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Habuchi F, Ishida N, Matsushita R, Ishizaki J, Suga Y. Analysis of Atypical Antipsychotics-Induced Adverse Events Related to Diabetes Mellitus in Patients With Dementia Using the Japanese Adverse Drug Event Report Database. Ann Pharmacother 2024; 58:912-920. [PMID: 38124305 DOI: 10.1177/10600280231213507] [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: 12/23/2023] Open
Abstract
BACKGROUND Patients with dementia are prescribed low-dose atypical antipsychotics (AAPs) to treat psycho-behavioral symptoms. Although AAPs are known to cause diabetes mellitus-related adverse events (DMAEs), information regarding AAPs-induced DMAEs experienced by patients with dementia is lacking. OBJECTIVE To use the Japan Adverse Drug Event Report (JADER) database to assess the onset tendencies and patterns of DMAEs attributable to AAPs prescribed to patients with dementia. METHODS We performed an analysis using dementia cases from the JADER database that were registered from April 2004 to December 2022. Data in the JADER database are completely anonymized; thus, we did not require institutional review board approval for using the JADER database in our study. The reporting odds ratio and proportional reporting ratio (PRR) were used to assess the onset tendencies of DMAEs with AAPs. In addition, Weibull shape parameters were used to assess the patterns of DMAEs that occur with the use of AAPs. RESULTS We identified AAPs associated with DMAEs. In particular, low doses of quetiapine showed the potential to induce DMAEs. An analysis of the onset of DMAEs showed the early failure patterns for AAPs (median onset = 38 days). CONCLUSION AND RELEVANCE The AAPs may cause DMAEs in patients with dementia. Low doses of quetiapine may induce DMAEs. Health care workers should focus on the development of DMAEs during the early administration period of AAPs. These results may assist with the safe management of patients with dementia who use AAPs.
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Affiliation(s)
- Fuga Habuchi
- Division of Pharmacy, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
| | - Ryo Matsushita
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
| | - Junko Ishizaki
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
| | - Yukio Suga
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Japan
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Zhong A, Tan Y, Liu Y, Chai X, Peng W. There Is No Direct Causal Relationship Between Coronary Artery Disease and Alzheimer Disease: A Bidirectional Mendelian Randomization Study. J Am Heart Assoc 2024; 13:e032814. [PMID: 39082403 DOI: 10.1161/jaha.123.032814] [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: 09/22/2023] [Accepted: 06/24/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND The association between poor cardiovascular health and cognitive decline as well as dementia progression has been inconsistent across studies. This study used Mendelian randomization (MR) to investigate the causal relationship between Alzheimer disease (AD), circulating levels of total-tau, and coronary artery disease (CAD). METHODS AND RESULTS This study used MR to investigate the causal relationship between AD or circulating levels of total-tau and CAD, including ischemic heart disease, myocardial infarction, coronary heart disease, coronary atherosclerosis, and heart failure. The primary analysis used the inverse-variance weighted method, with pleiotropy and heterogeneity assessed using MR-Egger regression and the Q statistic. The overall results of the MR analysis indicated that AD did not exhibit a causal effect on heart failure (odds ratio [OR], 0.969 [95% CI, 0.921-1.018]; P=0.209), myocardial infarction (OR, 0.972 [95% CI, 0.915-1.033]; P=0.359), ischemic heart disease (OR, 1.013 [95% CI, 0.949-1.082]; P=0.700), coronary heart disease (OR, 1.005 [95% CI, 0.937-1.078]; P=0.881), or coronary atherosclerosis (OR, 0.987 [95% CI, 0.926-1.052]; P=0.690). No significant causal effect of CAD was observed on AD in the reverse MR analysis. Additionally, our findings revealed that CAD did not influence circulating levels of total-tau, nor did circulating levels of total-tau increase the risk of CAD. Sensitivity analysis and assessment of horizontal pleiotropy suggested that these factors did not distort the causal estimates. CONCLUSIONS The findings of this study indicate the absence of a direct causal relationship between AD and CAD from a genetic perspective. Therefore, managing the 2 diseases should be more independent and targeted. Concurrently, investigating the mechanism underlying their comorbidity may not yield meaningful insights for advancing treatment strategies.
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Affiliation(s)
- Aifang Zhong
- Department of Emergency Medicine, The Second Xiangya Hospital Central South University Changsha Hunan China
| | - Yejun Tan
- School of mathematics University of Minnesota Twin Cities Minneapolis MN USA
| | - Yaqiong Liu
- Centre for Research in Medical Devices, Biosciences Research Building National University of Ireland Galway Galway Ireland
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital Central South University Changsha Hunan China
| | - Weijun Peng
- Department of Integrated Traditional Chinese & Western Medicine, The Second Xiangya Hospital Central South University Changsha Hunan China
- National Clinical Research Center for Metabolic Diseases Changsha Hunan China
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Fang CC, Liu YH, Huang SH. The symbiotic experiences of residents with and without dementia co-living in Taiwan's long-term care facilities: a phenomenological study. BMC Geriatr 2024; 24:611. [PMID: 39020319 PMCID: PMC11253483 DOI: 10.1186/s12877-024-05205-9] [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: 12/22/2023] [Accepted: 07/05/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND In Taiwan, residents with and without dementia mostly co-live in long-term care facilities. The behavioral and psychiatric symptoms of dementia residents often pose challenges for others living together. This study explored the symbiotic experiences of residents without dementia co-living with those with dementia in long-term care facilities in Taiwan to present their experiences of living together. METHODS This was a cross-sectional descriptive study with a phenomenological design. Semi-structured face-to-face interviews were conducted with 30 residents without dementia from three long-term care institutions in Taiwan. Colaizzi's data processing steps were used for analysis. RESULTS The analysis of interview transcripts revealed that the experiences of residents who lived with those with dementia were that of a "symbiosis." Three core themes were found: "the impact of co-living," "facing difficulties and coping," and "companionship and reciprocity." This study showed that residents without dementia may be affected by the behavioral and psychiatric symptoms of residents with dementia when co-living in long-term care facilities. However, there are also positive and mutually beneficial interactions between them. By helping people with dementia in their daily lives, residents without dementia feel happy and accomplished and their self-worth is enhanced. Furthermore, residents with dementia have more opportunities for social engagement and co-living interactions. CONCLUSION These results can guide long-term care facilities without special care dementia units to support residents without dementia, reduce the interference of the behavioral and psychiatric symptoms of residents with dementia, and promote mutual benefits. However, these findings warrant further investigation.
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Affiliation(s)
- Chan-Chuan Fang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No. 115, Sec. 2, Linong St. Beitou Dist. 112, Taipei, Taiwan, R.O.C
| | - Yi-Hsun Liu
- Nursing Home, Changhua Hospital, Ministry of Health and Welfare, No. 80, Sec. 2, Zhongzheng Rd., Puxin Township, 513, Changhua County, Taiwan, R.O.C
| | - Shu-He Huang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No. 115, Sec. 2, Linong St. Beitou Dist. 112, Taipei, Taiwan, R.O.C..
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Bogaerts JMK, Gussekloo J, de Jong-Schmit BEM, Le Cessie S, Mooijaart SP, van der Mast RC, Achterberg WP, Poortvliet RKE. Effects of the discontinuation of antihypertensive treatment on neuropsychiatric symptoms and quality of life in nursing home residents with dementia (DANTON): a multicentre, open-label, blinded-outcome, randomised controlled trial. Age Ageing 2024; 53:afae133. [PMID: 38970547 PMCID: PMC11227112 DOI: 10.1093/ageing/afae133] [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: 02/07/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Based on observational studies and randomised controlled trials (RCTs), the benefit-harm balance of antihypertensive treatment in older adults with dementia is unclear. OBJECTIVE To assess whether discontinuing antihypertensive treatment reduces neuropsychiatric symptoms (NPSs) and maintains quality of life (QoL) in nursing home residents with dementia. DESIGN Open-label, blinded-outcome RCT. Randomisation 1:1, stratified by nursing home organisation and baseline NPS. Trial registration: NL7365. SUBJECTS Dutch long-term care residents with moderate-to-severe dementia and systolic blood pressure (SBP) ≤160 mmHg during antihypertensive treatment. Exclusion criteria included heart failure NYHA-class-III/IV, recent cardiovascular events/procedures or life expectancy <4 months (planned sample size n = 492). MEASUREMENTS Co-primary outcomes NPS (Neuropsychiatric Inventory-Nursing Home [NPI-NH]) and QoL (Qualidem) at 16 weeks. RESULTS From 9 November 2018 to 4 May 2021, 205 participants (median age 85.8 [IQR 79.6-89.5] years; 79.5% female; median SBP 134 [IQR 123-146] mmHg) were randomised to either antihypertensive treatment discontinuation (n = 101) or usual care (n = 104). Safety concerns, combined with lacking benefits, prompted the data safety and monitoring board to advice a premature cessation of randomisation. At 16-week follow-up, no significant differences were found between groups for NPI-NH (adjusted mean difference 1.6 [95% CI -2.3 to 5.6]; P = 0.42) or Qualidem (adjusted mean difference - 2.5 [95% CI -6.0 to 1.0]; P = 0.15). Serious adverse events (SAEs) occurred in 36% (discontinuation) and 24% (usual care) of the participants (adjusted hazard ratio 1.65 [95% CI 0.98-2.79]). All 32-week outcomes favoured usual care. CONCLUSION Halfway through this study, a non-significant increased SAE risk associated with discontinuing antihypertensive treatment was observed, and an associated interim analysis showed that significant worthwhile health gain for discontinuation of antihypertensive treatment was unlikely. This unbeneficial benefit-harm balance shows that discontinuation of antihypertensive treatment in this context does not appear to be either safe or beneficial enough to be recommended in older adults with dementia.
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Affiliation(s)
- Jonathan M K Bogaerts
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Bianca E M de Jong-Schmit
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Saskia Le Cessie
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Biomedical Datasciences, Section Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Simon P Mooijaart
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Roos C van der Mast
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Psychiatry, The Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, S.033, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- University Network for the Care sector South Holland, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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Singh AK, Malviya R, Prakash A, Verma S. Neuropsychiatric Manifestations in Alzheimer's Disease Patients: Genetics and Treatment Options. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:39-54. [PMID: 36856177 DOI: 10.2174/1871527322666230301111216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/03/2022] [Accepted: 12/27/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by neuropsychiatric symptoms (NPS), which cause great misery to those with dementia and those who care for them and may lead to early institutionalization. OBJECTIVE The present systematic review aims to discuss the various aspects of Alzheimer's, including treatment options. METHODS The databases Embase, PubMed, and Web of Science were searched to collect data. RESULTS Incipient cognitive deterioration is commonly accompanied by these early warning signals of neurocognitive diseases. The neurobiology of NPSs in Alzheimer's disease, as well as particular symptoms, including psychosis, agitation, apathy, sadness, and sleep disorders, will be examined in this review. For NPSs in Alzheimer's disease, clinical trial designs, as well as regulatory issues, were also addressed. A fresh wave of research, however, is helping to push the discipline ahead. For medication development and repurposing, we highlight the most recent results in genetics, neuroimaging, and neurobiology. Even though identifying and treating psychosis in adults with dementia is still a challenging endeavor, new options are coming up that give the field fresh focus and hope. Conclsuion: It can be concluded from the complete literature survey that Alzheimer's-related psychosis as well as other symptoms that are not psychotic, have made significant progress in the last decade. These milestones in the development of safer, more effective treatments have been achieved as a consequence of great focus on non-pharmacological interventions like DICE or WHELD; the investigation into ways to improve existing drugs like aripiprazole, risperidone, amisulpride, and Escitalopram for safer precision-based treatment; and the development of a clinical trial program for pimavanserin.
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Affiliation(s)
- Arun Kumar Singh
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Anuj Prakash
- Reference Standard Division, Indian Pharmacopoeia Commission, Sec-23, Raj Nagar, Ghaziabad, Uttar Pradesh, India
| | - Swati Verma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
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Schliep KC, Ju S, Foster NL, Smith KR, Varner MM, Østbye T, Tschanz J. How good are medical and death records for identifying dementia? Alzheimers Dement 2022; 18:1812-1823. [PMID: 34873816 PMCID: PMC9170837 DOI: 10.1002/alz.12526] [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: 04/16/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Retrospective studies using administrative data may be an efficient way to assess risk factors for dementia if diagnostic accuracy is known. METHODS Within-individual clinical diagnoses of Alzheimer's disease (AD) and all-cause dementia in ambulatory (outpatient) surgery, inpatient, Medicare administrative records and death certificates were compared with research diagnoses among participants of Cache County Study on Memory, Health, and Aging (CCSMHA) (1995-2008, N = 5092). RESULTS Combining all sources of clinical health data increased sensitivity for identifying all-cause dementia (71%) and AD (48%), while maintaining relatively high specificity (81% and 93%, respectively). Medicare claims had the highest sensitivity for case identification (57% and 40%, respectively). DISCUSSION Administrative health data may provide a less accurate method than a research evaluation for identifying individuals with dementing disease, but accuracy is improved by combining health data sources. Assessing all-cause dementia versus a specific cause of dementia such as AD will result in increased sensitivity, but at a cost to specificity.
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Affiliation(s)
- Karen C. Schliep
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Shinyoung Ju
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Norman L. Foster
- Center for Alzheimer’s Care, Imaging & Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Ken R. Smith
- Department of Family and Consumer Studies and Population Sciences/Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Michael M. Varner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina, USA
| | - JoAnn Tschanz
- Department of Psychology, Utah State University, Logan, Utah, USA
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Yesiltepe M, Cimen B, Sara Y. Effects of chronic vagal nerve stimulation in the treatment of β-amyloid-induced neuropsychiatric symptoms. Eur J Pharmacol 2022; 931:175179. [PMID: 35973478 DOI: 10.1016/j.ejphar.2022.175179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
Abstract
Alzheimer's Disease (AD) is the leading cause of dementia and, at the time of diagnosis, half of AD patients display at least one neuropsychiatric symptom (NPS). However, there is no effective therapy for NPSs; furthermore, current treatments of NPSs accelerate cognitive decline. Due to the ineffectiveness and negative consequences of current treatments for NPSs, new approaches are strongly needed. Currently, indications for vagal nerve stimulation (VNS) include epilepsy, stroke rehabilitation and major depression but not NPSs or AD. Therefore, we investigated whether chronic VNS can treat NPSs in a rat model of AD. Here, we report the intracerebroventricular injection of amyloid-β (Aβ) results in depression-like behaviors and memory impairment in rats. Chronic VNS (0.8 mA, 500 μs, 30 Hz, 5 min/day) showed strong antidepressant and anxiolytic effects, and improved memory performance. Additionally, the anxiolytic effect of VNS was retained in the non-Aβ-treated rats. VNS also decreased aggressiveness and increased locomotor activity in both Aβ-treated and non-Aβ-treated rats. Recent studies showed VNS alters glutamatergic receptor levels, thus levels of GluA1, GluN2A, and GluN2B were determined. A significant reduction in GluN2B levels was seen in the hippocampus of VNS-treated groups which may relate to the anxiolytic effects and increased locomotor activity of VNS. In conclusion, VNS could be an effective treatment of NPSs, especially depression and anxiety, in AD patients without impairing cognition.
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Affiliation(s)
- Metin Yesiltepe
- Department of Medical Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers University, NJ, USA
| | - Bariscan Cimen
- Department of Medical Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yildirim Sara
- Department of Medical Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Vuic B, Konjevod M, Tudor L, Milos T, Nikolac Perkovic M, Nedic Erjavec G, Pivac N, Uzun S, Mimica N, Svob Strac D. Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia. Expert Rev Neurother 2022; 22:707-720. [PMID: 35950234 DOI: 10.1080/14737175.2022.2112668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) are symptoms of non-cognitive nature, which frequently develop during the course and different stages of dementia. The diagnosis of BPSD is complex due to symptom variety, and relies on detailed clinical evaluation and medical history. Accurate assessment of BPSD is crucial in order to tailor therapeutic intervention (non-pharmacological and pharmacological) for each individual and monitor patient response to therapy. AREAS COVERED This review encompasses the epidemiology, classification, assessment and etiology of BPSD, as well as their impact on caregiver distress, and gives an overview of current and emerging non-pharmacological and pharmacological therapeutic options, as well as potential BPSD biomarkers, in order to provide a framework for improving BPSD diagnosis and developing novel, targeted and specific therapeutic strategies for BPSD. EXPERT OPINION Due to the large heterogeneity of BPSD and of the fact that drugs available only alleviate symptoms, finding an adequate treatment is very challenging and often involves a polytherapeutic approach. Non-pharmacologic interventions have shown promising results in improving BPSD, however further research is needed to confirm their beneficial effects. Thus, the modification of pre-existancing as well as the development of novel pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy.
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Affiliation(s)
- Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
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Azocar I, Rapaport P, Burton A, Meisel G, Orgeta V. Risk factors for apathy in Alzheimer's disease: A systematic review of longitudinal evidence. Ageing Res Rev 2022; 79:101672. [PMID: 35714852 DOI: 10.1016/j.arr.2022.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/26/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Apathy is frequent and persistent in Alzheimer's disease (AD), associated with poor prognosis and carer distress; yet our knowledge of risk factors remains limited. AIMS To identify risk factors associated with apathy incidence and progression in AD over time. METHODS We systematically reviewed evidence based on longitudinal studies assessing risk factors for apathy in AD up to June 2021. Two authors independently assessed article eligibility and rated quality. RESULTS 13,280 articles were screened, of which 13 met inclusion criteria. Studies had a mean follow-up of 2.7 years reporting on a total of 2012 participants. Most findings were based on single studies of moderate quality evidence. Risk factors increasing apathy onset were: being a carrier of the T allele of the PRND gene polymorphism, and having high levels of the IL-6 and TNFα cytokines at baseline. Risk factors for apathy worsening were: reduced inferior-temporal cortical thickness, taking antidepressants, being an ApoE ε4 carrier, living longer with AD, lower cognitive test scores, higher baseline apathy, premorbid personality traits (lower agreeableness, higher neuroticism), and higher midlife motivational abilities. CONCLUSIONS Although results are limited by the small number of studies, this review identified specific genetic, neurobiological, AD specific, and dispositional factors that may increase risk of apathy onset and worsening in AD.
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Affiliation(s)
- Ignacia Azocar
- Division of Psychiatry, University College London, London, UK.
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | - Georgia Meisel
- Division of Psychiatry, University College London, London, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
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Ismail Z, Creese B, Aarsland D, Kales HC, Lyketsos CG, Sweet RA, Ballard C. Psychosis in Alzheimer disease - mechanisms, genetics and therapeutic opportunities. Nat Rev Neurol 2022; 18:131-144. [PMID: 34983978 PMCID: PMC9074132 DOI: 10.1038/s41582-021-00597-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
Psychosis is a common and distressing symptom in people with Alzheimer disease, and few safe and effective treatments are available. However, new approaches to symptom assessment and treatment are beginning to drive the field forward. New nosological perspectives have been provided by incorporating the emergence of psychotic symptoms in older adults - even in advance of dementia - into epidemiological and neurobiological frameworks as well as into diagnostic and research criteria such as the International Psychogeriatric Association criteria for psychosis in neurocognitive disorders, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) research criteria for psychosis in neurodegenerative disease, and the ISTAART criteria for mild behavioural impairment. Here, we highlight the latest findings in genomics, neuroimaging and neurobiology that are informing approaches to drug discovery and repurposing. Current pharmacological and non-pharmacological treatment options are discussed, with a focus on safety and precision medicine. We also explore trial data for pimavanserin, a novel agent that shows promise for the treatment of psychosis in people with dementia, and discuss existing agents that might be useful but need further exploration such as escitalopram, lithium, cholinesterase inhibitors and vitamin D. Although the assessment and management of psychosis in people with dementia remain challenging, new opportunities are providing direction and hope to the field.
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Affiliation(s)
- Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology, Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Byron Creese
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Science, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Robert A Sweet
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clive Ballard
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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11
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Castillo-García IM, López-Álvarez J, Osorio R, Olazarán J, Ramos García MI, Agüera-Ortiz L. Clinical Trajectories of Neuropsychiatric Symptoms in Mild-Moderate to Advanced Dementia. J Alzheimers Dis 2022; 86:861-875. [PMID: 35147532 DOI: 10.3233/jad-215133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is high prevalence of neuropsychiatric symptoms (NPS) among dementia patients. NPS are correlated with dementia progression, functional decline, early institutionalization, and death. There is scarce evidence on the progression of NPS in the latest stages of dementia. OBJECTIVE To describe the prevalence of NPS in mild-moderate to severe dementia and to reveal the progression of each NPS over time. METHODS We studied 317 patients (77.3% female, average age: 81.5 years) with a DSM-IV-TR diagnosis of dementia. This is a cross-sectional, and a prospective longitudinal study with 78-month follow-up. We assessed cognitive status (Mini-Mental State Examination and Severe Mini-Mental State Examination), dementia severity (Global Deterioration Scale and Clinical Dementia Rating), and psychopathological measures (Neuropsychiatric Inventory, APADEM-Nursing Home, Apathy Inventory, Cornell Scale for Depression in Dementia, and Cohen-Mansfield Agitation Inventory). RESULTS Overall prevalence of NPS was 94.6%, being apathy the most prevalent (66.7%) and the one whose severity increased the most with progression of dementia. Agitation/aggression, irritability, and sleeping and eating disorders also increased over time. Delusions and depressive symptoms decreased in severity with disease progression. In severe dementia, female displayed more severe depressive symptoms and eating disorders, while male displayed more agitation/aggression and sleep disturbances. CONCLUSION NPS in dementia follow a heterogeneous course. Apathy is the most prevalent NPS and the one that worsens most significantly over time. The course of some NPS differs between sexes. Further research is required to understand the evolution of NPS at advanced stages of dementia.
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Affiliation(s)
- Isabel M Castillo-García
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 deOctubre, Madrid, Spain
| | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 deOctubre, Madrid, Spain.,Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain
| | - Ricardo Osorio
- Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Department of Psychiatry NYU Grossman School of Medicine, New York, NY, USA
| | - Javier Olazarán
- Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Servicio de Neurología, HGU Gregorio Marañón, Madrid, Spain
| | - Maria I Ramos García
- Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Instituto de Psiquiatría y Salud Mental, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISC), Madrid, Spain
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 deOctubre, Madrid, Spain.,Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Centro deInvestigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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12
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Akhter F, Persaud A, Zaokari Y, Zhao Z, Zhu D. Vascular Dementia and Underlying Sex Differences. Front Aging Neurosci 2021; 13:720715. [PMID: 34566624 PMCID: PMC8457333 DOI: 10.3389/fnagi.2021.720715] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Vascular dementia (VaD) is the second most common form of dementia after Alzheimer's disease (AD); where Alzheimer's accounts for 60-70% of cases of dementia and VaD accounts for 20% of all dementia cases. VaD is defined as a reduced or lack of blood flow to the brain that causes dementia. VaD is also known occasionally as vascular contributions to cognitive impairment and dementia (VCID) or multi-infarct dementia (MID). VCID is the condition arising from stroke and other vascular brain injuries that cause significant changes to memory, thinking, and behavior, and VaD is the most severe stage while MID is produced by the synergistic effects caused by multiple mini strokes in the brain irrespective of specific location or volume. There are also subtle differences in the presentation of VaD in males and females, but they are often overlooked. Since 1672 when the first case of VaD was reported until now, sex and gender differences have had little to no research done when it comes to the umbrella term of dementia in general. This review summarizes the fundamentals of VaD followed by a focus on the differences between sex and gender when an individual is diagnosed. In addition, we provide critical evidence concerning sex and gender differences with a few of the main risk factors of VaD including pre-existing health conditions and family history, gene variants, aging, hormone fluctuations, and environmental risk factors. Additionally, the pharmaceutical treatments and possible mitigation of risk factors is explored.
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Affiliation(s)
- Firoz Akhter
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
| | - Alicia Persaud
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
| | - Younis Zaokari
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
| | - Zhen Zhao
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Donghui Zhu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
- Neuroscience Graduate Program, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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13
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Lappalainen L, Rajamaki B, Tolppanen AM, Hartikainen S. Coronary artery revascularizations and cognitive decline - A systematic review. Curr Probl Cardiol 2021; 47:100960. [PMID: 34363848 DOI: 10.1016/j.cpcardiol.2021.100960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022]
Abstract
Coronary artery disease (CAD) is a risk factor for cognitive decline. The aim of this study was to systematically review recent literature on whether coronary artery revascularizations are associated to cognitive decline and dementia. Pubmed, Scopus, and CINAHL (EBSCO) were searched systematically from January 2009 till September 2020. Studies were conducted on persons with CAD undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) procedure compared to other coronary artery disease treatments, and the outcome was cognitive decline or dementia. Altogether four of the 680 reviewed articles met inclusion criteria. Results were inconsistent, and the outcome measurements heterogeneous between studies. Our findings indicate an evidence gap in the current understanding of long-term outcomes following coronary artery revascularization. However, evidence of long-term effects on cognition would complement our understanding of their benefits. There is a need for more studies on long-term cognitive outcomes after coronary artery revascularizations.
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Affiliation(s)
- Laura Lappalainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Blair Rajamaki
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
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14
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Bränsvik V, Granvik E, Minthon L, Nordström P, Nägga K. Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study. Aging Ment Health 2021; 25:1101-1109. [PMID: 32067466 DOI: 10.1080/13607863.2020.1727848] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms of dementia (BPSD) are common in patients with dementia. In the elderly population, comorbidities frequently coexist with dementia and mortality in dementia is high. The aim of this study was to investigate the impact of BPSD on mortality in severe dementia. METHODS This study of 11,448 individuals was based on linked information from the Swedish BPSD registry, the National Patient Register and the Cause of Death register. BPSD was assessed with the Neuropsychiatric Inventory (NPI). Cox proportional hazards regressions were performed for survival analysis. To study different degrees of BPSD, data was categorized into groups: no (NPI, 0 points), mild (NPI, 1-3 points on ≥1 item), moderate (NPI, 4-8 points on ≥1 item) and severe (NPI, 9-12 points on ≥1 item) BPSD based on the highest score on any of the BPSD assessed (NPI items). RESULTS The presence of moderate or severe BPSD was associated with a stepwise increased risk of mortality (hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.08-1.60 and HR 1.74; 95% CI 1.44-2.12, respectively) compared with individuals with no BPSD. In addition, there was an association between total NPI score and mortality (HR 1.01; 95% CI 1.007-1.010). The results remained significant after multivariable adjustment for age, sex, dementia diagnosis, medication, previous myocardial infarction, hip fracture and stroke. CONCLUSIONS The results show a stepwise increase in mortality risk with increased BPSD, highlighting the importance of adequate management of BPSD to reduce mortality in dementia.
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Affiliation(s)
- Vanja Bränsvik
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Eva Granvik
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, Umeå, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Acute Internal Medicine and Geriatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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15
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de Jong‐Schmit BEM, Poortvliet RKE, Böhringer S, Bogaerts JMK, Achterberg WP, Husebo BS. Blood pressure, antihypertensive medication and neuropsychiatric symptoms in older people with dementia: The COSMOS study. Int J Geriatr Psychiatry 2021; 36:46-53. [PMID: 32748494 PMCID: PMC7756813 DOI: 10.1002/gps.5388] [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: 02/11/2020] [Revised: 06/11/2020] [Accepted: 07/21/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) are very common in older patients with dementia. There is increasing evidence that hypoperfusion of the brain plays a role in the development of NPS. The aim of this study is to assess whether there is an association between low systolic blood pressure (SBP) and NPS and if NPS are more prevalent in older people with dementia using antihypertensive medication. METHODS We studied the baseline data from participants in the Communication, Systematic pain treatment, Medication review, Organized activities and Safety study, a multicenter clustered trial with 765 participants from 72 nursing home units from 37 nursing homes in Norway. SBP (lowest quartile vs rest) and use of antihypertensive medication were predictors and Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score (total and clusters) was the outcome. Missing data were imputed, except for missing data in predictors. We used a mixed model analysis adjusted for age, sex and Minimal Mental State Examination (MMSE) score. In a sensitivity analysis, continuous SBP values were used. RESULTS In total, 412 patients were included with a mean age of 86.9 years, 53.9% had a MMSE score of <11. There was no difference in total NPI-NH score between low and high SBP (difference -1.07, Pdj = 0.62). There was no difference between high and low SBP and the NPI clusters. The use of antihypertensive medication was not associated with a different total or cluster NPI-NH score compared to no use (difference -0.99, Padj = 0.95, Pall = 0.37-0.99, respectively). In the sensitivity analyses with the continuous SBP levels, there was no association between SBP and NPI-NH score (estimate 1.00, 95%CI 0.98-1.01, P = 0.25). CONCLUSION We found no association between low SBP and NPS, nor between antihypertensive use and NPS.
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Affiliation(s)
| | | | - Stefan Böhringer
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
| | - Jonathan M. K. Bogaerts
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Bettina S. Husebo
- Department of Global Public Health and Primary CareCentre for Elderly and Nursing Home Medicine, University of BergenBergenNorway
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16
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Hellton KH, Cummings J, Vik-Mo AO, Nordrehaug JE, Aarsland D, Selbaek G, Giil LM. The Truth behind the Zeros: A New Approach to Principal Component Analysis of the Neuropsychiatric Inventory. MULTIVARIATE BEHAVIORAL RESEARCH 2021; 56:70-85. [PMID: 32329370 PMCID: PMC8867488 DOI: 10.1080/00273171.2020.1736976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psychiatric syndromes in dementia are often derived from the Neuropsychiatric Inventory (NPI) using principal component analysis (PCA). The validity of this statistical approach can be questioned, since the excessive proportion of zeros and skewness of NPI items may distort the estimated relations between the items. We propose a novel version of PCA, ZIBP-PCA, where a zero-inflated bivariate Poisson (ZIBP) distribution models the pairwise covariance between the NPI items. We compared the performance of the method to classical PCA under zero-inflation using simulations, and in two dementia-cohorts (N = 830, N = 1349). Simulations showed that component loadings from PCA were biased due to zero-inflation, while the loadings of ZIBP-PCA remained unaffected. ZIBP-PCA obtained a simpler component structure of "psychosis," "mood" and "agitation" in both dementia-cohorts, compared to PCA. The principal components from ZIBP-PCA had component loadings as follows: First, the component interpreted as "psychosis" was loaded by the items delusions and hallucinations. Second, the "mood" component was loaded by depression and anxiety. Finally, the "agitation" component was loaded by irritability and aggression. In conclusion, PCA is not equipped to handle zero-inflation. Using the NPI, PCA fails to identify components with a valid interpretation, while ZIBP-PCA estimates simple and interpretable components to characterize the psychopathology of dementia.
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Affiliation(s)
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Audun Osland Vik-Mo
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, United Kingdom
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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17
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García-Alberca JM, Mendoza S, Gris E, Royo JL, Cruz-Gamero JM, García-Casares N. White matter lesions and temporal atrophy are associated with cognitive and neuropsychiatric symptoms in patients with hypertension and Alzheimer's disease. Int J Geriatr Psychiatry 2020; 35:1292-1300. [PMID: 32584440 DOI: 10.1002/gps.5366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 06/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES An increasing evidence suggests hypertension (HTN) could be linked to cognitive impairment and incident Alzheimer's disease (AD). The precise mechanisms linking HTN and AD are not well-known. The aim of this study was to assess the putative association between HTN and AD. METHODS We assessed in patients with AD associations between HTN and demographic and clinical data, vascular risk factors, treatments, APOE genotypes, brain white matter hyperintensities (WMH), and medial temporal atrophy (MTA) in multivariate analysis of covariance. RESULTS We studied 92 patients with AD (mean ± SD age: 72.12 ± 6.91; women: 66.30%). Patients with HTN had significantly worse cognitive and functional status and higher frequency and severity of neuropsychiatric symptoms (P = .010). Magnetic resonance imaging analyzes showed significant increases in WMH (P = .018) and in MTA (P = .012) in patients with AD with HTN compared with those without HTN. CONCLUSIONS Neuroimaging burden (MTA and higher degree of severity of WMH) among patients with AD and HTN are associated with the impaired cognitive function and neuropsychiatric symptoms.
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Affiliation(s)
| | - Silvia Mendoza
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - Esther Gris
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - José Luis Royo
- Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - José Manuel Cruz-Gamero
- Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - Natalia García-Casares
- Department of Medicine, School of Medicine, University of Málaga, Research Medical Center of Málaga University, Biomedical Research Institute of Málaga, Málaga, Spain
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18
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Gerlach LB, Kales HC. Managing Behavioral and Psychological Symptoms of Dementia. Clin Geriatr Med 2020; 36:315-327. [DOI: 10.1016/j.cger.2019.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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20
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Callari A, Miniati M. Clinical and Therapeutic Challenges when Psychiatric Disorders Occur in Neurological Diseases: A Narrative Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190411142109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Over the course of the 20th century, neurology and psychiatry diverged and became two separate disciplines. Subsequently, the continuous progress of neurosciences confused their boundaries. However, with ‘the splitting’ and ‘the lumping’ approaches, relevant difficulties remain in targeting clinical and therapeutic goals, when psychiatric signs and symptoms co-occur with neurological diseases.Objective:The study summarize current evidence on psychiatric signs and symptoms comorbid with neurological diseases, with the aim to provide information on diagnostic problems and available therapeutic options.Methods:Finding from searches of publications on ‘PsycInfo’, ‘Medline’, and ‘Science Direct’, from January 1993 to December 2018 (25 years) is summarized in a narrative manner on six main neurological areas: congenital neurological illnesses (n=16), dementias (n=15), basal ganglia diseases (n=30), epilepsy (n=22), strokes/focal brain injuries (n=29), and neurological neoplastic/paraneoplastic diseases (n=15).Results:Clinical phenotypes of psychiatric syndromes are frequently described in neurological studies. Little evidence is provided on the most adequate therapeutic approaches.Conclusion:Psychiatric syndromes in comorbidity with neurological diseases are heterogeneous and severe; evidence-based treatments are scarce. Despite a model supporting an equal approach between psychiatric and neurological syndromes, psychiatric syndromes in neurological diseases have been described, to a relevant degree, as less important, leading to a hierarchical primate of the neurological manifestations, and thus, in our opinion, limiting the systematic studies on psychopharmacological treatments in this area.
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Affiliation(s)
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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21
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Veronese N, Solmi M, Basso C, Smith L, Soysal P. Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1316-1325. [PMID: 30156330 DOI: 10.1002/gps.4962] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/31/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPs) affect almost all patients with Alzheimer disease (AD). Because of the complications associated with the pharmacological treatment, nonpharmacological treatment (such as physical activity) can be considered as an additional complementary treatment option for NPs. The aim of this review is to evaluate the impact of physical activity on NPs in patients with AD. METHODS We searched Pubmed and Google Scholar for potential eligible articles until March 1, 2018. RESULTS Although there are contradictory results showing the impact of physical exercise on NPs, most of them reported that it had a significant effect on depression and sleep disturbances in patients with AD. The beneficial effects could be explained through several mechanisms, including modulated production of neurotransmitters; increasing neurotrophins, such as brain-derived neurotrophic factor; reduction of oxidative stress and inflammation; elevation of cerebral blood flow; hypothalamic pituitary adrenal axis regulation; and support of neurogenesis and synaptogenesis. Physical activity can also improve cardiovascular risk factors, which may exaggerate NPs. There is limited evidence for other NPs such as agitation, disinhibition, apathy, hallucinations, and anxiety. CONCLUSION Physical activity may ameliorate depression and sleep disturbances in patients with AD. Therefore, physical activity can be a "potential" add-on treatment to drugs to reduce or prevent these symptoms onset and recurrence in patients with AD. However, further studies are needed to focus on relationship between physical activity and other NPs.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.,Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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22
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Abstract
Alzheimer disease (AD) is characterized by wide heterogeneity in cognitive and behavioural syndromes, risk factors and pathophysiological mechanisms. Addressing this phenotypic variation will be crucial for the development of precise and effective therapeutics in AD. Sex-related differences in neural anatomy and function are starting to emerge, and sex might constitute an important factor for AD patient stratification and personalized treatment. Although the effects of sex on AD epidemiology are currently the subject of intense investigation, the notion of sex-specific clinicopathological AD phenotypes is largely unexplored. In this Review, we critically discuss the evidence for sex-related differences in AD symptomatology, progression, biomarkers, risk factor profiles and treatment. The cumulative evidence reviewed indicates sex-specific patterns of disease manifestation as well as sex differences in the rates of cognitive decline and brain atrophy, suggesting that sex is a crucial variable in disease heterogeneity. We discuss critical challenges and knowledge gaps in our current understanding. Elucidating sex differences in disease phenotypes will be instrumental in the development of a 'precision medicine' approach in AD, encompassing individual, multimodal, biomarker-driven and sex-sensitive strategies for prevention, detection, drug development and treatment.
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23
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Rozum WJ, Cooley B, Vernon E, Matyi J, Tschanz JT. Neuropsychiatric symptoms in severe dementia: Associations with specific cognitive domains the Cache County Dementia Progression Study. Int J Geriatr Psychiatry 2019; 34:1087-1094. [PMID: 30945374 PMCID: PMC6812503 DOI: 10.1002/gps.5112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the prevalence of neuropsychiatric symptoms (NPS) and cognitive correlates in severe dementia. METHODS A population-based sample of 56 individuals with severe dementia (85.7% Alzheimer's type; 67.9% female) were assessed with the Severe Cognitive Impairment Profile (SCIP) and the Neuropsychiatric Inventory (NPI). Descriptive statistics displayed the frequency of NPS and bivariate and multiple regression analyses examined the associations between cognitive domains on the SCIP and NPS total, domain, and cluster scores. RESULTS NPS were common in severe dementia with 98% of the sample exhibiting at least one symptom. Most common were delusions, apathy, agitation/aggression, and aberrant motor behavior, affecting 50% or more of participants. SCIP comportment was significantly associated with NPI total score and apathy (r = -.350 and -.292, respectively). All SCIP domains except for arithmetic, visuospatial, comportment, and motor behavior were significantly associated with agitation/aggression (r = -.285 to -.350). These associations remained in individual multiple regression models. CONCLUSION In severe dementia, impairment in specific cognitive domains was associated with more severe NPS. Environmental manipulations to reduce processing demands in persons with severe dementia may be a useful strategy to target agitation and aggressive behaviors.
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Affiliation(s)
| | | | | | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University;,Center for Epidemiologic Studies, Utah State University
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24
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Vernon EK, Cooley B, Rozum W, Rattinger GB, Behrens S, Matyi J, Fauth E, Lyketsos CG, Tschanz JT. Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia. Am J Geriatr Psychiatry 2019; 27:349-359. [PMID: 30616905 PMCID: PMC6812501 DOI: 10.1016/j.jagp.2018.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs. METHODS Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002-2012). RESULTS In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed -0.32 points per year for the psychosis cluster, -0.11 points per year for agitation/aggression, and -0.67 overall for the affective cluster. CONCLUSION Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.
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Affiliation(s)
- Elizabeth K Vernon
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Bryce Cooley
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - William Rozum
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Gail B Rattinger
- Department of Health Outcomes and Administrative Sciences (GBR), School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY
| | - Stephanie Behrens
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Joshua Matyi
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Elizabeth Fauth
- Department of Human Development and Family Studies (EF), Utah State University, Logan, UT
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences (CGL), Johns Hopkins University, Baltimore
| | - JoAnn T Tschanz
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT; Center for Epidemiological Studies (JTT), Utah State University, Logan, UT.
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Yunusa I, Alsumali A, Garba AE, Regestein QR, Eguale T. Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia: A Network Meta-analysis. JAMA Netw Open 2019; 2:e190828. [PMID: 30901041 PMCID: PMC6583313 DOI: 10.1001/jamanetworkopen.2019.0828] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Atypical antipsychotics offer modest effectiveness compared with placebo but with serious safety risks, including a boxed warning for the risk of death in the treatment of behavioral and psychological symptoms of dementia (BPSD). Their comparative effectiveness and safety are not fully known. OBJECTIVE To assess the relative benefits and safety of atypical antipsychotics in the treatment of BPSD shown in randomized clinical trials using network meta-analysis. DATA SOURCES PubMed/MEDLINE, Embase, PsychINFO, and Cochrane Library were searched from their inception until May 31, 2018. Key terms included dementia and atypical antipsychotics. STUDY SELECTION Randomized clinical trials comparing any atypical antipsychotic with another atypical antipsychotic or with placebo were included in the analysis. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used a standardized data extraction and quality assessment form. Random-effects network meta-analyses were performed. Effect sizes were reported as standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes with 95% CIs. In addition to ORs, the surface under the cumulative ranking curve (SUCRA) was ascertained, which represents the percentage of the effectiveness or safety for each treatment compared with a hypothetical treatment that would be ranked first without uncertainty. MAIN OUTCOMES AND MEASURES The primary effectiveness outcome assessed was the Neuropsychiatric Inventory (NPI); secondary effectiveness outcomes were the Brief Psychiatric Rating Scale (BPRS) and Cohen-Mansfield Agitation Inventory (CMAI). The primary safety outcomes were death and cerebrovascular adverse events (CVAEs). Secondary safety outcomes were extrapyramidal signs/symptoms; somnolence/sedation; falls, fracture, or injury; and urinary tract infection/incontinence. RESULTS Seventeen studies (5373 patients) were included. The mean (SD) age of all participants was 80.8 (3.1) years, and most were women (3748 [69.8%]). Compared with placebo, aripiprazole was associated with improvement in outcomes on the NPI (SMD, -0.17; 95% CI, -0.31 to -0.02), BPRS (SMD, -0.20; 95% CI, -0.35 to -0.05), and CMAI (SMD, -0.30; 95% CI, -0.55 to -0.05); quetiapine was associated with improvement in outcomes on the BPRS (SMD, -0.24; 95% CI, -0.46 to -0.01), and risperidone was associated with improvement in outcomes on the CMAI (SMD, -0.26; 95% CI, -0.37 to -0.15). Differences between atypical antipsychotics were not significant for effectiveness, death, or CVAE. Compared with placebo, risperidone (OR, 3.85; 95% CI, 1.55-9.55) and olanzapine (OR, 4.28; 95% CI, 1.26-14.56) were associated with increased risk of CVAEs. The SUCRA estimated relative ranking of treatments suggested that aripiprazole might be the most effective and safe atypical antipsychotic and that olanzapine provides the least benefit overall; however, these results should be interpreted with caution where point estimates (OR and SMD) show that there is no statistically significant difference. CONCLUSIONS AND RELEVANCE This network meta-analysis supports the existence of a trade-off between the effectiveness and safety of atypical antipsychotics in the treatment of BPSD and confirms that a single most effective and safe treatment option does not exist. Clinicians should individualize the assessment of safety risks against expected benefits when prescribing these medications to patients with dementia.
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Affiliation(s)
- Ismaeel Yunusa
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston
| | - Adnan Alsumali
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston
| | - Asabe E. Garba
- College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Quentin R. Regestein
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tewodros Eguale
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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26
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Jaïdi Y, Guilloteau A, Nonnonhou V, Bertholon LA, Badr S, Morrone I, Novella JL, Mahmoudi R. Threshold for a Reduction in Anticholinergic Burden to Decrease Behavioral and Psychological Symptoms of Dementia. J Am Med Dir Assoc 2018; 20:159-164.e3. [PMID: 30503588 DOI: 10.1016/j.jamda.2018.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/21/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND A high anticholinergic burden (AB) is associated with the occurrence of behavioral and psychological symptoms (BPSDs), which are frequent in dementia. OBJECTIVES Our aim was to determine the threshold for a reduction in AB that would lead to a clinically significant improvement in BPSDs (in terms of frequency, severity, and disruptiveness). DESIGN A single-center prospective study. SETTINGS Dedicated geriatric care unit specializing in the management of patients with dementia. PARTICIPANTS The study involved older patients with dementia, hospitalized for management of BPSDs. METHODS One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). The AB was assessed using 3 scales, namely, the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden scale (ACB), and the Anticholinergic Risk Scale (ARS). A clinically significant improvement in BPSDs was defined as a reduction of 4 points in the frequency × severity (F×S) score of the Neuropsychiatric Inventory-Nursing Home (NPI-NH) questionnaire. The threshold for a reduction in AB that corresponded to a clinically significant improvement in BPSDs was determined by multiple linear regression. RESULTS One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). Using the ADS, a reduction of 2 points in AB in patients with moderate-intensity BPSDs was associated with a clinically significant improvement in the F×S score of the NPI-NH [6.34, 95% confidence interval (CI) 4.54-8.14], and a reduction of 3 points was associated with a clinically significant improvement in the occupational disruptiveness score (4.26, 95% CI 3.11-5.41). CONCLUSIONS/IMPLICATIONS In older patients with dementia presenting BPSDs, the risk-benefit ratio of anticholinergic drugs is debatable and, where possible, drugs with a lower AB would be preferable. Because BPSDs are a frequent cause of hospitalization, a standardized approach to analysis and reduction of AB is warranted in this population. Depending on the scale used to assess anticholinergic burden (AB), a small reduction in AB is associated with a decrease in frequency, severity, and disruptiveness of moderate-intensity BPSDs. Drugs with a high AB should be avoided where possible in older patients with dementia, and drugs with a lower AB would be preferable. Heterogeneity between the assessment scales for AB precludes generalization of the impact of a reduction in AB on BPSDs.
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Affiliation(s)
- Yacine Jaïdi
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France
| | - Adrien Guilloteau
- Epidemiology and infection control unit, University hospital of Dijon, Dijon, France; INSERM U1231, EPICAD Team, Dijon, France
| | - Vignon Nonnonhou
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France
| | - Laurie-Anne Bertholon
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France
| | - Sarah Badr
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France
| | - Isabella Morrone
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France
| | - Jean-Luc Novella
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France
| | - Rachid Mahmoudi
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France.
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Fang G, Shi B, Wu K, Chen S, Gao X, Xiao S, Kang JX, Li W, Huang R. The protective role of endogenous n-3 polyunsaturated fatty acids in Tau Alzheimer’s disease mouse model. Int J Neurosci 2018; 129:325-336. [DOI: 10.1080/00207454.2018.1533824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Guang Fang
- Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang City, Guangdong, China
- Guangdong Key Laboratory Animal Lab, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
| | - Baoyan Shi
- Guangdong Key Laboratory Animal Lab, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
| | - Kefeng Wu
- Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang City, Guangdong, China
| | - Siyu Chen
- Guangdong Key Laboratory Animal Lab, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
| | - Xiang Gao
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, Guangdong, China
| | - Sa Xiao
- Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang City, Guangdong, China
- Guangdong Key Laboratory Animal Lab, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
| | - Jing X. Kang
- The Laboratory for Lipid Medicine and Technology, Massachusetts General Hospital, Boston, MA, USA
| | - Wende Li
- Guangdong Key Laboratory Animal Lab, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
| | - Ren Huang
- Guangdong Key Laboratory Animal Lab, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
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Steck N, Cooper C, Orgeta V. Investigation of possible risk factors for depression in Alzheimer's disease: A systematic review of the evidence. J Affect Disord 2018; 236:149-156. [PMID: 29734098 DOI: 10.1016/j.jad.2018.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Depression is common in people with Alzheimer's disease (AD), and is associated with increased risk of institutionalization and mortality. Understanding risk factors for depression in AD is key to its development and treatment. METHODS We searched the MEDLINE, EMBASE, PsycINFO, and CINAL databases for longitudinal prospective cohort studies that evaluated risk factors for depression in people with AD. Two authors independently selected articles for inclusion and assessed quality of studies using predetermined criteria. RESULTS In seven studies that met the inclusion criteria, 2029 participants were followed up for a median of 5 years. Gender and educational attainment were not predictors of depression risk. History of a past psychiatric disorder and greater cognitive impairment predicted increased risk of depression in more than one study. In single studies, younger age, having a family history of psychiatric disorder, neuroticism, functional decline, presence of sleep disturbance and aggression, and increased cardiovascular risk predicted depression risk. Not being within 6 months of dementia onset and, counterintuitively having two comorbid disorders were protective factors in one study. LIMITATIONS A small number of studies exist overall and only a few have examined the same risk factors. Most of the studies have measured depression using scales that are not validated in AD. CONCLUSIONS These results inform a preliminary model of depression risk in people with AD. Unlike in the general population, men and women and those with higher and lower educational levels of attainment may be equally at risk of depression. Clinicians should be aware of these possible differences in the risk profile for depression in AD populations, to assist detection and enable early treatment. Interventions to delay cognitive and functional decline may reduce depression risk.
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Affiliation(s)
- Natassa Steck
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Claudia Cooper
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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29
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Hunter S, Smailagic N, Brayne C. Dementia Research: Populations, Progress, Problems, and Predictions. J Alzheimers Dis 2018; 64:S119-S143. [DOI: 10.3233/jad-179927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sally Hunter
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
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30
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Chen Y, Sillaire AR, Dallongeville J, Skrobala E, Wallon D, Dubois B, Hannequin D, Pasquier F. Low Prevalence and Clinical Effect of Vascular Risk Factors in Early-Onset Alzheimer's Disease. J Alzheimers Dis 2018; 60:1045-1054. [PMID: 28984595 PMCID: PMC5676853 DOI: 10.3233/jad-170367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Determinants of early-onset Alzheimer’s disease (EOAD) are not well known. In late-onset AD, vascular risk factors (VRFs) are associated with earlier clinical manifestation. Objective: The objective of this study was to assess the putative association between VRFs and EOAD. Methods: We studied participants with dementia meeting criteria for EOAD (recruited into the French CoMAJ prospective cohort study from 1 June 2009 to 28 February 2014) and age-, gender-matched controls (ratio 1:3, drawn randomly from the French MONA-LISA population-based survey between 2005 and 2007). Demographic data, VRFs, comorbidities, treatments, and APOE genotypes were compared in multivariable logistic regression analyses. Results: We studied 102 participants with dementia (mean±standard deviation age: 59.5±3.8; women: 59.8%) and 306 controls. Compared with controls, EOAD participants had spent less time in formal education (9.9±2.9 versus 11.7±3.8 y; p < 0.0001), were less likely to be regular alcohol consumers (p < 0.0001), had a lower body mass index (–2 kg/m2; p < 0.0004), and a lower mean systolic blood pressure (–6.2 mmHg; p = 0.0036). The prevalence of APOE ɛ4 allele was higher in participants with dementia than in controls (50% versus 29.4%; p = 0.0002), as was the prevalence of depression (48% versus 32%; p < 0.001). Similar results were observed in multivariable analysis. Compared with EOAD participants lacking VRFs, EOAD participants with at least one VRF had a higher prevalence of depression (29.6% versus 53.3%, respectively; p = 0.03). Conclusion: The prevalence of VRFs is not elevated in EOAD patients (in contrast to older AD patients). Extensive genetic testing should be considered more frequently in the context of EOAD.
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Affiliation(s)
- Yaohua Chen
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France.,CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France
| | - Adeline Rollin Sillaire
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France.,CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France
| | | | - Emilie Skrobala
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France
| | - David Wallon
- CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France.,University Rouen, INSERM U1079 (IRIB), Rouen, France
| | - Bruno Dubois
- CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France.,Institute of Memory and Alzheimer's Disease (IM2A), UMR S1127, AP-HP, Pitié-Salpêtrière University Hospital, Pierre et Marie Curie University, Paris, France
| | - Didier Hannequin
- CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France.,University Rouen, INSERM U1079 (IRIB), Rouen, France
| | - Florence Pasquier
- University Lille, INSERM U1171 (Degenerative and Vascular Cognitive Disorders), Lille, France.,CHU Lille, Memory Clinic, Lille University Medical Center, Lille, France.,CNR-MAJ (Reference Center for Early-Onset Alzheimer's Disease and Related Disorders), Lille, France
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31
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Nagata T, Nakajima S, Shinagawa S, Plitman E, Nakayama K, Graff-Guerrero A, Mimura M. Baseline Predictors of Antipsychotic Treatment Continuation and Response at Week 8 in Patients with Alzheimer's Disease with Psychosis or Aggressive Symptoms: An Analysis of the CATIE-AD Study. J Alzheimers Dis 2018; 60:263-272. [PMID: 28800334 DOI: 10.3233/jad-170412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/OBJECTIVE The aim of the present study was to investigate predictors of atypical antipsychotic (AAP) treatment continuation and response by week 8 in patients with Alzheimer's disease (AD) who have psychotic/aggressive symptoms using the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) dataset. METHODS Clinical data was utilized from 421 AD outpatients with psychotic/aggressive symptoms who needed interventional treatment. Logistic regression analyses were performed to examine which baseline sociodemographic and clinical characteristics contributed to treatment 'continuation' and 'response', the latter of which was evaluated by the Clinical Global Impression of Change (CGI-C), Neuropsychiatric Inventory (NPI), and Brief Psychiatric Scale (BPRS). RESULTS The treatment continuation rate was 48.7%, and CGI-C, NPI, and BPRS response rate by the last observation carried forward method were 42.7%, 48.6%, and 37.5%, respectively. No significant predictor was identified for treatment continuation in the Caucasian patients (n = 331), while better treatment response was predicted by a lower Mini-Mental State Examination score, treatment with risperidone (versus olanzapine and quetiapine), history of diabetes mellitus, healthier physical status, and more severe initial psychotic symptoms. CONCLUSIONS Comparatively high intolerability from AAPs in the short term was confirmed. We found that baseline clinical predictors to treatment response in Caucasian AD patients with psychotic/aggressive symptoms include treatment with risperidone (versus quetiapine and olanzapine), diabetes mellitus, global physical status, cognitive impairment, and psychotic symptoms. Going forward, these findings may help to determine treatment strategies or care plans.
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Affiliation(s)
- Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kazuhiko Nakayama
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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32
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Ferreira MDC, Abreu MJ, Machado C, Santos B, Machado Á, Costa AS. Neuropsychiatric Profile in Early Versus Late Onset Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2018; 33:93-99. [PMID: 29210282 PMCID: PMC10852442 DOI: 10.1177/1533317517744061] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to investigate the frequency and severity of neuropsychiatric symptoms (NPS) in patients with early onset Alzheimer's disease (EAOD) and late onset AD (LOAD). METHODS Patients were selected from a specialized memory outpatient clinic. The Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), and the Global Deterioration Scale results were analyzed. RESULTS By comparing EOAD (n = 35) and LOAD (n = 35) patients, no significant differences were found in clinical or demographic variables, matched for sex, education, and disease severity. There were no differences between groups in total NPI frequency or severity scores. The most common NPS were irritability, apathy, anxiety, and depression. We found an association of NPI scores with disease severity and duration, which was more specific in patients with LOAD and was also associated with the presence of delusions and hallucinations. CONCLUSION Despite subtle differences, NPS is considered important in the assessment of patients with AD, regardless of the age of onset.
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Affiliation(s)
| | | | - Célia Machado
- Neurology Service, Hospital de Braga, Braga, Portugal
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33
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Reduction of the Anticholinergic Burden Makes It Possible to Decrease Behavioral and Psychological Symptoms of Dementia. Am J Geriatr Psychiatry 2018; 26:280-288. [PMID: 28890165 DOI: 10.1016/j.jagp.2017.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of a reduction of the anticholinergic burden (AB) on the frequency and severity of behavioral and psychological symptoms of dementia (BPSD) and their repercussions on the care team (occupational disruptiveness). METHODS In this prospective, single-center study in an acute care unit for Alzheimer disease (AD) and related disorders, 125 elderly subjects (mean age: 84.4 years) with dementia presented with BPSD. The reduction of the AB was evaluated by the Anticholinergic Cognitive Burden Scale. BPSD were evaluated with the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). The effect of the reduction of the AB on the BPSD was studied using logistic regression adjusting for the variables of the comprehensive geriatric assessment. RESULTS Seventy-one subjects (56.8%) presenting with probable AD, 32 (25.6%) mixed dementia (AD and vascular), 17 (13.6%) vascular dementia, and 5 (4.0%) Lewy body dementia were included. Reducing the AB by at least 20% enabled a significant decrease in the frequency × severity scores of the NPI-NH (adjusted odds ratio: 3.5; 95% confidence interval: 1.6-7.9) and of the occupational disruptiveness score (adjusted odds ratio: 9.9; 95% confidence interval: 3.6-27.3). CONCLUSION AB reduction in elderly subjects with dementia makes is possible to reduce BPSD and caregiver burden. Recourse to treatments involving an AB must be avoided as much as possible in these patients, and preferential use of nonpharmacologic treatment management plans is encouraged.
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Abstract
Behavioral and psychological symptoms of dementia (BPSD) are universally experienced by people with dementia throughout the course of the illness and cause a significant negative impact on quality of life for patients and caregivers. Nonpharmacologic treatments have been recommended as first-line treatment of BPSD by multiple professional organizations and should target patients with dementia factors, caregiver factors, and environmental factors. Psychotropic medications are often prescribed off-label without significant evidence to support their use. The Describe, Investigate, Create, Evaluate approach can provide a structured method to investigate and treat BPSD with flexibility to use in multiple treatment settings.
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Affiliation(s)
- Lauren B Gerlach
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Helen C Kales
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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35
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Hongisto K, Hallikainen I, Selander T, Törmälehto S, Väätäinen S, Martikainen J, Välimäki T, Hartikainen S, Suhonen J, Koivisto AM. Quality of Life in relation to neuropsychiatric symptoms in Alzheimer's disease: 5-year prospective ALSOVA cohort study. Int J Geriatr Psychiatry 2018; 33:47-57. [PMID: 28067961 DOI: 10.1002/gps.4666] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/07/2016] [Accepted: 12/20/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the association between neuropsychiatric symptoms (NPS) with self- and caregiver-rated Quality of Life (QoL) for patients with Alzheimer's disease (AD) during a 5-year follow-up. METHODS The ALSOVA 5-year follow-up study included, at baseline, 236 patients with either very mild (Clinical Dementia Rating Scale (CDR) 0.5), or mild (CDR 1) AD, together with their caregivers from three Finnish hospital districts. QoL was evaluated using patient self-reported, and caregiver-rated, QoL in AD (QoL-AD) scores. NPS were assessed using the Neuropsychiatric Inventory (NPI), and AD severity was evaluated using the CDR, with cognition tested by the mini-mental state examination. The performance of daily activities was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory. RESULTS Over the 5-year follow-up period, patient self-reported QoL-AD scores did not change significantly (p = 0.245), despite increases in their NPS. However, caregiver-rated patient QoL-AD scores declined significantly (p ≤ 0.001), as total NPI scores increased during follow-up. No NPS at baseline, and only apathy at follow-up, correlated significantly (p = 0.007) with patient self-rated QoL-AD scores. Caregiver-rated patient QoL-AD scores correlated significantly with most NPS, especially (p ≤ 0.001) apathy, agitation, anxiety, irritability, depression, and delusions at baseline, and delusions, hallucinations, apathy, appetite disturbances, and anxiety during follow-up. CONCLUSIONS Patient rated QoL-AD scores are an unreliable tool with which to evaluate the success of therapy for NPS. Instead, caregiver-rated scores for patients correlated well with NPI scores, and health care professionals in the clinic should preferentially use these. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kristiina Hongisto
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland.,NeuroCentre, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Soili Törmälehto
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Suhonen
- Department of Neurology, Al-Ahli Hospital, Doha, Qatar
| | - Anne M Koivisto
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,NeuroCentre, Neurology, Kuopio University Hospital, Kuopio, Finland
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Hypertension and Neuropsychiatric Symptoms in Patients with Drug-Naïve Alzheimer's Disease. Dement Neurocogn Disord 2017; 16:78-82. [PMID: 30906375 PMCID: PMC6427990 DOI: 10.12779/dnd.2017.16.3.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/10/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Neuropsychiatric symptoms (NPS) such as anxiety, depression, and delusions affect up to 90% of all patients with Alzheimer's disease (AD). NPS is associated with significant caregiver burden and patient distress. Given the severe burden of NPS in AD, it is critical to know potential modifiable risk factors of NPS in AD. This study explores the association between hypertension and NPS in patients with drug-naïve AD. Methods We reviewed medical records of 149 patients with AD with (n=80) and without (n=69) hypertension. NPS were assessed using the Korean version of Neuropsychiatric Inventory (K-NPI). Affective, psychotic, and behavior symptom clusters were assessed separately. Results The total score of K-NPI was not significantly different between patients with AD with and without hypertension. Among K-NPI domains, scores of depression/dysphoria (p=0.045), anxiety (p=0.022), and apathy/indifference (p=0.037) were significantly higher in patients with AD with hypertension. Systolic blood pressure (BP) was associated with higher total K-NPI and affective symptom cluster scores. Diastolic BP was associated with affective symptom cluster scores. Conclusions Results suggest that hypertension increases risk of specific NPS in patients with AD. Among NPS, hypertension was associated with affective symptom cluster.
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Sanderlin AH, Todem D, Bozoki AC. Obesity and Co-morbid Conditions Are Associated with Specific Neuropsychiatric Symptoms in Mild Cognitive Impairment. Front Aging Neurosci 2017; 9:164. [PMID: 28611655 PMCID: PMC5447016 DOI: 10.3389/fnagi.2017.00164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Neuropsychiatric symptoms (NPSs) in MCI, and midlife obesity increase the likelihood of developing Alzheimer's disease. It is unknown whether obesity or related health conditions modify the risk of NPS or severity of cognitive impairment in MCI. Methods: One hundred and thirteen subjects with MCI were assessed near the time of MCI diagnosis. The sample was divided by BMI and related disorders, type-2 diabetes (T2D) and obstructive sleep apnea (OSA) to measure the relationship of these groups with NPS and severity of MCI. NPSs scores were evaluated based on the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and Geriatric Depression Scale, along with NPI-Q clusters. MCI-severity was estimated based on a composite z-score of neuropsychological tests. Results: Obese and overweight subjects represented 65% of the sample and were on average 7 years younger than normal weight subjects. The presence of obesity, T2D and OSA status modified the prevalence and severity of specific NPI-Q symptom clusters, specifically affective symptoms were more frequent across groups and severe in OB and T2D. Total NPS scores were higher for subjects with T2D and OSA although MCI-severity did not differ across groups. Conclusion: MCI subjects with obesity, T2D and OSA demonstrated a higher susceptibility to psychopathologic changes.
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Affiliation(s)
- Ashley H Sanderlin
- Neuroscience Program, Michigan State University, East LansingMI, United States
| | - David Todem
- Division of Biostatistics, Department of Epidemiology and Biostatistics, Michigan State University, East LansingMI, United States
| | - Andrea C Bozoki
- Neuroscience Program, Michigan State University, East LansingMI, United States.,Department of Neurology and Ophthalmology, Michigan State University, East LansingMI, United States
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38
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Bagci E, Aydin E, Ungureanu E, Hritcu L. Anthriscus nemorosa essential oil inhalation prevents memory impairment, anxiety and depression in scopolamine-treated rats. Biomed Pharmacother 2016; 84:1313-1320. [PMID: 27810788 DOI: 10.1016/j.biopha.2016.10.075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/30/2022] Open
Abstract
Anthriscus nemorosa (Bieb.) Sprengel is used for medicinal purposes in traditional medicine around the world, including Turkey. Ethnobotanical studies suggest that Anthriscus essential oil could improve memory in Alzheimer's disease. The current study was hypothesized to investigate the beneficial effects of inhaled Anthriscus nemorosa essential oil on memory, anxiety and depression in scopolamine-treated rats. Anthriscus nemorosa essential oil was administered by inhalation in the doses of 1% and 3% for 21 continuous days and scopolamine (0.7mg/kg) was injected intraperitoneally 30min before the behavioral testing. Y-maze and radial arm-maze tests were used for assessing memory processes. Also, the anxiety and depressive responses were studied by elevated plus-maze and forced swimming tests. As expected, the scopolamine alone-treated rats exhibited the following: decrease the percentage of the spontaneous alternation in Y-maze test, increase the number of working and reference memory errors in radial arm-maze test, decrease of the exploratory activity, the percentage of the time spent and the number of entries in the open arm within elevated plus-maze test and decrease of swimming time and increase of immobility time within forced swimming test. However, dual scopolamine and Anthriscus nemorosa essential oil-treated rats showed significant improvement of memory formation and exhibited anxiolytic- and antidepressant-like effects in scopolamine-treated rats. These results suggest that Anthriscus nemorosa essential oil inhalation can prevent scopolamine-induced memory impairment, anxiety and depression.
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Affiliation(s)
- Eyup Bagci
- Department of Biology, Faculty of Science, Firat University, 23119 Elazig, Turkey
| | - Emel Aydin
- Department of Biology, Faculty of Science, Firat University, 23119 Elazig, Turkey
| | - Eugen Ungureanu
- Department of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I, No.11, 700506, Romania
| | - Lucian Hritcu
- Department of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I, No.11, 700506, Romania.
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Fischer CE, Qian W, Schweizer TA, Millikin CP, Ismail Z, Smith EE, Lix LM, Shelton P, Munoz DG. Lewy Bodies, Vascular Risk Factors, and Subcortical Arteriosclerotic Leukoencephalopathy, but not Alzheimer Pathology, are Associated with Development of Psychosis in Alzheimer's Disease. J Alzheimers Dis 2016; 50:283-95. [PMID: 26682680 DOI: 10.3233/jad-150606] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The neuropathological correlates of psychosis in Alzheimer's disease (AD) is unclear, with some studies reporting a correlation between psychosis and increased AD pathology while others have found no association. OBJECTIVE To determine the demographic, clinical, and neuropathological features associated with psychotic symptoms in clinically attributed and neuropathologically proven AD. METHOD We separately reviewed two overlapping groups of clinically diagnosed (cAD) AD patients with neuropathology data and neuropathologically definite (npAD) cases (regardless of clinical diagnosis) from the NACC database, and explored the relationships between psychosis and clinical variables, neuropathologic correlates, and vascular risk factors. Delusions and hallucinations, defined according to the NPI-Q, were analyzed separately. RESULTS 1,073 subjects in the database fulfilled our criteria (890 cAD and 728 npAD patients). 34% of cAD and 37% of npAD had psychotic symptoms during their illness. Hallucinations were associated with greater cognitive and functional impairments on the MMSE and CDR, while delusional patients showed less impairment on CDR, consistent across cAD and npAD groups. Burden of AD pathology appears to relate to presence of psychotic symptoms in the clinical AD group, but this result is not confirmed in the neuropathologically confirmed group suggesting the findings in the clinical group were due to misdiagnosis of AD. Lewy body pathology, subcortical arteriosclerotic leukoencephalopathy, and vascular risk factors, including a history of hypertension and diabetes, were associated with the development of psychosis. METHOD Vascular and Lewy body pathologies and vascular risk factors are important modifiers of the risk of psychosis in AD.
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Affiliation(s)
- Corinne E Fischer
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Winnie Qian
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Colleen P Millikin
- Department of Clinical Healthy Psychology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry and Neurology, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Eric E Smith
- Departments of Psychiatry and Neurology, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Shelton
- Division of Neurology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - David G Munoz
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Division of Pathology, St. Michael's Hospital, Toronto, ON, Canada
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40
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Hirao K, Pontone GM, Smith GS. Molecular imaging of neuropsychiatric symptoms in Alzheimer's and Parkinson's disease. Neurosci Biobehav Rev 2015; 49:157-70. [PMID: 25446948 PMCID: PMC4806385 DOI: 10.1016/j.neubiorev.2014.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 01/14/2023]
Abstract
Neuropsychiatric symptoms (NPS) are very common in neurodegenerative diseases and are a major contributor to disability and caregiver burden. There is accumulating evidence that NPS may be a prodrome and/or a "risk factor" of neurodegenerative diseases. The medications used to treat these symptoms in younger patients are not very effective in patients with neurodegenerative disease and may have serious side effects. An understanding of the neurobiology of NPS is critical for the development of more effective intervention strategies. Targeting these symptoms may also have implications for prevention of cognitive or motor decline. Molecular brain imaging represents a bridge between basic and clinical observations and provides many opportunities for translation from animal models and human post-mortem studies to in vivo human studies. Molecular brain imaging studies in Alzheimer's disease (AD) and Parkinson's disease (PD) are reviewed with a primary focus on positron emission tomography studies of NPS. Future directions for the field of molecular imaging in AD and PD to understand the neurobiology of NPS will be discussed.
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Affiliation(s)
- Kentaro Hirao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
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Tschanz JT, Norton MC, Zandi PP, Lyketsos CG. The Cache County Study on Memory in Aging: factors affecting risk of Alzheimer's disease and its progression after onset. Int Rev Psychiatry 2013; 25:673-85. [PMID: 24423221 PMCID: PMC4089882 DOI: 10.3109/09540261.2013.849663] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Cache County Study on Memory in Aging is a longitudinal, population-based study of Alzheimer's disease (AD) and other dementias. Initiated in 1995 and extending to 2013, the study has followed over 5,000 elderly residents of Cache County, Utah (USA) for over twelve years. Achieving a 90% participation rate at enrolment, and spawning two ancillary projects, the study has contributed to the literature on genetic, psychosocial and environmental risk factors for AD, late-life cognitive decline, and the clinical progression of dementia after its onset. This paper describes the major study contributions to the literature on AD and dementia.
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Affiliation(s)
- JoAnn T. Tschanz
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | - Maria C. Norton
- Center for Epidemiologic Studies, Utah State University,Department of Family, Consumer & Human Development, Utah State University
| | - Peter P. Zandi
- Bloomberg School of Public Health, Johns Hopkins University
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