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Altunkalem Seydi K, Kaya D, Yavuz I, Ontan MS, Dost FS, Isik AT. Primitive reflexes and dementia in older adults: a meta-analysis of observational and cohort studies. Psychogeriatrics 2024; 24:688-700. [PMID: 38400649 DOI: 10.1111/psyg.13098] [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: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Primitive reflexes (PRs) are clinical signs that indicate diffuse cerebral dysfunction and frontal lesions. We aimed to present a comprehensive analysis of the prevalence and risk of PRs in patients with dementia. English-language articles published from January 1990 to April 2021 were searched in PubMed, ScienceDirect, Cochrane, and Web of Science with keywords. The titles and abstracts of the identified articles were screened to identify potentially relevant papers. Odds ratios and risk ratios were extracted with 95% confidence intervals and combined using the random-effects model after logarithmic transformation. The prevalence in dementia patients was also combined using the random-effects model. This meta-analysis involved 29 studies. The snout reflex (48% of cases) was the most prevalent. It was found that the risk of PRs in individuals with dementia was significantly elevated, ranging from 13.94 to 16.38 times higher than in healthy controls. The grasp reflex exhibited the highest risk for dementia. This meta-analysis showed that the prevalence and the risk of PRs is high in older patients with dementia. Therefore, PRs, especially the grasp reflex, should be carefully assessed as a part of routine physical examination in the diagnostic process for dementia.
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Affiliation(s)
- Kübra Altunkalem Seydi
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Derya Kaya
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Idil Yavuz
- Department of Statistics, Dokuz Eylul University, Faculty of Science, Izmir, Turkey
| | - Mehmet Selman Ontan
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fatma Sena Dost
- Department of Geriatric Medicine, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Ahmet Turan Isik
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Liu J, Kanno S, Iseki C, Kawakami N, Kakinuma K, Katsuse K, Matsubara S, Ota S, Endo K, Takanami K, Osawa SI, Kawaguchi T, Endo H, Mugikura S, Suzuki K. The grasp reflex in patients with idiopathic normal pressure hydrocephalus. J Neurol 2024:10.1007/s00415-024-12341-0. [PMID: 38587636 DOI: 10.1007/s00415-024-12341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the prevalence and intensity of grasp reflexes and to examine changes in these reflexes after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS We enrolled 147 patients with probable iNPH. A standard procedure was used to determine the presence of grasp reflexes, and the intensity of these reflexes was assessed using a four-category classification. Clinical rating scales and their correlation with grasp reflexes were also evaluated. Grasp reflexes were reassessed in 72 patients 1 year after surgery. RESULTS We found that approximately 50.3% of patients with iNPH exhibited a positive grasp reflex. Among these patients, 69% exhibited bilateral positivity, while the remaining patients showed unilateral positivity. Furthermore, the intensity of the grasp reflex was significantly correlated with the severity of gait and with cognitive, urinary, motor, and behavioural symptoms. Surgical interventions led to a reduction (41.7%) or maintenance (30.6%) of the reflex intensity in 72.3% of iNPH patients. The changes in reflex intensity showed significant positive correlations with changes in the number of steps of the Timed Up and Go test and Trail Making Test-A scores but not with changes in total scores on the iNPH Grading Scale. CONCLUSION This retrospective study identified grasp reflexes as a highly prevalent phenomenon in patients with iNPH. These reflexes can assist in evaluating the severity of various symptoms, including cognitive, gait, urinary, motor and emotional symptoms.
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Affiliation(s)
- Junyan Liu
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Chifumi Iseki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuto Katsuse
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Shiho Matsubara
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shoko Ota
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Keiko Endo
- Department of Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Sokolovič L, Hofmann MJ, Mohammad N, Kukolja J. Neuropsychological differential diagnosis of Alzheimer's disease and vascular dementia: a systematic review with meta-regressions. Front Aging Neurosci 2023; 15:1267434. [PMID: 38020767 PMCID: PMC10657839 DOI: 10.3389/fnagi.2023.1267434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Diagnostic classification systems and guidelines posit distinguishing patterns of impairment in Alzheimer's (AD) and vascular dementia (VaD). In our study, we aim to identify which diagnostic instruments distinguish them. Methods We searched PubMed and PsychInfo for empirical studies published until December 2020, which investigated differences in cognitive, behavioral, psychiatric, and functional measures in patients older than 64 years and reported information on VaD subtype, age, education, dementia severity, and proportion of women. We systematically reviewed these studies and conducted Bayesian hierarchical meta-regressions to quantify the evidence for differences using the Bayes factor (BF). The risk of bias was assessed using the Newcastle-Ottawa-Scale and funnel plots. Results We identified 122 studies with 17,850 AD and 5,247 VaD patients. Methodological limitations of the included studies are low comparability of patient groups and an untransparent patient selection process. In the digit span backward task, AD patients were nine times more probable (BF = 9.38) to outperform VaD patients (β g = 0.33, 95% ETI = 0.12, 0.52). In the phonemic fluency task, AD patients outperformed subcortical VaD (sVaD) patients (β g = 0.51, 95% ETI = 0.22, 0.77, BF = 42.36). VaD patients, in contrast, outperformed AD patients in verbal (β g = -0.61, 95% ETI = -0.97, -0.26, BF = 22.71) and visual (β g = -0.85, 95% ETI = -1.29, -0.32, BF = 13.67) delayed recall. We found the greatest difference in verbal memory, showing that sVaD patients outperform AD patients (β g = -0.64, 95% ETI = -0.88, -0.36, BF = 72.97). Finally, AD patients performed worse than sVaD patients in recognition memory tasks (β g = -0.76, 95% ETI = -1.26, -0.26, BF = 11.50). Conclusion Our findings show inferior performance of AD in episodic memory and superior performance in working memory. We found little support for other differences proposed by diagnostic systems and diagnostic guidelines. The utility of cognitive, behavioral, psychiatric, and functional measures in differential diagnosis is limited and should be complemented by other information. Finally, we identify research areas and avenues, which could significantly improve the diagnostic value of cognitive measures.
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Affiliation(s)
- Leo Sokolovič
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Markus J. Hofmann
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Nadia Mohammad
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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Caselli RJ, Langlais BT, Dueck AC, Henslin BR, Johnson TA, Woodruff BK, Hoffman-Snyder C, Locke DEC. Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment. J Am Geriatr Soc 2018; 66:671-678. [PMID: 29341070 DOI: 10.1111/jgs.15182] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Behavioral problems in individuals with Alzheimer's disease (AD) impose major management challenges. Current prevention strategies are anchored to cognitive outcomes, but behavioral outcomes may provide another, clinically relevant opportunity for preemptive therapy. We sought to determine whether personality changes that predispose to behavioral disorders arise during the transition from preclinical AD to mild cognitive impairment (MCI). DESIGN Longitudinal observational cohort study. SETTING Academic medical center. PARTICIPANTS Members of an apolipoprotein E (APOE) ɛ4 genetically enriched cohort of Maricopa County residents who were neuropsychiatrically healthy at entry (N = 277). Over a mean interval of 7 years, 25 who developed MCI and had the Neuroticism, Extraversion, and Openness Personality Inventory-Revised (NEO-PI-R) before and during the MCI transition epoch were compared with 252 nontransitioners also with serial NEO-PI-R administrations. INTERVENTION Longitudinal administration of the NEO-PI-R and neuropsychological test battery. MEASUREMENTS Change in NEO-PI-R factor scores (neuroticism, extraversion, openness, agreeableness, conscientiousness) from entry to the epoch of MCI diagnosis or an equivalent follow-up duration in nontransitioners. RESULTS NEO-PI-R neuroticism T-scores increased significantly more in MCI transitioners than in nontransitioners (mean 2.9, 95% confidence interval (CI) = 0.9-4.9 vs 0, 95% CI = -0.7-0.7, P = .02), and openness decreased more in MCI transitioners than in nontransitioners (-4.8, 95% CI = -7.3 to -2.4 vs -1.0, 95% CI = -1.6 to -0.4, P < .001). Concurrent subclinical but statistically significant changes in behavioral scores worsened more in MCI transitioners than nontransitioners for measures of depression, somatization, irritability, anxiety, and aggressive attitude. CONCLUSION Personality and subclinical behavioral changes begin during the transition from preclinical AD to incident MCI and qualitatively resemble the clinically manifest behavioral disorders that subsequently arise in individuals with frank dementia.
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Affiliation(s)
| | - Blake T Langlais
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bruce R Henslin
- Department of Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Travis A Johnson
- Department of Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bryan K Woodruff
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Dona E C Locke
- Division of Psychology, Mayo Clinic Arizona, Scottsdale, Arizona
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Personality traits in women with Alzheimer's disease: Comparisons with control groups with the NEO-FFI. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Personality describes persistent human behavioral responses to broad classes of environmental stimuli. Change in personality may be an early sign of dementia. Our goal was to review scientific literature on the association between personality and dementia. Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published since 1980. Search terms used included personality, dementia, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies. People with dementia commonly exhibit changes in personality that sometimes precede the other early clinical manifestations of the condition, such as cognitive impairment. Premorbid personality might be a determining factor so that caricature or exaggeration of original personality emerges as dementia progresses. Although it is generally accepted that these personality changes reflect the impact of progressive brain damage, there are several possible patterns of personality alterations with dementia. Early identification of personality modifications might assist with the timely diagnosis of dementia.
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Law J, Richmond RL, Kay-Lambkin F. The contribution of personality to longevity: findings from the Australian Centenarian Study. Arch Gerontol Geriatr 2014; 59:528-35. [PMID: 25108617 DOI: 10.1016/j.archger.2014.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 06/19/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine whether centenarians have a unique set of personality traits, which may in part explain their longevity. METHODS 79 Australian centenarians completed the NEO Five Factory Inventory (NEO-FFI), Connor-Davidson Resilience Scale (CD-RISC) and Life Orientation Test Revised (LOT-R) to assess different dimensions of their personalities. Centenarians were asked to answer items of the NEO-FFI, CD-RISC and LOT-R based on current views, and were then asked to recall in the presence of an informant (e.g. carers, offspring) on past personality (i.e. at mid-adult-life). Both sets of answers were recorded and analysed. RESULTS Centenarians were currently low in Openness and Extraversion and high in Neuroticism, but were low in Openness and high in Neuroticism, Conscientiousness and Extraversion when reflecting on past traits. Currently, centenarians in high care facilities reported higher levels of Neuroticism, as did centenarians who did not socialize. Cognitively intact centenarians reported higher levels of Agreeableness; and males reported lower Neuroticism compared to females when reflecting on past experiences. DISCUSSION Centenarians were characterized by several personality traits, which facilitated positive health behaviors and thus contributed to their longevity. It is possible that personality may not be static across the lifespan, but instead, reflect advancing age, psychosocial factors and changes in life circumstances.
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Affiliation(s)
- Jenaleen Law
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Robyn L Richmond
- Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Frances Kay-Lambkin
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, NSW 2308, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
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Pocnet C, Rossier J, Antonietti JP, von Gunten A. Personality traits and behavioral and psychological symptoms in patients at an early stage of Alzheimer's disease. Int J Geriatr Psychiatry 2013; 28:276-83. [PMID: 22552913 DOI: 10.1002/gps.3822] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/29/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The origins of behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) are still poorly understood. Focusing on individual personality structure, we explored the relationship between premorbid personality and its changes over 5 years, and BPS in patients at an early stage of AD. METHOD A total of 54 patients at an early stage of AD according to ICD-10 and NINCDS-ADRDA criteria and 64 control subjects were included. Family members filled in the Neuropsychiatric Inventory Questionnaire to evaluate their proxies' current BPS and the NEO Personality Inventory Revised twice, the first time to evaluate the participants' current personality and the second time to assess personality traits as they were remembered to be 5 years earlier. RESULTS Behavioral and psychological symptoms, in particular apathy, depression, anxiety, and agitation, are frequent occurrences in early stage AD. Premorbid personality differed between AD patients and normal control, but it was not predictive of BPS in patients with AD. Personality traits clearly change in the course of beginning AD, and this change seems to develop in parallel with BPS as early signs of AD. CONCLUSIONS Premorbid personality was not associated with BPS in early stage of AD, although complex and non-linear relationships between the two are not excluded. However, both personality and behavioral changes occur early in the course of AD, and recognizing them as possible, early warning signs of neurodegeneration may prove to be a key factor for early detection and intervention.
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Affiliation(s)
- Cornelia Pocnet
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne, Switzerland
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Helmes E, Norton MC, Østbye T. Personality change in older adults with dementia: Occurrence and association with severity of cognitive impairment. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/aar.2013.21004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pocnet C, Rossier J, Antonietti JP, von Gunten A. Personality changes in patients with beginning Alzheimer disease. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:408-17. [PMID: 21835104 DOI: 10.1177/070674371105600704] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate personality traits in patients with Alzheimer disease, compared with mentally healthy control subjects. We compared both current personality characteristics using structured interviews as well as current and previous personality traits as assessed by proxies. METHOD Fifty-four patients with mild Alzheimer disease and 64 control subjects described their personality traits using the Structured Interview for the Five-Factor Model. Family members filled in the Revised NEO Personality Inventory, Form R, to evaluate their proxies' current personality traits, compared with 5 years before the estimated beginning of Alzheimer disease or 5 years before the control subjects. RESULTS After controlling for age, the Alzheimer disease group presented significantly higher scores than normal control subjects on current neuroticism, and significantly lower scores on current extraversion, openness, and conscientiousness, while no significant difference was observed on agreeableness. A similar profile, though less accentuated, was observed when considering personality traits as the patients' proxies remembered them. Diachronic personality assessment showed again significant differences between the 2 groups for the same 4 domains, with important personality changes only for the Alzheimer disease group. CONCLUSIONS Group comparison and retrospective personality evaluation are convergent. Significant personality changes follow a specific trend in patients with Alzheimer disease and contrast with the stability generally observed in mentally healthy people in their personality profile throughout their lives. Whether or not the personality assessment 5 years before the current status corresponds to an early sign of Alzheimer disease or real premorbid personality differences in people who later develop Alzheimer disease requires longitudinal studies.
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Affiliation(s)
- Cornelia Pocnet
- Service of Old Age Psychiatry, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
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Karim S, Minhas HM, Bhattacharya S, Sein K, Nayar B, Morris J, Nizami A, Minhas F, Burns A. The symptomatology of Alzheimer's disease: a cross-cultural study. Int J Geriatr Psychiatry 2011; 26:415-22. [PMID: 21412847 DOI: 10.1002/gps.2544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 04/16/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This paper presents the results of a trans-cultural study looking at the possible differences in the symptomatology of Alzheimer's disease (AD) in people from Manchester, UK and Rawalpindi, Pakistan. METHODS Two groups of people with AD (45 in each group) were recruited at the two sites. The participants and their carers were interviewed to investigate possible differences in demographics and symptomatology including cognition, depression, personality change and every day activities. The instrument used included the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD), The Brooks and McKinlay Personality Inventory and Informant Questionnaire on Cognitive Decline in the Elderly (IQ CODE). RESULTS The data analysis showed that compared to people from Manchester the Pakistanis had lower literacy levels but similar cognitive deficits when MMSE scores were adjusted for education. They were however more depressed; they had a different profile of personality change since the onset of illness and their reported changes in activities of daily living were more severe. CONCLUSION The study has shown a number of possible cultural differences in affective symptoms, personality changes and every day activities. It highlights the need for developing mental health services for older people in Pakistan and making UK services more accessible for this growing community. Further research on service and care needs along with developing culturally sensitive instruments for assessing cognition, psychiatric symptoms, personality changes and daily activities is needed.
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Affiliation(s)
- Salman Karim
- Psychiatry Research Group, University of Manchester, Manchester, UK.
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von Gunten A, Pocnet C, Rossier J. The impact of personality characteristics on the clinical expression in neurodegenerative disorders—A review. Brain Res Bull 2009; 80:179-91. [DOI: 10.1016/j.brainresbull.2009.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/05/2009] [Accepted: 07/06/2009] [Indexed: 11/27/2022]
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Abstract
RÉSUMÉPlusieurs études ont documenté le profil cognitif des individus ayant un trouble cognitif léger (TCL), mais très peu se sont intéressées à leur santé psychologique et à leurs traits de personnalité ainsi qu’aux interactions entre ces facteurs et la cognition. Dans cette étude, 27 personnes âgées saines et 30 personnes ayant un TCL ont été soumises à une évaluation neuropsychologique et ont rempli des questionnaires portant sur la santé psychologique, le bien-être, la personnalité, l’auto-efficacité et l’auto-actualisation. Les résultats indiquent que les individus ayant un TCL sont plus déprimés, anxieux, hostiles et ont moins de bien-être que ce que rapporte un groupe de personnes âgées sans trouble de cognition. De plus, nos résultats révèlent une association positive entre le niveau de dépression des personnes ayant un TCL et la sévérité de leurs atteintes cognitives. En revanche, aucune différence n’est observée entre les groupes sur les échelles de personnalité. Ainsi, alors que la détresse psychologique est présente chez les personnes ayant un TCL, celles-ci ne montrent pas de différence de traits de personnalité par rapport aux personnes âgées n’éprouvant pas de troubles cognitifs.
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Abstract
BACKGROUND Assessment of personality changes in patients with dementia has received little systematic investigation, although caregivers report personality modifications in every phase of dementia. METHODS A group of 52 patients with probable Alzheimer's disease (AD) vs. a group of fifteen control subjects were selected for these personality tests before and after the manifestation of dementia using an Italian version of Brooks and McKinaly's Personality Inventory (PI). RESULTS After the onset of AD, a significant shift from positive to negative characteristics in PI was observed in 12 of 18 bipolar pairs of adjectives constituting the instrument and the total mean PI score decreased significantly (p < 0.001), indicating a substantial worsening of personality profile. In the control group however, evaluated before and after retirement, personality traits and total mean PI score did not show a significant change. The association of personality traits and total PI score with demographic, cognitive and functional characteristics of AD patients was calculated. CONCLUSION Personality changes have been depicted to be influenced by severity of cognitive, functional and behavioural complaints rather than age, sex, education and disease duration. These first applications of the Italian version of PI confirmed that personality modifications make a consistent aspect of the phenomenology of AD although in the negative direction. Further studies are needed to understand the nature of personality changes in dementia and the utility of PI to investigate these changes.
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Affiliation(s)
- E Talassi
- Department of Medicine, Istituto Clinico S. Anna, Hospital, Brescia, Italy
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Twigg P, Burgener SC, Popovich A. Measurement and relevance of personality characteristics in persons with dementia: a longitudinal perspective. Res Theory Nurs Pract 2007; 21:13-31. [PMID: 17378462 DOI: 10.1891/rtnpij-v21i1a004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies of personality and outcomes in persons with dementia (PWD) have focused primarily on disease stages or change from premorbid personality following diagnosis. Data from a longitudinal study of 96 caregiver/PWD dyads was used to evaluate psychometric properties of two personality measures: one rated by proxies, the other by PWD. Proxy ratings indicate change in strength of personality traits across disease stages; self-ratings were stable, excepting decreased extroversion. Items detracting from reliability of some subscales reflected disease-related changes in PWD rather than true shifts in personality. Findings support importance of collecting both proxy and self-ratings of personality, examining individual items contributing to low reliability, and evaluating change in personality within the context of expected changes inherent in dementia.
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Balsis S, Carpenter BD, Storandt M. Personality Change Precedes Clinical Diagnosis of Dementia of the Alzheimer Type. ACTA ACUST UNITED AC 2005; 60:P98-P101. [PMID: 15746024 DOI: 10.1093/geronb/60.2.p98] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined personality changes reported by a collateral source on the Blessed Dementia Scale in people who were nondemented when they entered a longitudinal study. Of the 108 participants examined here, 68 received a clinical diagnosis of dementia at some point after entry into the study. The other 40 participants died and came to autopsy with a clinical diagnosis of no dementia; however, 14 received a neuropathological diagnosis of Alzheimer's disease. The results indicate that initial personality changes often occur early, even earlier than clinical diagnosis. Individuals without a clinical diagnosis who showed presence of the disease at autopsy experienced personality changes comparable with those of individuals who had received a clinical diagnosis. Personality changes may aid in the early detection of dementia of the Alzheimer type, which could facilitate early treatment.
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Affiliation(s)
- Steve Balsis
- Department of Psychology, Campus Box 1125, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA.
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Gilley DW, Wilson RS, Bienias JL, Bennett DA, Evans DA. Predictors of Depressive Symptoms in Persons With Alzheimer's Disease. J Gerontol B Psychol Sci Soc Sci 2004; 59:P75-83. [PMID: 15014090 DOI: 10.1093/geronb/59.2.p75] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In a 4-year longitudinal study, we evaluated factors related to the development of depressive symptoms in 410 persons with Alzheimer's disease. We measured depressive symptoms annually by using the 17-item Hamilton Rating Scale, which we completed by using structured interviews with family members. On the basis of informant ratings of premorbid personality, we associated neuroticism with a higher rate of depressive symptoms, particularly mood disturbances. We associated greater cognitive impairment with a small reduction in mood symptoms and a modest increase in somatic symptoms. Among demographic variables, somatic symptoms were more common in men and mood symptoms were inversely related to age. Depressive symptoms in Alzheimer's disease appear to follow a more predictable pattern of expression than previously described.
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Affiliation(s)
- David W Gilley
- Rush Institute for Healthy Aging and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois 60612, USA.
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Copeland MP, Daly E, Hines V, Mastromauro C, Zaitchik D, Gunther J, Albert M. Psychiatric symptomatology and prodromal Alzheimer's disease. Alzheimer Dis Assoc Disord 2003; 17:1-8. [PMID: 12621314 DOI: 10.1097/00002093-200301000-00001] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the prevalence of psychiatric symptoms among nondemented individuals with memory changes and whether such symptoms predict progression of functional decline or diagnosis of Alzheimer disease (AD). A semi-structured interview was administered at baseline to controls (n = 32) and to nondemented subjects with memory changes (n = 112) and to each subject's collateral source. The interview assessed the impact of cognition on functional abilities in daily life and a variety of psychiatric symptoms, including symptoms of psychosis, depression, and personality change. Participants were followed annually for 3 years to determine who had progressive functional decline and who progressed to meet clinical criteria for AD. Those diagnosed with AD on follow-up had more symptoms of personality change, such as agitation and passivity, at baseline than those who did not progress to meet clinical criteria for AD. Mild depressive symptoms were also more common among individuals at baseline who subsequently 'converted' to AD. Symptoms of personality change were associated with a more rapid increase in functional difficulty over time, whereas depressive symptoms were not. Changes in personality are more common among subjects with memory changes who go on to develop AD. Particular types of personality change, such as agitation and passivity, are related to progression of functional difficulty over time. Depressive symptoms, although common in prodromal AD, are not associated with a more rapid functional decline.
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Affiliation(s)
- Maura P Copeland
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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De Vreese LP, Neri M, Fioravanti M, Belloi L, Zanetti O. Memory rehabilitation in Alzheimer's disease: a review of progress. Int J Geriatr Psychiatry 2001; 16:794-809. [PMID: 11536347 DOI: 10.1002/gps.428] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Memory rehabilitation is a sadly misrepresented area of applied research in Alzheimer's disease. OBJECTIVES To gather and evaluate recent evidence for the clinical effectiveness or ecologically validity of memory rehabilitation for mild to moderate Alzheimer's patients. METHODS Computerised searches and some handsearching were conducted spanning the last five years, from 1995 to 2000, inclusively. Criteria for inclusion in this overview involved the use of a precise memory rehabilitation technique within an experimental study design applied to Alzheimer's patients with pre- and post-treatment evaluation. FINDINGS Three potential levels of memory rehabilitation procedures with proven clinical or pragmatic efficacy were identified. The first level bears on the facilitation of residual explicit memory with structured support both at encoding and at subsequent recall; the second level of memory rehabilitation exploits the relatively intact implicit memory system (priming and procedural memory); the last deals with finding ways of coping with the patient's limited explicit memory capacities through the use of external memory aids. A proposal of suggestions for good practice and future research in memory rehabilitation is also offered with the hope to spur further development in this rapidly expanding area of applied research. CONCLUSION The available evidence shows that alternative and innovative ways of memory rehabilitation for Alzheimer's patients can indeed be clinically effective or pragmatically useful with a great potential for use within the new culture of a more graded and proactive type of Alzheimer's disease care.
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Affiliation(s)
- L P De Vreese
- Special Care Unit for Dementia Patients, Health Care Facility for Elderly, Via Paul Harris 165, 41100 Modena, Italy.
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