10NC4), VA Central Office, Washington, District of Columbia, USA
| | - Michele J Karel
- Geriatric Mental Health, Office of Mental Health and Suicide Prevention, VA Central Office, Washington, District of ColumbiaUSA
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Daemen MMJ, Boots LMM, Oosterloo M, de Vugt ME, Duits AA. Facilitators and barriers in caring for a person with Huntington's disease: input for a remote support program. Aging Ment Health 2024; 28:178-187. [PMID: 37409463 DOI: 10.1080/13607863.2023.2230949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES This study aims to provide more insight into possible barriers and facilitators caregivers of people with Huntington's disease (HD) encounter, and what their needs and wishes are regarding a remote support program. METHODS In total, 27 persons participated in four focus group interviews. Eligible participants were caregivers (n = 19) of a person with HD, and healthcare professionals (n = 8) involved in HD care. Qualitative data were analyzed by two researchers who independently performed an inductive content analysis. RESULTS Four major themes emerged from the data, including (1) a paradox between taking care of yourself and caring for others; (2) challenges HD caregivers face in daily life, including lack of HD awareness, taboo and shame, feelings of loneliness, concerns about heredity and children, and coping with HD symptoms; (3) facilitators in the caregiving process, including a social network, professional support, openness, talking in early phases, and daily structure; (4) needs regarding a support program. CONCLUSION These insights will be used to develop a remote support program for HD caregivers, using a blended and self-management approach. Newly developed and tailored support should be aimed at empowering caregivers in their role and help them cope with their situation, taking into account barriers and facilitators.
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Affiliation(s)
- Maud M J Daemen
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lizzy M M Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mayke Oosterloo
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Annelien A Duits
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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Altomare D, Rivolta J, Libri I, Mattioli I, Cantoni V, Padovani A, Borroni B. Neuropsychiatric Symptoms in Frontotemporal Dementia: More Than Just Noise? J Alzheimers Dis 2024; 98:133-144. [PMID: 38363612 DOI: 10.3233/jad-231256] [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] [Indexed: 02/17/2024]
Abstract
Background Neuropsychiatric symptoms cause significant suffering and poor quality of life for patients and their caregivers. They are not considered specific to frontotemporal dementia (FTD); therefore, their clinical role and impact might be underestimated. Objective The aims of the present study are to: 1) describe the prevalence of neuropsychiatric symptoms in FTD starting from the prodromal stage, 2) define their association with disease severity, 3) identify symptoms which are unrelated to FTD-specific symptoms, and 4) assess their association with clinical features and outcomes. Results In this retrospective study, we analyzed data of 461 FTD patients, including behavioral variant of FTD (bvFTD, n = 318) and primary progressive aphasia (PPA, n = 143). Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory, and patients' staging and global disease severity were estimated using the Clinical Dementia Rating plus NACC FTLD. Results The most common neuropsychiatric symptoms in prodromal FTD were irritability (48%), depression (35%), and anxiety (34%); delusions were reported in 6%of prodromal bvFTD cases. The severity of most neuropsychiatric symptoms increased with global disease severity. Psychosis (delusions and hallucinations) and mood symptoms (depression and anxiety) were mostly independent from FTD-specific symptoms. Psychosis was associated with older age, higher disease severity, shorter survival rate, and was higher in bvFTD than in PPA. Conclusions Neuropsychiatric symptoms are common in patients with FTD, also in the prodromal phase. Psychosis might be unrelated to FTD pathology, and be associated with worse clinical outcomes. The prompt detection and treatment of these symptoms might improve patient's management and quality of life.
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Affiliation(s)
- Daniele Altomare
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Jasmine Rivolta
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Ilenia Libri
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Irene Mattioli
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Valentina Cantoni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
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Thunell JA, Joyce GF, Ferido PM, Chen Y, Guadamuz JS, Qato DM, Zissimopoulos JM. Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia. J Alzheimers Dis 2024; 99:513-523. [PMID: 38669535 DOI: 10.3233/jad-231266] [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] [Indexed: 04/28/2024]
Abstract
Background Behavioral and psychological symptoms of dementia (BPSD) and prescribed central nervous system (CNS) active drugs to treat them are prevalent among persons living with Alzheimer's disease and related dementias (PLWD) and lead to negative outcomes for PLWD and their caregivers. Yet, little is known about racial/ethnic disparities in diagnosis and use of drugs to treat BPSD. Objective Quantify racial/ethnic disparities in BPSD diagnoses and CNS-active drug use among community-dwelling PLWD. Methods We used a retrospective cohort of community-dwelling Medicare Fee-for-Service beneficiaries with dementia, continuously enrolled in Parts A, B and D, 2017-2019. Multivariate logistic models estimated rates of BPSD diagnosis and, conditional on diagnosis, CNS-active drug use. Results Among PLWD, 67.1% had diagnoses of an affective, psychosis or hyperactivity symptom. White (68.3%) and Hispanic (63.9%) PLWD were most likely, Blacks (56.6%) and Asians (52.7%) least likely, to have diagnoses. Among PLWD with BPSD diagnoses, 78.6% took a CNS-active drug. Use was highest among whites (79.3%) and Hispanics (76.2%) and lowest among Blacks (70.8%) and Asians (69.3%). Racial/ethnic differences in affective disorders were pronounced, 56.8% of white PLWD diagnosed; Asians had the lowest rates (37.8%). Similar differences were found in use of antidepressants. Conclusions BPSD diagnoses and CNS-active drug use were common in our study. Lower rates of BPSD diagnoses in non-white compared to white populations may indicate underdiagnosis in clinical settings of treatable conditions. Clinicians' review of prescriptions in this population to reduce poor outcomes is important as is informing care partners on the risks/benefits of using CNS-active drugs.
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Affiliation(s)
- Johanna A Thunell
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Geoffrey F Joyce
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Patricia M Ferido
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Yi Chen
- Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Jenny S Guadamuz
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Dima M Qato
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Julie M Zissimopoulos
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
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Belfort Almeida Dos Santos TT, Nogueira MML, Lacerda IB, Brandt M, de Lucena AT, Rangel R, Gaigher J, Oliveira F, Dourado MCN. A Longitudinal Evaluation of the Pattern of Social Cognition Impairment in Brazilians With Alzheimer's Disease. Alzheimer Dis Assoc Disord 2023; 37:363-369. [PMID: 37916936 DOI: 10.1097/wad.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Social cognition (SC) impairments contribute to the dependence of people with Alzheimer disease (AD), influencing their functional disability and the burden on family members and caregivers. Our objective was to longitudinally investigate the relationship between SC and cognitive and clinical variables in persons with AD and their caregivers. We also evaluated the different SC predictors from 3 perspectives: people with AD, caregivers of people with AD, and discrepancy analysis. METHODS In all, 137 dyads (people with AD and their caregivers) underwent 2 assessments: at baseline (M1) and after 1 year (M2). During follow-up, 58 dyads were excluded, and the study was thus concluded with 79. RESULTS Longitudinal analysis of the people with AD showed that while some cognitive functions declined (which is consistent with disease progression), SC impairments showed a more stable pattern. Another interesting result was related to SC predictors. For people with AD, SC was associated with cognition at both time points. For caregivers, besides cognition, other predictors included reduced functional abilities and quality of life in people with AD. These results are consistent with the discrepancy predictors. CONCLUSION The stable pattern in SC functioning over 12 months in AD suggests that this neurocognitive domain may be influenced more by emotional processing than by cognitive impairment. In addition, the SC predictors showed that the investigation of different points of view enables a more global understanding, contributing to better and more targeted treatment for the patient.
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Celis K, Zaman A, Adams LD, Gardner O, Farid R, Starks TD, Lacroix FC, Hamilton-Nelson K, Mena P, Tejada S, Laux R, Song YE, Caban-Holt A, Feliciano-Astacio B, Vance JM, Haines JL, Byrd GS, Beecham GW, Pericak-Vance MA, Cuccaro ML. Neuropsychiatric features in a multi-ethnic population with Alzheimer disease and mild cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e5992. [PMID: 37655494 PMCID: PMC10518518 DOI: 10.1002/gps.5992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Alzheimer disease (AD) is more prevalent in African American (AA) and Hispanic White (HIW) compared to Non-Hispanic White (NHW) individuals. Similarly, neuropsychiatric symptoms (NPS) vary by population in AD. This is likely the result of both sociocultural and genetic ancestral differences. However, the impact of these NPS on AD in different groups is not well understood. METHODS Self-declared AA, HIW, and NHW individuals were ascertained as part of ongoing AD genetics studies. Participants who scored higher than 0.5 on the Clinical Dementia Rating (CDR) Scale (CDR) were included. Group similarities and differences on Neuropsychiatric Inventory Questionnaire (NPI-Q) outcomes (NPI-Q total score, NPI-Q items) were evaluated using univariate ANOVAs and post hoc comparisons after controlling for sex and CDR stage. RESULTS Our sample consisted of 498 participants (26% AA; 30% HIW; 44% NHW). Overall, NPI-Q total scores differed significantly between our groups, with HIW having the highest NPI-Q total scores, and by AD stage as measured by CDR. We found no significant difference in NPI-Q total score by sex. There were six NPI-Q items with comparable prevalence in all groups and six items that significantly differed between the groups (Anxiety, Apathy, Depression, Disinhibition, Elation, and Irritability). Further, within the HIW group, differences were found between Puerto Rican and Cuban American Hispanics across several NPI-Q items. Finally, Six NPI-Q items were more prevalent in the later stages of AD including Agitation, Appetite, Hallucinations, Irritability, Motor Disturbance, and Nighttime Behavior. CONCLUSIONS We identified differences in NPS among HIW, AA, and NHW individuals. Most striking was the high burden of NPS in HIW, particularly for mood and anxiety symptoms. We suggest that NPS differences may represent the impact of sociocultural influences on symptom presentation as well as potential genetic factors rooted in ancestral background. Given the complex relationship between AD and NPS it is crucial to discern the presence of NPS to ensure appropriate interventions.
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Affiliation(s)
- Katrina Celis
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olivia Gardner
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rajabli Farid
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Faina C Lacroix
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kara Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pedro Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Renee Laux
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yeunjoo E Song
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan L Haines
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Institute for Computational Biology, Cleveland, Ohio, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
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Cannizzaro A, Ronat L, El Haffaf LM, Hanganu A. Associations between neuropsychiatric symptoms of affective and vegetative domains and brain morphology in aging people with mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry 2023; 38:e5952. [PMID: 37351584 DOI: 10.1002/gps.5952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPS) are common in mild cognitive impairment (MCI) and even more in Alzheimer's disease (AD). The symptom-based cluster including nighttime disturbances, depression, appetite changes, anxiety, and apathy (affective and vegetative symptoms) was associated with an increased risk of dementia in MCI and has common neuroanatomical associations. Our objective was to investigate the differences in brain morphology associations with affective and vegetative symptoms between three groups: cognitively normal older adults (CN), MCI and AD. MATERIAL AND METHODS Alzheimer's Disease Neuroimaging Initiative data of 223 CN, 367 MCI and 175 AD, including cortical volumes, surface areas and thicknesses and severity scores of the five NPS were analyzed. A whole-brain vertex-wise general linear model was performed to test for intergroup differences (CN-MCI, CN-AD, AD-MCI) in brain morphology associations with five NPS. Multiple regressions were conducted to investigate cortical change as a function of NPS severity in the AD-MCI contrast. RESULTS We found (1) signature differences in nighttime disturbances associations with prefrontal regions in AD-MCI, (2) signature differences in NPS associations with temporal regions in AD-MCI for depression and in CN-AD for anxiety, (3) decreased temporal metrics in MCI as nighttime disturbances and depression severity increased, (4) decreased pars triangularis metrics in AD as nighttime disturbances and apathy severity increased. CONCLUSION Each NPS seems to have a signature on brain morphology. Affective and vegetative NPS were primarily associated with prefrontal and temporal regions. These signatures open the possibility of potential future assessments of links between brain morphology and NPS on an individual level.
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Affiliation(s)
- Adriana Cannizzaro
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Lucas Ronat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté de Médecine, Département de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Lyna Mariam El Haffaf
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandru Hanganu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
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12
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Eikelboom WS, van den Berg E, Coesmans M, Goudzwaard JA, Koopmanschap M, Lazaar N, van Bruchem-Visser RL, Driesen JJM, den Heijer T, Hoogers S, de Jong FJ, Mattace-Raso F, Thomeer EC, Vrenken S, Vroegindeweij LJHM, Zuidema SU, Singleton EH, van Swieten JC, Ossenkoppele R, Papma JM. Effects of the DICE Method to Improve Timely Recognition and Treatment of Neuropsychiatric Symptoms in Early Alzheimer's Disease at the Memory Clinic: The BEAT-IT Study. J Alzheimers Dis 2023:JAD230116. [PMID: 37182887 DOI: 10.3233/jad-230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are highly prevalent in Alzheimer's disease (AD) and are associated with negative outcomes. However, NPS are currently underrecognized at the memory clinic and non-pharmacological interventions are scarcely implemented. OBJECTIVE To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic. METHODS We enrolled sixty community-dwelling people with mild cognitive impairment or AD dementia and NPS across six Dutch memory clinics with their caregivers. The first wave underwent care as usual (n = 36) and the second wave underwent the DICE method (n = 24). Outcomes were quality of life (QoL), caregiver burden, NPS severity, NPS-related distress, competence managing NPS, and psychotropic drug use. Reliable change index was calculated to identify responders to the intervention. A cost-effectiveness analysis was performed and semi-structured interviews with a subsample of the intervention group (n = 12). RESULTS The DICE method did not improve any outcomes over time compared to care as usual. Half of the participants of the intervention group (52%) were identified as responders and showed more NPS and NPS-related distress at baseline compared to non-responders. Interviews revealed substantial heterogeneity among participants regarding NPS-related distress, caregiver burden, and availability of social support. The intervention did not lead to significant gains in quality-adjusted life years and well-being years nor clear savings in health care and societal costs. CONCLUSION The DICE method showed no benefits at group-level, but individuals with high levels of NPS and NPS-related distress may benefit from this intervention.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Najoua Lazaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Jan J M Driesen
- Department of Neurology, Franciscus Vlietland, Schiedam, The Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Susanne Hoogers
- Department of Neurology, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Elsbeth C Thomeer
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne Vrenken
- Department of Geriatrics, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | | | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen H Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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13
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Jin P, Xu J, Liao Z, Zhang Y, Wang Y, Sun W, Yu E. A review of current evidence for mild behavioral impairment as an early potential novel marker of Alzheimer's disease. Front Psychiatry 2023; 14:1099333. [PMID: 37293396 PMCID: PMC10246741 DOI: 10.3389/fpsyt.2023.1099333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/31/2023] [Indexed: 06/10/2023] Open
Abstract
Mild behavioral impairment (MBI) is a neurobehavioral syndrome that occurs in the absence of cognitive impairment later in life (≥50 years of age). MBI is widespread in the pre-dementia stage and is closely associated with the progression of cognitive impairment, reflecting the neurobehavioral axis of pre-dementia risk states and complementing the traditional neurocognitive axis. Despite being the most common type of dementia, Alzheimer's disease (AD) does not yet have an effective treatment; therefore, early recognition and intervention are crucial. The Mild Behavioral Impairment Checklist is an effective tool for identifying MBI cases and helps identify people at risk of developing dementia. However, because the concept of MBI is still quite new, the overall understanding of it is relatively insufficient, especially in AD. Therefore, this review examines the current evidence from cognitive function, neuroimaging, and neuropathology that suggests the potential use of MBI as a risk indicator in preclinical AD.
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Affiliation(s)
- Piaopiao Jin
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaxi Xu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhengluan Liao
- Department of Geriatric VIP No. 3 (Department of Clinical Psychology), Rehabilitation Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yuhan Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wangdi Sun
- Department of Psychiatry, Zhejiang Hospital, Hangzhou, China
| | - Enyan Yu
- Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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14
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Aguilar Barberà M, Soler Girabau P, Tabuenca Martín AI, Prieto Del Val L. Fortasyn Connect Improves Neuropsychiatric Symptoms in Patients with Mild Cognitive Impairment and Dementia: Results from a Retrospective Real-World Study. J Alzheimers Dis 2023; 93:621-631. [PMID: 37066911 DOI: 10.3233/jad-221122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) manifest in the early stages of the disease and impair patients' and caregivers' quality of life. OBJECTIVE To assess the effectiveness of the nutritional supplement Fortasyn Connect on BPSD for 12 months in people with mild cognitive impairment (MCI) and dementia in clinical practice. METHODS Retrospective, national, single-center study of 236 patients (158 MCI and 78 dementia; 55.1% of AD etiology). BPSD were assessed with the Neuropsychiatric Inventory (NPI) at month 3, 6, and 12. Cognition (Mini-Mental State Examination, MMSE), depression (Geriatric Depression Scale, GDS), and everyday functioning (Blessed Dementia Scale, BLS-D; Rapid Disability Rating Scale 2, RDRS2) were also evaluated. RESULTS Total NPI score, caregiver impact, and symptoms of depression, anxiety, apathy, and irritability improved after 3, 6, and 12 months from Fortasyn Connect initiation (p < 0.001). NPI decreases were more pronounced when baseline NPI score was higher than > 20 points (p < 0.001). The benefit was independent of gender, age, diagnosis, etiology, or concomitant treatment (p < 0.0001), although larger decreases in NPI total score were observed in MCI patients (p < 0.0001). After 12 months, GDS scores decreased (p = 0.042), and MMSE, BLS-D, and RDRS 2 scores remained stable. CONCLUSION Fortasyn Connect improved BPSD over at least a year in patients with MCI and dementia. Depression, anxiety, apathy, and irritability were the symptoms that improved the most. The benefit was independent of patients' characteristics and treatment but was greater if prescribed early and when baseline NPI scores were higher.
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15
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Efficacy of Kami Guibi-tang as an Add-On Therapy to Acetylcholinesterase Inhibitor for Cognitive Function in Mild Alzheimer's Disease: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:4846770. [PMID: 36756039 PMCID: PMC9902163 DOI: 10.1155/2023/4846770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/05/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023]
Abstract
Background Kami Guibi-tang (KGT), a traditional Korean herbal medicine is mainly used to treat insomnia and nervousness. Acetylcholinesterase inhibitors (AChEIs) are the main treatments for mild Alzheimer's disease (AD), a degenerative brain disease. However, currently no drug can fundamentally treat AD or reverse the advanced cognitive decline. This clinical study explored the efficacy and safety of adding KGT to AChEI for cognitive function in mild AD. Methods This was a pilot study for a larger randomized, double-blind, placebo-controlled trial. Participants between 55-90 years diagnosed with mild AD were recruited from Kyung Hee University Hospital at Gangdong, Seoul, Korea. They were randomized to receive either KGT or placebo for 24 weeks, in addition to their regular AChEI. The primary outcome was treatment efficacy, as assessed by the relative amount of change over the study period in total scores on the Dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D). Changes in SNSB subscores were assessed as secondary outcomes. Safety parameters, including adverse events and abnormalities in blood tests, electrocardiograms, and brain magnetic resonance imaging were also monitored. Results Between March 2018 and November 2020, seven participants each in the KGT group and the placebo group completed the 24-week trial. There were no significant changes in SNSB-D total or subindex scores for either group (p = 0.69 and 0.63, respectively), and no significant differences were observed between them (p=0.71). No adverse events related to KGT were reported. We also compared and analyzed the results of a previous pilot study conducted on amnestic mild cognitive impairment (aMCI) using protocol of this study. The aMCI group showed a significant improvement in the total SNSB-D score, especially in the memory domain, compared to the mild AD group (p = 0.04 and 0.02, respectively). The Korean Mini-Mental State Exam and Korean Instrumental Activities of Daily Living scores also significantly improved in the aMCI group (p = 0.01 and 0.02, respectively). Conclusions Compared to placebo, adding KGT to AChEI did not significantly improve cognitive function in SNSB in patients with mild AD. We suggest that KGT would have a positive effect on patients with early stages of cognitive impairment such as aMCI. The findings could assist design larger, longer-term clinical trials of KGT use in elderly patients with mild AD. This study was registered in the Korean Clinical Trial Registry on December 26, 2017, with the CRIS approval number KCT0002904.
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16
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Kamoga R, Mubangizi V, Owokuhaisa J, Muwanguzi M, Natakunda S, Rukundo GZ. Behavioral and Psychological Symptoms of Dementia: Prevalence, Symptom Severity, and Caregiver Distress in South-Western Uganda-A Quantitative Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2336. [PMID: 36767708 PMCID: PMC9916294 DOI: 10.3390/ijerph20032336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
The purpose of the study was to investigate behavioral and psychological symptoms (BPSD) prevalence, severity, and distress experienced by caregivers of people living with dementia (PLWD). A cross-sectional, population-based study was conducted in a rural area in southwestern Uganda. A Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to determine the presence of BPSD as perceived by caregivers of PLWD. We carried out both descriptive and inferential data analysis. A total of 175 caregivers of PLWD were enrolled in this study. Among PLWD, 99% had presented BPSD in the past month. Hallucinations (75%) and dysphoria/depression (81%) were the two BPSD that occurred most frequently. Most participants (70%) stated that PLWD experienced hallucinations of significant severity. Aberrant motor activity was reported by 60% of the participants as the type of BPSD that caused severe distress. There was a high positive correlation (0.82) between the total severity score and total distress scores. Interventions aimed at addressing dysphoria and hallucinations may be essential for the reduction of caregiver distress. These findings point to the need for promoting early screening for BPSDs and the provision of support to caregivers.
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Affiliation(s)
- Ronald Kamoga
- Department of Anatomy, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Vincent Mubangizi
- Department of Community Practice and Family Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Judith Owokuhaisa
- Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Moses Muwanguzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Sylivia Natakunda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
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17
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Davidoff H, Van den Bulcke L, Vandenbulcke M, De Vos M, Van den Stock J, Van Helleputte N, Van Hoof C, Van Den Bossche MJA. Toward Quantification of Agitation in People With Dementia Using Multimodal Sensing. Innov Aging 2022; 6:igac064. [PMID: 36600807 PMCID: PMC9799041 DOI: 10.1093/geroni/igac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Objectives Agitation, a critical behavioral and psychological symptom in dementia, has a profound impact on a patients' quality of life as well as their caregivers'. Autonomous and objective characterization of agitation with multimodal systems has the potential to capture key patient responses or agitation triggers. Research Design and Methods In this article, we describe our multimodal system design that encompasses contextual parameters, physiological parameters, and psychological parameters. This design is the first to include all three of these facets in an n > 1 study. Using a combination of fixed and wearable sensors and a custom-made app for psychological annotation, we aim to identify physiological markers and contextual triggers of agitation. Results A discussion of both the clinical as well as the technical implementation of the to-date data collection protocol is presented, as well as initial insights into pilot study data collection. Discussion and Implications The ongoing data collection moves us toward improved agitation quantification and subsequent prediction, eventually enabling just-in-time intervention.
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Affiliation(s)
- Hannah Davidoff
- Department of Electrical Engineering (ESAT), KU Leuven, Heverlee, Belgium,CSH (Circuits and Systems for Health) - imec, Heverlee, Belgium
| | - Laura Van den Bulcke
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium,Center for Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium,Center for Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- Department of Electrical Engineering (ESAT), KU Leuven, Heverlee, Belgium,Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Center for Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | - Chris Van Hoof
- Department of Electrical Engineering (ESAT), KU Leuven, Heverlee, Belgium,imec OnePlanet, Wageningen, Netherlands
| | - Maarten J A Van Den Bossche
- Address correspondence to: Maarten J. A. Van Den Bossche, MD, PhD, Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, Herestraat 49, 3000 Leuven, Belgium. E-mail:
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18
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Madrigal C, Resnick B, Eshraghi K, Ellis J, Kolanowski A, Van Haitsma K. Testing the Reliability and Validity of the Revised Care Plan Checklist for Evidence of Person-Centered Care Approaches for Behavioral and Psychological Symptoms of Distress in Persons With Dementia. Res Gerontol Nurs 2022; 15:303-311. [PMID: 36214737 DOI: 10.3928/19404921-20220930-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Checklist for Evidence of Person-Centered Care Approaches for Behavioral and Psychological Symptoms of Distress (BPSD) in Care Plans was developed to assess the person-centeredness of care plans for nursing home residents living with behavioral and psychological symptoms associated with dementia. The purpose of the current study was to evaluate the reliability and validity of a revised version of the Checklist. Data from a larger randomized clinical trial testing the implementation of the Evidence of Integration Triangle for BPSD were used. One hundred seventy-nine care plans for 103 residents were examined. Descriptive statistics, Rasch analysis, and inter-rater reliability were used. The Checklist demonstrated evidence of inter-rater reliability and validity based on model fit and acceptable INFIT and OUTFIT statistics. This study serves as pilot work for future Checklist use and validation efforts on a larger scale. Findings encourage a discourse on the inclusion of BPSD and person-centered approaches in care plans for those living with dementia. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Brown B, Nurock S, Michael S, Ware P, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England. EClinicalMedicine 2022; 52:101692. [PMID: 36313148 PMCID: PMC9596302 DOI: 10.1016/j.eclinm.2022.101692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia. Methods National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration). Findings Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia. Interpretation Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes. Funding This work was supported by the Alzheimer's Society.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E. J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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McManus KR, Patrick R, Striepe MI, Drury MJ, Ozonsi R, Forester BP, Weinberg MS. Psychedelics for Alzheimer's Disease Palliative Care. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2022; 2:37-46. [PMID: 37786540 PMCID: PMC10544719 DOI: 10.1016/j.ypsc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
| | - Regan Patrick
- Mclean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
| | - Meg I. Striepe
- California Institute of Integral Studies, San Francisco, CA
| | | | | | | | - Marc S. Weinberg
- Mclean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
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21
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Li K, Zeng Q, Luo X, Qi S, Xu X, Fu Z, Hong L, Liu X, Li Z, Fu Y, Chen Y, Liu Z, Calhoun VD, Huang P, Zhang M. Neuropsychiatric symptoms associated multimodal brain networks in Alzheimer's disease. Hum Brain Mapp 2022; 44:119-130. [PMID: 35993678 PMCID: PMC9783460 DOI: 10.1002/hbm.26051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/11/2022] [Accepted: 07/30/2022] [Indexed: 02/05/2023] Open
Abstract
Concomitant neuropsychiatric symptoms (NPS) are associated with accelerated Alzheimer's disease (AD) progression. Identifying multimodal brain imaging patterns associated with NPS may help understand pathophysiology correlates AD. Based on the AD continuum, a supervised learning strategy was used to guide four-way multimodal neuroimaging fusion (Amyloid, Tau, gray matter volume, brain function) by using NPS total score as the reference. Loadings of the identified multimodal patterns were compared across the AD continuum. Then, regression analyses were performed to investigate its predictability of longitudinal cognition performance. Furthermore, the fusion analysis was repeated in the four NPS subsyndromes. Here, an NPS-associated pathological-structural-functional covaried pattern was observed in the frontal-subcortical limbic circuit, occipital, and sensor-motor region. Loading of this multimodal pattern showed a progressive increase with the development of AD. The pattern significantly correlates with multiple cognitive domains and could also predict longitudinal cognitive decline. Notably, repeated fusion analysis using subsyndromes as references identified similar patterns with some unique variations associated with different syndromes. Conclusively, NPS was associated with a multimodal imaging pattern involving complex neuropathologies, which could effectively predict longitudinal cognitive decline. These results highlight the possible neural substrate of NPS in AD, which may provide guidance for clinical management.
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Affiliation(s)
- Kaicheng Li
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina,Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS): Georgia State UniversityGeorgia Institute of Technology, and Emory UniversityAtlantaGeorgiaUSA
| | - Qingze Zeng
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Xiao Luo
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Shile Qi
- Department of Computer Science and EngineeringNanjing University of Aeronautics and AstronauticsNanjingChina
| | - Xiaopei Xu
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Zening Fu
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS): Georgia State UniversityGeorgia Institute of Technology, and Emory UniversityAtlantaGeorgiaUSA
| | - Luwei Hong
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Xiaocao Liu
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Zheyu Li
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Yanv Fu
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Yanxing Chen
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Zhirong Liu
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Vince D. Calhoun
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS): Georgia State UniversityGeorgia Institute of Technology, and Emory UniversityAtlantaGeorgiaUSA,Department of Psychology, Computer Science, Neuroscience Institute, and PhysicsGeorgia State UniversityAtlantaGeorgiaUSA,Department of Electrical and Computer EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Peiyu Huang
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Minming Zhang
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
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22
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Iravani B, Abdollahi E, Eslamdoust-Siahestalkhi F, Soleimani R. Neuropsychiatric Symptoms of Alzheimer's Disease and Caregiver Burden. Front Neurol 2022; 13:877143. [PMID: 35968317 PMCID: PMC9372403 DOI: 10.3389/fneur.2022.877143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction/Objectives In addition to cognitive decline, one of the most important problems for caregivers of patients with Alzheimer's is neuropsychiatric symptoms (NPS). This study aimed to evaluate the NPS in patients with Alzheimer's disease (AD) and investigate its relationship with caregiver burden (CB). Methods In a cross-sectional study of 85 patients with AD referred to Shafa Hospital in Rasht and their caregivers in 2020, information was collected using a demographic questionnaire, Neuropsychiatric Inventory Questionnaire (NPI-Q), and the Caregiver Burden Inventory (CBI). Data were analyzed by Spearman correlation, t-test, and linear regression, with SPSS version 22. Results The mean age of the patients and their caregivers were 74.95 ± 8.87 years and 43.98 ± 11.38 years, respectively. The mean total score of NPS in patients with AD was 44.25 (0–144) and the mean CB score was 36.27 (0–96), which was a moderate level. According to the results, 91% of patients had apathy, while happiness/euphoria was reported as the most uncommon symptom. In addition, there was a significant relationship between the score of NPS and CB (r = 0.542, P < 0.0001), as well as all its sub-components, time-dependence burden with more correlation (r = 0.509, P < 0.0001), and social burden with less correlation (r = 0.352, P < 0.001). NPS, hallucination, aberrant motor behavior (AMB), delusion, and depression were most correlated with CB. Also, the mean score of CB was significantly higher in women than in men (P = 0.045). Living in a rural area had a significant relationship with NPS score (P = 0.026). Also, linear regression showed that with increasing 1 year of patients' age, the mean score of patient's NPS decreased by 0.374 (P = 0.048). Conclusion Neuropsychiatric symptoms, especially hallucination, aberrant motor behavior (AMB), delusion, and depression were associated with caregiver burden. Apathy was the most common symptom in patients with AD.
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23
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Sep YCP, Leeuwis AE, Exalto LG, Boomsma JM, Prins ND, Verwer JH, Scheltens P, van der Flier WM, Biessels GJ. Neuropsychiatric Symptoms as Predictor of Poor Clinical Outcome in Patients With Vascular Cognitive Impairment. Am J Geriatr Psychiatry 2022; 30:813-824. [PMID: 35082085 DOI: 10.1016/j.jagp.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Examine the association between neuropsychiatric symptoms (NPS) and clinical outcome in memory clinic patients with vascular brain injury. DESIGN/SETTING TRACE-VCI prospective memory clinic cohort with follow-up (2.1 ± 0.5 years). PARTICIPANTS Five hundred and seventy-five memory clinic patients with vascular brain injury on MRI (i.e. possible Vascular Cognitive Impairment [VCI]). Severity of cognitive impairment ranged from no objective cognitive impairment to mild cognitive impairment (MCI) and dementia. MEASUREMENTS We used Neuropsychiatric Inventory (total score and score on hyperactive, psychotic, affective, and apathetic behavior domains) to measure NPS. We assessed the association between NPS and institutionalization, mortality and cognitive deterioration (increase ≥0.5 on Clinical Dementia Rating scale) with Cox proportional hazards models and logistic regression analyses. RESULTS NPS were present in 89% of all patients, most commonly in the hyperactive and apathetic behavior domain. Across the whole cohort, affective behavior was associated with institutionalization (HR: 1.98 [1.01-3.87]), mainly driven by the dementia subgroup (HR: 2.06 [1.00-4.21]). Apathetic behavior was associated with mortality and cognitive deterioration (HR: 2.07 [1.10-3.90],OR: 1.67 [1.12-2.49], respectively), mainly driven by the MCI subgroup (HR: 4.93 [1.07-22.86],OR: 3.25 [1.46-7.24], respectively). Conversely, hyperactive behavior was related to lower mortality (HR: 0.54 [0.29-0.98]), again particularly driven by the MCI subgroup (HR:0.17 [0.04-0.75]). Psychotic behavior was associated with cognitive deterioration in patients with no objective cognitive impairment (OR: 3.10 [1.09-8.80]) and with institutionalization in MCI (HR: 12.45 [1.28-121.14]). CONCLUSION NPS are common and have prognostic value in memory clinic patients with possible VCI. This prognostic value depends on the severity of cognitive impairment.
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Affiliation(s)
- Yoni C P Sep
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna E Leeuwis
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, the Netherlands
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jooske M Boomsma
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels D Prins
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jurre H Verwer
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Epidemiology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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24
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Strandenaes MG, Lund A, Engedal K, Kirkevold Ø, Selbaek G, Benth JŠ, Rokstad AMM. Self-reported quality of life in people with dementia attending a day-care programme in Norway: A 24-month quasi-experimental study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1315-1324. [PMID: 34032347 DOI: 10.1111/hsc.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
The objectives of the study were (a) to compare self-reported Quality of Life (QoL) in a 24-month follow-up of people with dementia attending day care designed for people with dementia (day-care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi-experimental design with a 24-month follow-up period was used. The DC group included 181 participants recruited from 53 day-care services. The CG included 76 participants recruited from 19 municipalities with no available day care designed for people with dementia. The sample covered the four health regions of Norway and inclusion period lasted from December 2013 to July 2015. The Quality of Life in Alzheimer's Disease (QoL-AD) scale was used as the outcome measure. The differences in QoL between groups and the associations between participant characteristics and QoL, such as depressive symptoms and functional dependency, were examined using a linear mixed model. In the multiple model, the overall trend in QoL did not differ significantly between the DC and CG. However, the DC group exhibited significantly higher self-reported QoL than the CG at all time points (p < 0.001 at T0, p = 0.018 at T12, and p = 0.006 at T24). Participants with shallow or no awareness who attended day care had significantly higher scores on QoL-AD than persons with full awareness (p = 0.017). More depressive symptoms (p < 0.001) and higher functional dependency (p < 0.001) were associated with lower self-reported QoL. The study revealed higher scores of self-reported QoL among people attending day care compared with those who did not attend, showing that day care might have positive impact on the lives of people with dementia.
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Affiliation(s)
- Margit Gausdal Strandenaes
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Lund
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Research Centre for Age Related Functional decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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25
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Heilman KM, Nadeau SE. Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease. Neurotherapeutics 2022; 19:99-116. [PMID: 35013934 PMCID: PMC9130428 DOI: 10.1007/s13311-021-01172-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/03/2023] Open
Abstract
Alzheimer's disease is associated with impairments in emotional communication including comprehension and production of facial emotional expressions, comprehension of affective prosody, and alexithymia. It is also associated with disorders of emotional experience including mood disorders (depression and anxiety), agitation/aggression, and psychosis. Agitation/aggression and psychosis are particularly disruptive, are associated with earlier institutionalization, and pose a major challenge to institutional management. Treatment of disorders of emotional experience has been primarily pharmacologic (reviewed here in detail) and has relied heavily on antipsychotic medications despite the small effect sizes demonstrated in a large number of randomized controlled trials and the prevalence of serious side effects associated with these drugs. Recent studies suggest that treatment with pimavanserin, an antipsychotic without activity at dopamine receptors, may represent an important advance for treatment of psychotic manifestations, even as the drug appears to pose significant risk. Dextromethorphan/quinidine may represent an important advance in the treatment of agitation/aggression. There is also compelling evidence that sleep disorders, which are common among patients with Alzheimer's disease and are readily treatable, may potentiate psychotic manifestations and agitation/aggression, but further studies are needed.
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Affiliation(s)
- Kenneth M Heilman
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA
- The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA
- Malcom Randall VA Medical Center and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephen E Nadeau
- Research Service, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
- The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
- Malcom Randall VA Medical Center and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
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26
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Roberto N, Portella MJ, Marquié M, Alegret M, Hernández I, Mauleón A, Rosende-Roca M, Abdelnour C, Esteban de Antonio E, Tartari JP, Vargas L, López-Cuevas R, Bojaryn U, Espinosa A, Ortega G, Pérez-Cordón A, Sanabria Á, Orellana A, de Rojas I, Moreno-Grau S, Montrreal L, Alarcón-Martín E, Ruíz A, Tárraga L, Boada M, Valero S. Neuropsychiatric Profile as a Predictor of Cognitive Decline in Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:718949. [PMID: 34955804 PMCID: PMC8693625 DOI: 10.3389/fnagi.2021.718949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Mild cognitive impairment is often associated with affective and other neuropsychiatric symptoms (NPS). This co-occurrence might have a relevant impact on disease progression, from MCI to dementia. Objective: The aim of this study was to explore the trajectories of cognitive decline in an MCI sample from a memory clinic, taking into consideration a perspective of isolated cognitive functions and based on NPS clusters, accounting for the different comorbid symptoms collected at their baseline visit. Methods: A total of 2,137 MCI patients were monitored over a 2.4-year period. Four clusters of NPS (i.e., Irritability, Apathy, Anxiety/Depression and Asymptomatic) were used to run linear mixed models to explore the interaction of cluster with time on cognitive trajectories using a comprehensive neuropsychological battery (NBACE) administered at baseline and at the three subsequent follow-ups. Results: A significant interaction between cluster and time in cognitive decline was found when verbal learning and cued-recall were explored (p = 0.002 for both memory functions). For verbal learning, the Irritability cluster had the largest effect size (0.69), whereas the Asymptomatic cluster showed the smallest effect size (0.22). For cued-recall, the Irritability cluster had the largest effect size among groups (0.64), and Anxiety/Depression had the smallest effect size (0.21). Conclusions: In MCI patients, the Irritability and Apathy NPS clusters shared similar patterns of worsening in memory functioning, which could point to these NPS as risk factors of a faster cognitive decline, acting as early prognostic markers and helping in the diagnostic process.
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Affiliation(s)
- Natalia Roberto
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria J Portella
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Psychiatry, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Networking Research Center on Mental Health (CIBERSAM), Madrid, Spain
| | - Marta Marquié
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Montserrat Alegret
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Isabel Hernández
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Ana Mauleón
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Maitee Rosende-Roca
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Carla Abdelnour
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | | | - Juan P Tartari
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Liliana Vargas
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Rogelio López-Cuevas
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Urszula Bojaryn
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Ana Espinosa
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Gemma Ortega
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alba Pérez-Cordón
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Ángela Sanabria
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Adelina Orellana
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Itziar de Rojas
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Sonia Moreno-Grau
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Laura Montrreal
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Emilio Alarcón-Martín
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Agustín Ruíz
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Lluís Tárraga
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Mercè Boada
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Sergi Valero
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
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27
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Cherkasov NS, Kolykhalov IV. [Non-cognitive psychopathological symptoms in mild cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:41-51. [PMID: 34870913 DOI: 10.17116/jnevro202112110241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Noncognitive psychopathological symptoms (NPS) in elderly patients are increasingly attracting the attention of researchers in the field of neurodegenerative diseases. The question is raised whether these symptoms are risk factors or initial manifestations of the neurodegeneration process. This article provides information on the prevalence of late-onset NPS together with mild cognitive impairment (MCI), combination of which reflects the risk of developing dementia. The characteristic of mild behavioral impairment syndrome, which is currently used along with the concept of MCI, is given. The authors summarized data of the studies published over the past 10 years on the effect of NPS on the progression of cognitive impairment. Topics related to the differential diagnosis of these disorders, as well as existing approaches to treatment, are considered.
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28
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Kan CN, Xu X, Schmetterer L, Venketasubramanian N, Chen C, Tan CH. Interactions of comorbid neuropsychiatric subsyndromes with neurodegenerative and cerebrovascular pathologies on cognition. Neurobiol Aging 2021; 109:239-246. [PMID: 34814099 DOI: 10.1016/j.neurobiolaging.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
Comorbid neuropsychiatric symptoms are commonly found in individuals with dementia and is likely influenced by a combination of neurodegenerative and cerebrovascular pathophysiology. We evaluated the associations of a validated composite MRI-based quantitative measure of both neurodegeneration (hippocampus volume and cortical thickness of AD-specific regions) and cerebrovascular disease (CeVD; white matter hyperintensities and infarcts) with neuropsychiatric subsyndromes, and their interactions on cognition in a community-based sample across the disease spectrum (N = 773). Lower composite MRI scores corresponding to greater comorbid neurodegeneration and CeVD burden were associated with hyperactivity (OR = 1.48) and apathy (OR = 1.90) subsyndromes. Lower MRI scores with concomitant hyperactivity was associated with greater cognitive impairment, especially in patients who were at least moderately impaired, while the interaction with apathy was not dependent on disease stage. These MRI scores interaction models resulted in a better fit than models consisting of neurodegeneration or CeVD alone. Integrating multiple biomarkers with specific, disease stage-dependent neuropsychiatric subsyndromes may provide a more holistic risk profile to facilitate the identification of individuals at the highest risk of disease progression.
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Affiliation(s)
- Cheuk Ni Kan
- Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Xu
- Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Leopold Schmetterer
- Singapore Eye Research Institute (SERI), Singapore National Eye Center, Singapore; Academic Clinical Program, Duke-NUS Medical School, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | | | - Christopher Chen
- Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Hong Tan
- Division of Psychology, Nanyang Technological University, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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29
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Smith EE, Crites S, Wang M, Charlton A, Zwiers A, Sekhon R, Sajobi T, Camicioli R, McCreary CR, Frayne R, Ismail Z. Cerebral Amyloid Angiopathy Is Associated With Emotional Dysregulation, Impulse Dyscontrol, and Apathy. J Am Heart Assoc 2021; 10:e022089. [PMID: 34755541 PMCID: PMC8751932 DOI: 10.1161/jaha.121.022089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cerebral amyloid angiopathy (CAA) causes cognitive decline, but it is not known whether it is associated with neuropsychiatric symptoms (NPS). Methods and Results Participants with CAA, mild cognitive impairment, mild dementia due to Alzheimer's disease, and normal cognition were recruited from stroke and dementia clinics and community advertising. NPS were captured using the Neuropsychiatric Inventory Questionnaire short form. The number and total severity (number multiplied by severity of each symptom [mild, moderate, or severe]) of NPS were analyzed using generalized linear regression with a negative binomial link and multiple linear regression, adjusting for age, sex, and education. A total of 109 participants (43 with CAA, 15 with Alzheimer's disease, 28 with mild cognitive impairment, and 23 with normal cognition) (mean age 71.1 [SD=7.6]; 53.2% male) were included. The most frequent NPS in CAA were depression/dysphoria (48.8%), irritability/lability (37.2%), agitation/aggression (37.2%), apathy/indifference (34.9%), and anxiety (32.6%). In adjusted models, patients with CAA had 3.2 times (95% CI, 1.7-6.0) more NPS symptoms and 3.1 units (95% CI, 1.0-5.1) higher expected severity score. The number of NPS was similar to patients with mild cognitive impairment (3.2 times higher than controls) but less than in patients with Alzheimer's disease dementia (4.1 times higher than controls). Within patients with CAA, there were 1.20 times (95% CI, 1.01-1.32) more NPS per 1% increase in white matter hyperintensity as a percentage of intracranial volume. Conclusions NPS are common in CAA, with a similar prevalence as in mild cognitive impairment. The association of the total number of NPS with higher white matter hyperintensity volume suggests that white matter damage may underlie some of these symptoms.
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Affiliation(s)
- Eric E Smith
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada
| | | | - Meng Wang
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Alberta Canada
| | - Anna Charlton
- Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Angela Zwiers
- Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Ramnik Sekhon
- Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Tolulope Sajobi
- Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Alberta Canada
| | - Richard Camicioli
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Radiology University of Calgary Alberta Canada
| | - Richard Frayne
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Radiology University of Calgary Alberta Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Psychiatry University of Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Alberta Canada
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30
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Jetsonen V, Kuvaja-Köllner V, Välimäki T, Selander T, Martikainen J, Koivisto AM. Total cost of care increases significantly from early to mild Alzheimer's disease: 5-year ALSOVA follow-up. Age Ageing 2021; 50:2116-2122. [PMID: 34255025 PMCID: PMC8581391 DOI: 10.1093/ageing/afab144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION We studied the costs of formal and informal care in relation to Alzheimer's disease (AD) progression. METHODS 231 persons with AD with a family caregiver were followed up for 5 years. The Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) was used to measure AD progression. Health and social care unit costs were used for formal care costs. An opportunity cost method for lost leisure time was applied to analyse the cost of informal care. RESULTS Total cost of care in early stage AD (CDR-SB ≤ 4) was 16,448€ (95% CI 13,722-19,716) annually. In mild (CDR-SB 4.5-9), moderate (CDR-SB 9.5-15.5) and severe (CDR-SB ≥ 16) AD, the total costs were 2.3, 3.4 and 4.4 times higher, respectively. A one-unit increase in CDR-SB increased the total, formal and informal costs by 15, 11 and 18%, respectively. CONCLUSIONS Compared to early AD, the costs of total, formal and informal care are remarkably higher already in mild AD. This finding emphasises early diagnosis, interventions and family support for persons with AD and their caregivers.
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Affiliation(s)
- Viivi Jetsonen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio Finland
| | | | - Anne M Koivisto
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
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31
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Garcia-Romeu A, Darcy S, Jackson H, White T, Rosenberg P. Psychedelics as Novel Therapeutics in Alzheimer's Disease: Rationale and Potential Mechanisms. Curr Top Behav Neurosci 2021; 56:287-317. [PMID: 34734390 DOI: 10.1007/7854_2021_267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Serotonin 2A receptor (5-HT2AR) agonist "classic psychedelics" are drawing increasing interest as potential mental health treatments. Recent work suggests psychedelics can exert persisting anxiolytic and antidepressant effects lasting up to several months after a single administration. Data indicate acute subjective drug effects as important psychological factors involved in observed therapeutic benefits. Additionally, animal models have shown an important role for 5-HT2AR agonists in modulating learning and memory function with relevance for Alzheimer's Disease (AD) and related dementias. A number of biological mechanisms of action are under investigation to elucidate 5-HT2AR agonists' therapeutic potential, including enhanced neuroplasticity, anti-inflammatory effects, and alterations in brain functional connectivity. These diverse lines of research are reviewed here along with a discussion of AD pathophysiology and neuropsychiatric symptoms to highlight classic psychedelics as potential novel pharmacotherapies for patients with AD. Human clinical research suggests a possible role for high-dose psychedelic administration in symptomatic treatment of depressed mood and anxiety in early-stage AD. Preclinical data indicate a potential for low- or high-dose psychedelic treatment regimens to slow or reverse brain atrophy, enhance cognitive function, and slow progression of AD. In conclusion, rationale and potential approaches for preliminary research with psychedelics in patients with AD are presented, and ramifications of this line of investigation for development of novel AD treatments are discussed.
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Affiliation(s)
- Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sean Darcy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hillary Jackson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Toni White
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Memory and Alzheimer's Treatment Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Memory and Alzheimer's Treatment Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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32
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Douglas S, Stott J, Spector A, Brede J, Hanratty É, Charlesworth G, Noone D, Payne J, Patel M, Aguirre E. Mindfulness-based cognitive therapy for depression in people with dementia: A qualitative study on participant, carer and facilitator experiences. DEMENTIA 2021; 21:457-476. [PMID: 34558340 PMCID: PMC8811330 DOI: 10.1177/14713012211046150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Depression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed. Objective This study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators. Methods This qualitative study was nested within a randomised controlled feasibility study. Semi-structured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data. Findings Several beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups. Conclusion Results of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population.
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Affiliation(s)
- Sarah Douglas
- Division of Psychiatry, 4919University College London, UK
| | - Josh Stott
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Aimee Spector
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Janina Brede
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Éanna Hanratty
- Waltham Forest Child and Family Consultation Service, 5098North East London NHS Foundation Trust, UK
| | - Georgina Charlesworth
- Department of Clinical, Education and Health Psychology, 4919University College London; Goodmayes Hospital, 5098North East London NHS Foundation Trust, UK
| | - Deirdre Noone
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Jacob Payne
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Mina Patel
- 5098North East London NHS Foundation Trust, UK
| | - Elisa Aguirre
- Department of Clinical, Education and Health Psychology, 4919University College London; Goodmayes Hospital, 5098North East London NHS Foundation Trust, UK
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Zhang J, Li LW, McLaughlin SJ. Psychological Well-Being and Cognitive Function among Older Adults in China: A Population-Based Longitudinal Study. J Aging Health 2021; 34:173-183. [PMID: 34510952 DOI: 10.1177/08982643211036226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ObjectivesThis study aims to examine the relationship between psychological well-being (PWB) and cognitive function in older adults in China. Methods: Data are from the Chinese Longitudinal Healthy Longevity Survey. Analyses were restricted to 9,487 older persons (age ≥ 60) without cognitive impairment at baseline. Respondents were followed over a 12-year period. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (C-MMSE). PWB was assessed using a composite index capturing optimism, conscientiousness, neuroticism, loneliness, personal control, self-esteem, and happiness. Results: Multilevel mixed effects generalized linear models showed that respondents with greater PWB had a slower rate of cognitive decline over time, adjusting for sociodemographic and health characteristics. In addition, multilevel multinomial logistic regression models showed that greater PWB was associated with lower odds of developing cognitive impairment. Conclusions: Findings suggest that fostering PWB may prevent or delay adverse cognitive changes.
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Affiliation(s)
| | - Lydia W Li
- 1259University of Michigan, Ann Arbor, MI, USA
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34
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Leung DKY, Chan WC, Spector A, Wong GHY. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1330-1344. [PMID: 33905138 DOI: 10.1002/gps.5556] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The present study aimed to resolve inconsistency in reported prevalence of affective symptoms by dementia stage. METHODS/DESIGN We conducted a meta-analysis of studies with data on dementia stage and prevalence of depression, anxiety, or apathy assessed using validated tools. We performed random-effects meta-analysis and subgroup analysis on symptom prevalence by dementia stage, according to CDR. RESULTS The meta-analysis included 5897 people with dementia from 20 studies. Prevalence rates of depression in mild, moderate, and severe dementia were 38% (95% CI 32%-45%), 41% (95% CI 33%-49%), and 37% (95% CI 17%-56%) respectively. The corresponding prevalence for anxiety was 38% (95% CI 31%-45%), 41% (95% CI 31%-52%), and 37% (95% CI -8%-82%); and 54% (95% CI 45%-62%), 59% (95% CI 44%-73%), and 43% (95% CI 10%-75%) for apathy. The prevalence of depression, anxiety, and apathy did not differ with regard to dementia stage and type. The prevalence of depression in Alzheimer's disease (AD) was significantly lower when it was assessed using diagnostic criteria compared to screening tools. The prevalence of depression in AD was lowest in America, while anxiety in vascular dementia was higher in Europe than Asia. CONCLUSIONS Depression, anxiety, and apathy symptoms are highly prevalent across dementia stages. There is no evidence of any changes in prevalence of affective symptom as the illness progresses. Evaluation methods and cultural difference may explain some of the variance, suggesting further investigation of factors that may influence the report of symptoms, such as carer psychosocial characteristics, and more cross-cultural studies are needed.
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Affiliation(s)
- Dara K Y Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Sweeder LA, Yannuzzi AL, Hill N. Mild Behavioral Impairment: A New At-Risk State for Alzheimer's Disease? J Gerontol Nurs 2021; 47:29-36. [PMID: 33626162 DOI: 10.3928/00989134-20210210-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
Improving our response to Alzheimer's disease (AD), including prevention and early intervention, is critical for maximizing healthy aging outcomes. Identifying older adults at highest risk for AD would provide an opportunity to offer support, plan for the future, and implement strategies to enhance cognitive and functional outcomes. The emergence of neuropsychiatric symptoms may be one indicator of early AD-related cognitive decline, but distinguishing symptoms from those due to other causes can be challenging. Mild behavioral impairment (MBI) describes an at-risk state for cognitive decline characterized by the late-life onset of neuropsychiatric symptoms. In this article, we discuss the current conceptualization of MBI, the potential for its characteristic neuropsychiatric symptoms to indicate risk for future cognitive decline, and present potential clinical implications. [Journal of Gerontological Nursing, 47(3), 29-36.].
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36
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Illán‐Gala I, Casaletto KB, Borrego‐Écija S, Arenaza‐Urquijo EM, Wolf A, Cobigo Y, Goh SYM, Staffaroni AM, Alcolea D, Fortea J, Blesa R, Clarimon J, Iulita MF, Brugulat‐Serrat A, Lladó A, Grinberg LT, Possin K, Rankin KP, Kramer JH, Rabinovici GD, Boxer A, Seeley WW, Sturm VE, Gorno‐Tempini ML, Miller BL, Sánchez‐Valle R, Perry DC, Lleó A, Rosen HJ. Sex differences in the behavioral variant of frontotemporal dementia: A new window to executive and behavioral reserve. Alzheimers Dement 2021; 17:1329-1341. [PMID: 33590953 PMCID: PMC8364861 DOI: 10.1002/alz.12299] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/10/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Biological sex is an increasingly recognized factor driving clinical and structural heterogeneity in Alzheimer's disease, but its role in the behavioral variant of frontotemporal dementia (bvFTD) is unknown. METHODS We included 216 patients with bvFTD and 235 controls with magnetic resonance imaging (MRI) from a large multicenter cohort. We compared the clinical characteristics and cortical thickness between men and women with bvFTD and controls. We followed the residuals approach to study behavioral and cognitive reserve. RESULTS At diagnosis, women with bvFTD showed greater atrophy burden in the frontotemporal regions compared to men despite similar clinical characteristics. For a similar amount of atrophy, women demonstrated better-than-expected scores on executive function and fewer changes in apathy, sleep, and appetite than men. DISCUSSION Our findings suggest that women might have greater behavioral and executive reserve than men, and neurodegeneration must be more severe in women to produce symptoms similar in severity to those in men.
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Tommasi NS, Gonzalez C, Briggs D, Properzi MJ, Gatchel JR, Marshall GA. Affective symptoms and regional cerebral tau burden in early-stage Alzheimer's disease. Int J Geriatr Psychiatry 2021; 36:1050-1058. [PMID: 33682933 PMCID: PMC8187284 DOI: 10.1002/gps.5530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPS) are often present in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. NPS are associated with structural and functional changes in the brain such as atrophy, regional hypometabolism, and hypoperfusion, considered proxies of neurodegeneration. Our objective was to evaluate the association between NPS and regional cerebral tau burden, a more direct representation of neurodegeneration, in cognitively normal (CN), MCI, and AD dementia individuals. METHODS Cross-sectional NPS were assessed using the Neuropsychiatric Inventory (NPI) in 410 CN, 199 MCI, and 61 AD dementia participants who underwent flortaucipir tau positron emission tomography as part of the AD Neuroimaging Initiative (ADNI). Total NPI score and two factors of NPS (affective and hyperactive) were used in analyses. Linear regression models with backward elimination were employed with NPI as dependent variable and regional tau or tau-amyloid interaction as predictor of interest. Covariates included education, age, sex, Rey Auditory Verbal Learning Test Total Learning, and Trail Making Test B. RESULTS There were significant associations (p < 0.05) between the NPI variables (total score, Affective factor) and entorhinal and precuneus tau across all participants. These associations were also significant for the tau-amyloid interaction. These effects were significant in cognitively symptomatic participants (MCI and AD dementia), but not in CN participants. CONCLUSIONS Increased tau burden in the entorhinal and precuneus cortices was modestly associated with greater NPS in MCI and AD dementia. Further evaluation of NPS and their effect on early-stage AD could aid in finding new interventions and slowing disease progression.
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Affiliation(s)
- Nicole S. Tommasi
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher Gonzalez
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Danielle Briggs
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Michael J. Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jennifer R. Gatchel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;,Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA;,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;,Correspondence to: Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, 60 Fenwood Road, 9016P, Boston, MA 02115, P: 617-732-8085, F: 617-264-6831,
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Xu L, Li T, Xiong L, Wang X, Ismail Z, Fukuda M, Sun Z, Wang J, Gauthier S, Yu X, Wang H. Reliability and Validity of the Chinese Version of Mild Behavioral Impairment Checklist in Mild Cognitive Impairment and Mild Alzheimer's Disease. J Alzheimers Dis 2021; 81:1141-1149. [PMID: 33935092 DOI: 10.3233/jad-210098] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mild behavioral impairment (MBI) has been proposed as an early manifestation of dementia. The Mild Behavioral Impairment Checklist (MBI-C) may help identify MBI in prodromal and preclinical dementia. OBJECTIVE The study aimed to evaluate the reliability and validity of the Chinese version of MBI-C in mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), and to explore the structure of the five factors of the MBI-C in Chinese culture. METHODS Sixty dyads of MCI and mild AD (MCI, n = 33; mild AD, n = 35) were recruited. The informants completed the MBI-C and Neuropsychiatric Inventory Questionnaire (NPI-Q) and were interviewed for clinician rating of the NPI. The Cronbach's coefficient was used to measure the structural reliability of the MBI-C. The criterion-validity was evaluated with the correlation coefficient between the MBI-C and the total scores of NPI-Q and NPI. Exploratory factor analysis was conducted to investigate the structure of the MBI-C. RESULTS The Cronbach's α coefficient was 0.895. The MBI-C total score was positively correlated with all five domains (r = 0.577∼0.840). The total score of MBI-C was significantly correlated with the total scores of NPI-Q (r = 0.714) and NPI (r = 0.749). Similarly, the five domain scores of MBI-C were significantly correlated with the factor and total scores of NPI-Q (r = 0.312∼0.673) and NPI (r = 0.389∼0.673). The components of each factor in Chinese version of MBI-C were slightly different from those of the a priori defined domains (χ2 = 1818.202, df = 496, p < 0.001). CONCLUSION The Chinese version of MBI-C has good reliability and validity, and can be used to evaluate the psychological and behavioral changes in MCI and mild AD.
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Affiliation(s)
- Lujie Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Tao Li
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Lingchuan Xiong
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Xiao Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Masami Fukuda
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Zhiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Jing Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Serge Gauthier
- McGill Center for Studies in Aging; Douglas Mental Health Research Institute; McGill University, Montreal, Canada
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Huali Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
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Shao Y, Xu H, Wang J, Dai X, Liang W, Ren L, Wang Y. Agitation and apathy increase risk of dementia in psychiatric inpatients with late-onset psychiatric symptoms. BMC Psychiatry 2021; 21:214. [PMID: 33910556 PMCID: PMC8080316 DOI: 10.1186/s12888-021-03210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A diagnosis of dementia in middle-aged and elder people is often complicated by physical frailty and comorbid neuropsychiatric symptoms (NPSs). Previous studies have identified NPSs as a risk factor for dementia. The aim of this study was to figure out to what extent individual NPS and certain demographic factors increased the risk of dementia in middle-aged and senior psychiatric inpatients. METHODS One hundred twenty-seven middle-aged and senior patients admitted to psychiatric wards for late-onset (age ≥ 50 years) psychiatric symptoms were included and categorized into dementia or non-demented psychiatric disorders (NDPD). The patients' demographic information and medical records were collected during the first hospitalization and subjected to statistical analyses. RESULTS 41.73% of the registered psychiatric inpatients were diagnosed as dementia in which Alzheimer's disease (AD) was the dominant subtype. The NDPD group consisted of nine individual diagnoses, except for schizophrenia. The frequencies of dementia inpatients increased with first episode age while that of NDPD inpatients decreased with first episode age. In the enrolled inpatients, most of dementia patients were males while females accounted for a higher proportion of NDPD patients. 58.49% of enrolled dementia inpatients presented cognitive deficit (CD) as the initial symptom while the remaining 41.51% showed NPS as initial symptom. Of the 12 NPSs, agitation and apathy greatly and significantly increased risk of dementia in psychiatric inpatients with late-onset psychiatric symptoms. CONCLUSIONS These results added evidence that the demented patients admitted to psychiatric ward are more likely to be male, older first episode age, and have characteristic NPS including aberrant motor behavior (AMB), hallucinations, agitation, irritability and apathy. Further, this study emphasized the importance of agitation and apathy of NPSs functioning as risk factors of dementia in these inpatients.
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Affiliation(s)
- Yuan Shao
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Haiyun Xu
- grid.268099.c0000 0001 0348 3990The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Jian Wang
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xijian Dai
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Wei Liang
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Lina Ren
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yongjun Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.
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40
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Ng KP, Chiew H, Rosa-Neto P, Kandiah N, Ismail Z, Gauthier S. Associations of AT(N) biomarkers with neuropsychiatric symptoms in preclinical Alzheimer's disease and cognitively unimpaired individuals. Transl Neurodegener 2021; 10:11. [PMID: 33789730 PMCID: PMC8011383 DOI: 10.1186/s40035-021-00236-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
The development of in vivo biomarkers of Alzheimer's disease (AD) has advanced the diagnosis of AD from a clinical syndrome to a biological construct. The preclinical stage of AD continuum is defined by the identification of AD biomarkers crossing the pathological threshold in cognitively unimpaired individuals. While neuropsychiatric symptoms (NPS) are non-cognitive symptoms that are increasingly recognized as early manifestations of AD, the associations of NPS with AD pathophysiology in preclinical AD remain unclear. Here, we review the associations between NPS and AD biomarkers amyloid-β (Aβ), tau and neurodegeneration in preclinical AD and cognitively-unimpaired individuals in 19 eligible English-language publications (8 cross-sectional studies, 10 longitudinal, 1 both cross-sectional and longitudinal). The cross-sectional studies have consistently shown that NPS, particularly depressive and anxiety symptoms, are associated with higher Aβ. The longitudinal studies have suggested that greater NPS are associated with higher Aβ and cognitive decline in cognitively unimpaired subjects over time. However, most of the studies have either cross-sectionally or longitudinally shown no association between NPS and tau pathology. For the association of NPS and neurodegeneration, two studies have shown that the cerebrospinal fluid total-tau is linked to longitudinal increase in NPS and that the NPS may predict longitudinal metabolic decline in preclinical AD, respectively. However, evidence for the association between atrophy and NPS in preclinical AD is less consistent. Therefore, future longitudinal studies with well-designed methodologies and NPS measurements are required not only to determine the relationship among AT(N) biomarkers, NPS and cognitive decline, but also to elucidate the contribution of comorbid pathology to preclinical AD.
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Affiliation(s)
- Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine - Imperial College London, Nanyang Technological University, Singapore, Singapore
| | - Hui Chiew
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine - Imperial College London, Nanyang Technological University, Singapore, Singapore
| | - Pedro Rosa-Neto
- The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine - Imperial College London, Nanyang Technological University, Singapore, Singapore
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health; Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Serge Gauthier
- The McGill University Research Centre for Studies in Aging, Montreal, Canada.
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Ibenthal E, Kehmann M, Backhaus C. Effectiveness of personalized music systems to influence neuropsychiatric symptoms associated with dementia: A quasi-experimental study. Explore (NY) 2021; 18:319-326. [PMID: 33781719 DOI: 10.1016/j.explore.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Studies have shown that music can improve the neuropsychiatric symptoms in people with dementia. Personalized music has the greatest impact. However, people with dementia in residential care rarely listen to personalized music; in doing so, they themselves as well as their caregivers pass up the positive effects associated with it. As a result, customizable music systems have been developed that allow people with dementia to listen to their favorite music. AIM To determine the effectiveness of personalized music systems on the neuropsychiatric symptoms of people with dementia in residential care and the perceived distress of caregivers. METHOD 14 residents heard personalized music during personal care for eight weeks. Outcomes were derived from pre-post-follow up assessments of residents' neuropsychiatric symptoms and caregivers' distress using the Neuropsychiatric Inventory Questionnaire (NPI-Q). The frequency of the music systems' usage was recorded in log files. A control group of 14 residents received standard care. RESULTS Caregivers used the music systems among the residents with varying frequency. During the intervention, an increasing trend of the severity value of apathy was observed, while the severity values of delusions and nighttime disturbances tended to decrease. However, the trends did not reach statistical significance. Caregivers' perceived distress was not affected. CONCLUSION A practicable solution for providing personalized music to people with dementia in residential care was tested. Possible positive effects were observed for delusions and nighttime disturbances in people with dementia, but a larger study will be required to verify these observations.
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Affiliation(s)
- Elisabeth Ibenthal
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany.
| | - Maximilian Kehmann
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany
| | - Claus Backhaus
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany
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Abstract
AIM To describe older persons who had commenced a memory assessment, experiences of living with memory impairment and related symptoms. BACKGROUND Persons with subjective memory impairment are two times more likely to develop dementia over the years than their peers. Older persons seldom seek help from primary health care clinics solely for subjective memory impairment. Of those who seek help, it can take up to 35 months from the person experiencing initial symptoms to referral to a memory clinic. Further research is needed regarding how older persons live with memory impairment with related symptoms before they receive a memory diagnosis. METHOD A qualitative study with 23 participants who had commenced a memory assessment in primary care. Semi-structured interviews were held. During the interviews, the Neuropsychiatric Inventory was completed and discussed with the participants. Interview data were analysed using Interpretive Description. RESULTS The results are presented under four themes: Conflicting views about the situation, Unveiling the presence of neuropsychiatric symptoms, Compensating with external and internal strategies to recall and Worrying about self and future. Persons with memory impairment were encouraged by family members or others to seek a memory assessment. Few persons were self-referred as memory impairment was often seen as a part of aging. Polarised viewpoints existed within the families regarding the impact of memory impairment on daily life. The presence of neuropsychiatric symptoms appeared unexplored in the participants seeking a memory assessment. In this study, the majority of participants experienced neuropsychiatric symptoms at the time of contact for a memory assessment. CONCLUSIONS Memory problems experienced were often viewed by the person as being part of an aging process. The presence of neuropsychiatric symptoms was not acknowledged as being connected to memory impairment. Contextualising 'memory impairment' as a part of a 'cognitive process' may help the person in identifying the presence of neuropsychiatric symptoms.
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Affiliation(s)
- Marie Tyrrell
- Sophiahemmet University, Sweden; NVS, Karolinska Institutet, Sweden
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43
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Ng KP, Pascoal TA, Mathotaarachchi S, Chan YH, Jiang L, Therriault J, Benedet AL, Shin M, Kandiah N, Greenwood CMT, Rosa-Neto P, Gauthier S. Neuropsychiatric symptoms are early indicators of an upcoming metabolic decline in Alzheimer's disease. Transl Neurodegener 2021; 10:1. [PMID: 33390174 PMCID: PMC7780680 DOI: 10.1186/s40035-020-00225-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background Neuropsychiatric symptoms (NPS) are increasingly recognized as early non-cognitive manifestations in the Alzheimer’s disease (AD) continuum. However, the role of NPS as an early marker of pathophysiological progression in AD remains unclear. Dominantly inherited AD (DIAD) mutation carriers are young individuals who are destined to develop AD in future due to the full penetrance of the genetic mutation. Hence, the study of DIAD mutation carriers enables the evaluation of the associations between pure AD pathophysiology and metabolic correlates of NPS without the confounding effects of co-existing pathologies. In this longitudinal study, we aimed to identify regional brain metabolic dysfunctions associated with NPS in cognitively intact DIAD mutation carriers. Methods We stratified 221 cognitively intact participants from the Dominantly Inherited Alzheimer’s Network according to their mutation carrier status. The interactions of NPS measured by the Neuropsychiatric Inventory-Questionnaire (NPI-Q), age, and estimated years to symptom onset (EYO) as a function of metabolism measured by [18F]flurodeoxyglucose ([18F]FDG) positron emission tomography, were evaluated by the mixed-effects regression model with family-level random effects in DIAD mutation carriers and non-carriers. Exploratory factor analysis was performed to identify the neuropsychiatric subsyndromes in DIAD mutation carriers using the NPI-Q sub-components. Then the effects of interactions between specific neuropsychiatric subsyndromes and EYO on metabolism were evaluated with the mixed-effects regression model. Results A total of 119 mutation carriers and 102 non-carriers were studied. The interaction of higher NPI-Q and shorter EYO was associated with more rapid declines of global and regional [18F]FDG uptake in the posterior cingulate and ventromedial prefrontal cortices, the bilateral parietal lobes and the right insula in DIAD mutation carriers. The neuropsychiatric subsyndromes of agitation, disinhibition, irritability and depression interacted with the EYO to drive the [18F]FDG uptake decline in the DIAD mutation carriers. The interaction of NPI and EYO was not associated with [18F]FDG uptake in DIAD mutation non-carriers. Conclusions The NPS in cognitively intact DIAD mutation carriers may be a clinical indicator of subsequent metabolic decline in brain networks vulnerable to AD, which supports the emerging conceptual framework that NPS represent early manifestations of neuronal injury in AD. Further studies using different methodological approaches to identify NPS in preclinical AD are needed to validate our findings.
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Affiliation(s)
- Kok Pin Ng
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada.,Department of Neurology, National Neuroscience Institute, Singapore City, Singapore
| | - Tharick A Pascoal
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Sulantha Mathotaarachchi
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Lai Jiang
- Lady Davis Institute, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Joseph Therriault
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Andrea L Benedet
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Monica Shin
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore City, Singapore
| | - Celia M T Greenwood
- Lady Davis Institute, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Pedro Rosa-Neto
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Serge Gauthier
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Montréal, Québec, Canada. .,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada.
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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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45
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Zhang M, Chen B, Zhong X, Zhou H, Wang Q, Mai N, Wu Z, Chen X, Peng Q, Zhang S, Yang M, Lin G, Ning Y. Neuropsychiatric Symptoms Exacerbate the Cognitive Impairments in Patients With Late-Life Depression. Front Psychiatry 2021; 12:757003. [PMID: 34867543 PMCID: PMC8639522 DOI: 10.3389/fpsyt.2021.757003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Neuropsychiatric symptoms (NPS) and cognitive impairments are both common in patients with late-life depression (LLD). However, the relationship between NPS and cognitive functions in LLD patients remains unclear. The current study aims to explore the effects of NPS on cognitive impairments in LLD patients. Methods: Two hundred and sixty-two LLD patients and 141 normal controls (NC) were recruited. Exploratory factor analysis was used to extract factors from the Neuropsychiatric Inventory (NPI). Correlation, mediation, and moderation analyses were used to explore whether NPS exacerbated the cognitive impairments in LLD and whether NPS exhibited different effects on cognitive impairments in acute-state LLD (aLLD) and recovery-state LLD (rLLD). Results: Three main factors were extracted from the NPI, including emotional, behavioral, and psychotic factors. The patients with LLD exhibited worse cognition and higher NPI scores, and the scores of NPI-total and three extracted factors were negatively associated with cognitive scores. The mediation analyses exhibited that NPI-total and behavioral factor scores increase the difference in cognition scores between LLD and NC groups. The mediation analyses exhibited that behavioral factor score played a greater effect on impairing MMSE in the rLLD group than in the aLLD group. Additionally, behavioral factor score was in a trend to be negatively associated with Mini-Mental State Examination (MMSE) score changes at a one-year follow-up (p = 0.051). Conclusions: NPS, especially behavioral symptoms, exacerbate cognitive impairments in LLD and may contribute to residual cognitive impairment in rLLD patients. Early intervention for behavioral symptoms in LLD patients may be beneficial to their long-term clinical prognosis.
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Affiliation(s)
- Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ben Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huarong Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Naikeng Mai
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhangying Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinru Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Peng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Si Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minfeng Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gaohong Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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46
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Sibley AA, Shrestha S, Lipovac-Dew M, Kunik ME. Examining Depression Symptoms With/Without Coexisting Anxiety Symptoms in Community-Dwelling Persons With Dementia. Am J Alzheimers Dis Other Demen 2021; 36:1533317521990267. [PMID: 33530695 PMCID: PMC10624070 DOI: 10.1177/1533317521990267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression and anxiety are common in persons with dementia (PWD) and associated with poor outcomes. We explored frequency, pharmacologic management and mental health service use in PWD and depression symptoms with/without coexisting anxiety symptoms. The sample comprised 160 community-dwelling PWD in a trial to prevent development of aggression. Baseline data on depression and anxiety symptoms, psychotropic medications and mental health service use were examined. Regarding participants, 65 (41%) lacked clinically significant depression or anxiety symptoms, 45 (28%) had depression symptoms, 43 (27%) had depression and anxiety symptoms, and 7 (4%) had anxiety symptoms. Comorbid anxiety was associated with more severe depression symptoms. One third with depression symptoms and one half with depression and anxiety symptoms were taking an antidepressant. Mental health service use was very low, regardless of depression symptom severity or coexisting anxiety. Research needs to evaluate therapies for depressed PWD, but treatment of those with comorbid anxiety and depression is more urgent. Clinical Trial Registration for Parent Trial: ClinicalTrials.gov (NCT02380703).
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Affiliation(s)
- Alexandra A. Sibley
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Srijana Shrestha
- Psychology Department, Wheaton College, Norton, MA, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Martha Lipovac-Dew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a Virtual Center), Houston, TX, USA
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47
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The challenge of bridging the gap between assessment and intervention in people with dementia care. Int Psychogeriatr 2020; 32:1027-1029. [PMID: 33025872 DOI: 10.1017/s1041610220001556] [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: 11/07/2022]
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48
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Abdeljalil AB, de Mauléon A, Baziard M, Vellas B, Lapeyre-Mestre M, Soto M. Antidepressant Use and Progression of Mild to Moderate Alzheimer's Disease: Results from the European ICTUS Cohort. J Am Med Dir Assoc 2020; 22:433-439. [PMID: 32736994 DOI: 10.1016/j.jamda.2020.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) are a core and troubling feature among patients with Alzheimer disease (AD). Because of growing safety warnings against antipsychotics, the use of antidepressants (ATD) in AD has increased extensively. We investigated the potential long-term associations between ATD exposure and functional and cognitive progression in patients with mild to moderate AD. DESIGN Two-year prospective multicenter cohort ICTUS (Impact of Cholinergic Treatment USe) study with biannual assessments. SETTING Twenty-nine memory clinics from 12 European countries. PARTICIPANTS Community-dwelling patients with mild to moderate AD. METHODS Global cognitive function was measured using the Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Functional impairment was measured using the Activities of Daily Living (ADL). Assessments were performed biannually for 2 years. Antidepressant exposure was defined by an ATD prescription for a minimum period of 6 months. Linear mixed models were used to study the associations between ATD exposure and cognitive and functional progression. RESULTS Antidepressant exposure was not associated with cognitive decline [MMSE: β-coefficients of the linear mixed models (Coef) = 0.06, 95% confidence interval (CI) -0.65 to 0.76, P = .87; ADAS-Cog: Coef = -13.9, 95% CI -34.80 to 7.03, P = .19] or with functional decline (ADL: Coef = -0.05, 95% CI -0.21 to 0.09, P = .48) at 2-year follow-up. Antipsychotic exposure at baseline was associated with a greater functional decline in the ADL score (Coef = -0.39, 95% CI - 0.68 to 0.10, P < .01). CONCLUSIONS AND IMPLICATIONS Antidepressant exposure was not associated with a faster rate of cognitive or functional decline in patients with mild to moderate AD. Antidepressants might be appropriate alternatives to antipsychotics in the management of NPS in mild to moderate AD.
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Affiliation(s)
- Anne-Bahia Abdeljalil
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France.
| | - Adélaïde de Mauléon
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France
| | - Marion Baziard
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France
| | - Bruno Vellas
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France
| | - Maryse Lapeyre-Mestre
- University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Maria Soto
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France
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49
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Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia. J Women Aging 2020; 33:635-652. [PMID: 32142386 DOI: 10.1080/08952841.2020.1735925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly VanHaitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Liza Behrens
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Eshraghi
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
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50
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Kan CN, Gyanwali B, Hilal S, Ng KP, Venketasubramanian N, Chen CLH, Xu X. Neuropsychiatric Correlates of Small Vessel Disease Progression in Incident Cognitive Decline: Independent and Interactive Effects. J Alzheimers Dis 2020; 73:1053-1062. [DOI: 10.3233/jad-190999] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cheuk Ni Kan
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Bibek Gyanwali
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Saima Hilal
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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