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Kaushik K, de Kort AM, van Dort R, van der Zwet RGJ, Siegerink B, Voigt S, van Zwet EW, van der Plas MC, Koemans EA, Rasing I, Kessels RPC, Middelkoop HAM, Schreuder FHBM, Klijn CJM, Verbeek MM, Terwindt GM, van Etten ES, Wermer MJH. Neuropsychiatric symptoms with focus on apathy and irritability in sporadic and hereditary cerebral amyloid angiopathy. Alzheimers Res Ther 2024; 16:74. [PMID: 38582898 PMCID: PMC10998371 DOI: 10.1186/s13195-024-01445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) may affect cognition, but their burden in cerebral amyloid angiopathy (CAA), one of the main causes of intracerebral hemorrhage (ICH) and dementia in the elderly, remains unclear. We investigated NPS, with emphasis on apathy and irritability in sporadic (sCAA) and Dutch-type hereditary (D-)CAA. METHODS We included patients with sCAA and (pre)symptomatic D-CAA, and controls from four prospective cohort studies. We assessed NPS per group, stratified for history of ICH, using the informant-based Neuropsychiatric Inventory (NPI-Q), Starkstein Apathy scale (SAS), and Irritability Scale. We modeled the association of NPS with disease status, executive function, processing speed, and CAA-burden score on MRI and investigated sex-differences. RESULTS We included 181 participants: 82 with sCAA (mean[SD] age 72[6] years, 44% women, 28% previous ICH), 56 with D-CAA (52[11] years, 54% women, n = 31[55%] presymptomatic), and 43 controls (69[9] years, 44% women). The NPI-Q NPS-count differed between patients and controls (sCAA-ICH+:adj.β = 1.4[95%CI:0.6-2.3]; sCAA-ICH-:1.3[0.6-2.0]; symptomatic D-CAA:2.0[1.1-2.9]; presymptomatic D-CAA:1.2[0.1-2.2], control median:0[IQR:0-3]), but not between the different CAA-subgroups. Apathy and irritability were reported most frequently: n = 12[31%] sCAA, 19[37%] D-CAA had a high SAS-score; n = 12[29%] sCAA, 14[27%] D-CAA had a high Irritability Scale score. NPS-count was associated with decreased processing speed (adj.β=-0.6[95%CI:-0.8;-0.4]) and executive function (adj.β=-0.4[95%CI:-0.6;-0.1]), but not with radiological CAA-burden. Men had NPS more often than women. DISCUSSION According to informants, one third to half of patients with CAA have NPS, mostly apathy, even in presymptomatic D-CAA and possibly with increased susceptibility in men. Neurologists should inform patients and caregivers of these disease consequences and treat or refer patients with NPS appropriately.
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Affiliation(s)
- Kanishk Kaushik
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands.
| | - Anna M de Kort
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Rosemarie van Dort
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Reinier G J van der Zwet
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Bob Siegerink
- Clinical Epidemiology, LUMC, Leiden, the Netherlands
| | - Sabine Voigt
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
- Radiology, LUMC, Leiden, the Netherlands
| | | | - Maaike C van der Plas
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Emma A Koemans
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Ingeborg Rasing
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
- Medical Psychology and RUMC Alzheimer Center, Nijmegen, the Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Huub A M Middelkoop
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
- Institute of Psychology, Health and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - Floris H B M Schreuder
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Catharina J M Klijn
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Marcel M Verbeek
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
- Laboratory Medicine, RUMC, Nijmegen, the Netherlands
| | - Gisela M Terwindt
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Ellis S van Etten
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Marieke J H Wermer
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
- Neurology, University Medical Center Groningen, Groningen, the Netherlands
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Ronat L, Hanganu A, Chylinski D, Van Egroo M, Narbutas J, Besson G, Muto V, Schmidt C, Bahri MA, Phillips C, Salmon E, Maquet P, Vandewalle G, Collette F, Bastin C. Prediction of cognitive decline in healthy aging based on neuropsychiatric symptoms and PET-biomarkers of Alzheimer's disease. J Neurol 2024; 271:2067-2077. [PMID: 38114820 DOI: 10.1007/s00415-023-12131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
Neuropsychiatric symptoms (NPS) have been associated with a risk of accelerated cognitive decline or conversion to dementia of the Alzheimer's Disease (AD) type. Moreover, the NPS were also associated with higher AD biomarkers (brain tau and amyloid burden) even in non-demented patients. But the effect of the relationship between NPS and biomarkers on cognitive decline has not yet been studied. This work aims to assess the relationship between longitudinal cognitive changes and NPS, specifically depression and anxiety, in association with AD biomarkers in healthy middle-aged to older participants. The cohort consisted of 101 healthy participants aged 50-70 years, 66 of whom had neuropsychological assessments of memory, executive functions, and global cognition at a 2-year follow-up. At baseline, NPS were assessed using the Beck Depression and Anxiety Inventories while brain tau and amyloid loads were measured using positron emission topography. For tau burden, THK5351 uptake is used as a proxy of tau and neuroinflammation. Participants, declining or remaining stable at follow-up, were categorized into groups for each cognitive domain. Group classification was investigated using binary logistic regressions based on combined AD biomarkers and the two NPS. The results showed that an association between anxiety and prefrontal amyloid burden significantly classified episodic memory decline, while the classification of global cognitive decline involved temporal and occipital amyloid burden but not NPS. Moreover, depression together with prefrontal and hippocampal tau burden were associated with a decline in memory. The classification of participants based on executive decline was related to depression and mainly prefrontal tau burden. These findings suggest that the combination of NPS and brain biomarkers of AD predicts the occurrence of cognitive decline in aging.
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Affiliation(s)
- Lucas Ronat
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, QC, Canada
- Research Centre, University Institute of Geriatrics of Montreal, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Alexandru Hanganu
- Research Centre, University Institute of Geriatrics of Montreal, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Faculty of Arts and Sciences, Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Daphné Chylinski
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Maxime Van Egroo
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Justinas Narbutas
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
| | - Gabriel Besson
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Vincenzo Muto
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Christina Schmidt
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Christophe Phillips
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Eric Salmon
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
- Department of Neurology, CHU Liege, 4000, Liege, Belgium
| | - Pierre Maquet
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Department of Neurology, CHU Liege, 4000, Liege, Belgium
| | - Gilles Vandewalle
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Fabienne Collette
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Christine Bastin
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium.
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium.
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium.
- Bât. B30 GIGA CRC In Vivo Imaging - Aging and Memory, Quartier Agora, Allée du 6 Août 8, 4000, Liege, Belgium.
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Ronat L, Hanganu A. Neuropsychiatric and cognitive features of major depressive disorder in aging, based on the data from the US National Alzheimer's Coordinating Center (NACC). Encephale 2024; 50:130-136. [PMID: 37088582 DOI: 10.1016/j.encep.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE The diagnosis of Major Depressive Disorder (MDD) is based on the DSM-V criteria and is established by a clinician. This allows quantifying depression based on clinical criteria. As such, MDD differs from other types of depressions that are measured by subjective scales. Here, we evaluated the MDD risk factor on other neuropsychiatric symptoms (NPS) as well as MDD association with cognitive performance in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI) and Healthy Controls (HC). METHODS Data of 208 patients with AD, 291 patients with MCI and 647 HC were extracted from the National Alzheimer's Coordinating Center database. All participants included in this study were assessed by a physician for the MDD criteria, underwent an NPS evaluation using the NeuroPsychiatric Inventory, and a comprehensive cognitive assessment. Participants were classified as being with and without MDD. We performed logistic regression and MANCOVA models respectively with NPS and cognitive performance as variables of interest and MDD as fixed factors within each group. The MANCOVA was controlled for the effects of age, sex, and education. RESULTS MDD increased the risk for psychotic, affective and behavioral NPS in MCI, as well as affective and behavioral NPS in HC and AD. Also, MCI with MDD had lower performance on selective attention and mental flexibility. CONCLUSIONS MDD seems to increase the probability of a prevalence of NPS in all groups (HC, MCI and AD). Longitudinal data processing would help to understand the neuropsychiatric evolution of elderly subjects with MDD.
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Affiliation(s)
- L Ronat
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, M7819, 4545 ch. Queen-Mary, H3W 1W6, Montréal, QC, Canada; Faculté de médecine, département de médecine, université de Montréal, Québec, Canada
| | - A Hanganu
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, M7819, 4545 ch. Queen-Mary, H3W 1W6, Montréal, QC, Canada; Faculté des arts et des sciences, département de psychologie, université de Montréal, Québec, Canada.
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Jakob E, Meininger J, Hillebrand M, Weise L, Wilz G. Study protocol: randomized controlled trial of an individualized music intervention for people with dementia in the home care setting. BMC Psychiatry 2024; 24:230. [PMID: 38532365 PMCID: PMC10967058 DOI: 10.1186/s12888-024-05697-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Studies suggest that individualized music listening is an effective, non-pharmacological intervention for improving the quality of life of people with dementia in the institutional care setting. Noting that most people with dementia live at home, we conduct a randomized controlled trial to assess the feasibility and effectiveness of an app-based individualized music listening intervention for people with dementia in the home care setting. The intervention is delivered by family caregivers. METHODS We will recruit N = 130 dyads consisting of one person with dementia living at home and their family caregiver. After a baseline assessment, dyads are randomly assigned by gender to either the intervention or control group. People with dementia in the intervention group listen to individualized music playlists for 20 min every other day for six weeks via the self-developed Individualized Music and Dementia app. The control group receives standard care. All dyads complete paper-and-pencil questionnaires six weeks before the start of the intervention (T0), directly before the intervention (T1), directly after the intervention (T2), and six weeks later (T3). During the intervention period, all caregivers also complete daily ecological momentary assessments via the app. During three home visits, a trained project member will observe the dyads and collect hair samples. After the intervention, semi-structured interviews will be conducted to collect information about participants' experiences with the app and intervention. The primary outcome is the attainment of individual goals established during the baseline assessment. Secondary outcomes are the well-being, physiological stress and quality of life of people with dementia and their caregivers; people with dementia's behavioural and psychological symptoms of dementia, resistance during care, and reactions to the music; caregivers' burden of care, positive aspects of care, and caregiving self-efficacy; and the quality of the caregiver-care recipient interaction. DISCUSSION Our study will assess the extent to which an app-based individualized music listening intervention is feasible and effective for enhancing the well-being and quality of life of people with dementia living at home and their family caregivers. TRIAL REGISTRATION German Clinical Trials Register DRKS00025502 and ISRCTN registry ISRCTN68084105, https://doi.org/10.1186/ISRCTN68084105.
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Affiliation(s)
- Elisabeth Jakob
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Humboldtstrasse 11, 07743, Jena, Germany.
| | - Juliane Meininger
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Humboldtstrasse 11, 07743, Jena, Germany
| | - Mareike Hillebrand
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Humboldtstrasse 11, 07743, Jena, Germany
| | - Lisette Weise
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Humboldtstrasse 11, 07743, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Humboldtstrasse 11, 07743, Jena, Germany
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Rabl M, Zullo L, Lewczuk P, Kornhuber J, Karikari TK, Blennow K, Zetterberg H, Bavato F, Quednow BB, Seifritz E, von Gunten A, Clark C, Popp J. Plasma neurofilament light, glial fibrillary acid protein, and phosphorylated tau 181 as biomarkers for neuropsychiatric symptoms and related clinical disease progression. Res Sq 2024:rs.3.rs-4116836. [PMID: 38562890 PMCID: PMC10984087 DOI: 10.21203/rs.3.rs-4116836/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are common in older people, may occur early in the development of dementia disorders, and have been associated with faster cognitive decline. Here, our objectives were to investigate whether plasma levels of neurofilament light chain (NfL), glial fibrillary acid protein (GFAP), and tau phosphorylated at threonine 181 (pTau181) are associated with current NPS and predict future NPS in non-demented older people. Furthermore, we tested whether the presence of NPS combined with plasma biomarkers are useful to predict Alzheimer's disease (AD) pathology and cognitive decline. METHODS One hundred and fifty-one participants with normal cognition (n=76) or mild cognitive impairment (n=75) were examined in a longitudinal brain aging study at the Memory Centers, University Hospital of Lausanne, Switzerland. Plasma levels of NfL, GFAP, and pTau181 along with CSF biomarkers of AD pathology were measured at baseline. NPS were assessed through the Neuropsychiatric Inventory Questionnaire (NPI-Q), along with the cognitive and functional performance at baseline and follow-up (mean: 20 months). Linear regression and ROC analyses were used to address the associations of interest. RESULTS Higher GFAP levels were associated with NPS at baseline (β=0.23, p=.008). Higher NfL and GFAP levels were associated with the presence of NPS at follow-up (β=0.29, p=.007 and β=0.28, p=.007, respectively) and with an increase in the NPI-Q severity score over time (β=0.23, p=.035 and β=0.27, p=.011, respectively). Adding NPS and the plasma biomarkers to a reference model improved the prediction of future NPS (AUC 0.73 to 0.84, p=.007) and AD pathology (AUC 0.79 to 0.86, p=.006), but not of cognitive decline (AUC 0.79 to 0.84, p=.068). CONCLUSION Plasma GFAP is associated with NPS while NfL and GFAP are both associated with future NPS and NPS severity. Considering the presence of NPS along with blood-based AD-biomarkers may improve diagnosis and prediction of clinical progression of NPS and inform clinical decision-making in non-demented older people.
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Affiliation(s)
- Miriam Rabl
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich
| | - Leonardo Zullo
- Department of Psychiatry, Old Age Psychiatry Service, Lausanne University Hospital
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-Alexander Universität Erlangen-Nürnberg
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-Alexander Universität Erlangen-Nürnberg
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg
| | - Francesco Bavato
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich
| | - Armin von Gunten
- Department of Psychiatry, Old Age Psychiatry Service, Lausanne University Hospital
| | - Christopher Clark
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich
| | - Julius Popp
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich
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Lee DR, Romero T, Serrano K, Panlilio M, Rojas-Parra A, Matsuno L, Mendez MF, Willinger C, Reuben DB. Demographics, Symptoms, Psychotropic Use, and Caregiver Distress in Patients With Early vs Late Onset Dementia. Am J Geriatr Psychiatry 2024:S1064-7481(24)00289-6. [PMID: 38600005 DOI: 10.1016/j.jagp.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Understanding experiences and challenges faced by persons living with Early-Onset Dementia (EOD) compared to individuals diagnosed with Late-Onset Dementia (LOD) is important for the development of targeted interventions. OBJECTIVE Describe differences in sociodemographic, neuropsychiatric behavioral symptoms, caregiver characteristics, and psychotropic use. DESIGN, SETTING, PARTICIPANTS Cross-sectional, retrospective study including 908 UCLA Alzheimer's Dementia Care Program participants (177 with EOD and 731 with LOD). MEASUREMENTS Onset of dementia was determined using age at program enrollment, with EOD defined as age <65 years and LOD defined as age >80 years. Sociodemographic and clinical characteristics were measured once at enrollment. Behavioral symptoms were measured using the Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score and caregiver distress was measured using the NPI-Q distress score. Medications included antipsychotic, antidepressant, benzodiazepines and other hypnotics, antiepileptics, and dementia medications. RESULTS EOD compared to LOD participants were more likely men, college graduates, married, live alone, and have fewer comorbidities. EOD caregivers were more often spouses (56% vs 26%, p <0.01), whereas LOD caregivers were more often children (57% vs 10%, p <0.01). EOD was associated with lower odds of being above the median (worse) NPI-Q severity (adjusted odds ratio [aOR], 0.58; 95% CI 0.35-0.96) and NPI-Q distress scores (aOR, 0.53; 95% CI 0.31-0.88). Psychotropic use did not differ between groups though symptoms were greater for LOD compared to EOD. CONCLUSION Persons with EOD compared to LOD had sociodemographic differences, less health conditions, and fewer neuropsychiatric symptoms. Future policies could prioritize counseling for EOD patients and families, along with programs to support spousal caregivers of persons with EOD.
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Affiliation(s)
- David R Lee
- Multicampus Program in Geriatric Medicine and Gerontology, Division of Geriatrics, David Geffen School of Medicine at UCLA, University of California (DRL, KS, DBR), Los Angeles, CA.
| | - Tahmineh Romero
- Department of Medicine Statistics Core (TR), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Katherine Serrano
- Multicampus Program in Geriatric Medicine and Gerontology, Division of Geriatrics, David Geffen School of Medicine at UCLA, University of California (DRL, KS, DBR), Los Angeles, CA
| | - Michelle Panlilio
- Department of Medicine (MP, LM, CW), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Abel Rojas-Parra
- Department of Geriatric Medicine (ARP), Clinica Sierra Vista, Bakersfield, CA
| | - Lauren Matsuno
- Department of Medicine (MP, LM, CW), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Mario F Mendez
- Department of Neurology, Department of Psychiatry and Behavioral Sciences (MFM), David Geffen School of Medicine, University of California Los Angeles (UCLA), Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Christine Willinger
- Department of Medicine (MP, LM, CW), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, Division of Geriatrics, David Geffen School of Medicine at UCLA, University of California (DRL, KS, DBR), Los Angeles, CA
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Geng C, Tan L, Chenchen. Neuropsychiatric symptoms profile and markers of Alzheimer disease-type pathology in patients with Lewy body dementias. Brain Res 2024; 1833:148881. [PMID: 38519009 DOI: 10.1016/j.brainres.2024.148881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND To determine whether Lewy body dementia (LBD) patients with likely copathology of Alzheimer's disease (AD) exhibit greater neuropsychiatric symptom (NPS) compared to those without likely AD-type copathology. METHODS We enrolled 69 individuals diagnosed with Lewy body dementia (LBD), comprising both dementia with Lewy bodies (DLB) (n = 36) and Parkinson's disease dementia (PDD) (n = 33). These participants had accessible cerebrospinal fluid (CSF) markers related to Alzheimer's disease (AD) and cognitive data. We assessed CSF levels of β-amyloid 42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau). Employing autopsy-validated CSF thresholds (t-tau/Aβ42 ratio > 0.3, n = 69), we categorized individuals into LBD with AD pathology (LBD + AD, n = 31) and LBD without apparent AD co-pathology (LBD - AD, n = 38). Moreover, the Hamilton Depression Scale (HAMD24), Hamilton Anxiety Scale (HAMA14), and Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess the NPS. Spearman correlations were utilized to explore links between NPS and CSF marker profiles. RESULTS In terms of neuropsychiatric symptoms, LBD + AD patients demonstrated notably elevated levels of depressive symptoms (HAMD24) in comparison to LBD - AD patients (P < 0.001). However, based on PDD and DLB groups, no significant variations were noted in the neuropsychiatric symptoms(P>0.05). Moreover, CSF-derived biomarkers of Aβ42, and t-tau/Aβ42 were also associated with HAMD24 total scores in the LBD + AD subsample (P < 0.05). CONCLUSION There is an association between AD pathological markers and the NPS of LBD. The biologically based classification of LBD may be more advantageous in elucidating clinical heterogeneity than clinically defined syndromes.
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Affiliation(s)
- Chaofan Geng
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Leilei Tan
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chenchen
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
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8
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Nouraeinejad A. The bidirectional links between coronavirus disease 2019 and Alzheimer's disease. Int J Neurosci 2024:1-15. [PMID: 38451045 DOI: 10.1080/00207454.2024.2327403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
Coronavirus disease 2019 (COVID-19) can be a critical disease, particularly in the elderly and those with comorbidities. Patients with Alzheimer's disease are more vulnerable to COVID-19 consequences. The latest results have indicated some common risk factors for both diseases. An understanding of the pathological link between COVID-19 and Alzheimer's disease will help develop timely strategies to treat both diseases. This review explores the bidirectional links between COVID-19 and Alzheimer's disease.
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Affiliation(s)
- Ali Nouraeinejad
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
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9
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Kwak S, Kim H, Kim KY, Oh DY, Lee D, Nam G, Lee JY. Neuroanatomical and neurocognitive correlates of delusion in Alzheimer's disease and mild cognitive impairment. BMC Neurol 2024; 24:89. [PMID: 38448803 PMCID: PMC10916051 DOI: 10.1186/s12883-024-03568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms and delusions are highly prevalent among people with dementia. However, multiple roots of neurobiological bases and shared neural basis of delusion and cognitive function remain to be characterized. By utilizing a fine-grained multivariable approach, we investigated distinct neuroanatomical correlates of delusion symptoms across a large population of dementing illnesses. METHODS In this study, 750 older adults with mild cognitive impairment and Alzheimer's disease completed brain structural imaging and neuropsychological assessment. We utilized principal component analysis followed by varimax rotation to identify the distinct multivariate correlates of cortical thinning patterns. Five of the cognitive domains were assessed whether the general cognitive abilities mediate the association between cortical thickness and delusion. RESULTS The result showed that distributed thickness patterns of temporal and ventral insular cortex (component 2), inferior and lateral prefrontal cortex (component 1), and somatosensory-visual cortex (component 5) showed negative correlations with delusions. Subsequent mediation analysis showed that component 1 and 2, which comprises inferior frontal, anterior insula, and superior temporal regional thickness accounted for delusion largely through lower cognitive functions. Specifically, executive control function assessed with the Trail Making Test mediated the relationship between two cortical thickness patterns and delusions. DISCUSSION Our findings suggest that multiple distinct subsets of brain regions underlie the delusions among older adults with cognitive impairment. Moreover, a neural loss may affect the occurrence of delusion in dementia largely due to impaired general cognitive abilities.
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Affiliation(s)
- Seyul Kwak
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Hairin Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Keun You Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Da Young Oh
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Dasom Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Gieun Nam
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea.
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10
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Jiang J, Wang A, Shi H, Jiang S, Li W, Jiang T, Wang L, Zhang X, Sun M, Zhao M, Zou X, Xu J. Clinical and neuroimaging association between neuropsychiatric symptoms and nutritional status across the Alzheimer's disease continuum: a longitudinal cohort study. J Nutr Health Aging 2024; 28:100182. [PMID: 38336502 DOI: 10.1016/j.jnha.2024.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To investigate the association between neuropsychiatric symptoms (NPS) and nutritional status, and explore their shared regulatory brain regions on the Alzheimer's disease (AD) continuum. DESIGN A longitudinal, observational cohort study. SETTING Data were collected from the Chinese Imaging, Biomarkers, and Lifestyle study between June 1, 2021 and December 31, 2022. PARTICIPANTS Overall, 432 patients on the AD continuum, including amnestic mild cognitive impairment and AD dementia, were assessed at baseline, and only 165 patients completed the (10.37 ± 6.08) months' follow-up. MEASUREMENTS The Mini-Nutritional Assessment (MNA) and Neuropsychiatric Inventory (NPI) were used to evaluate nutritional status and NPS, respectively. The corrected cerebral blood flow (cCBF) measured by pseudo-continuous arterial spin labeling of the dietary nutrition-related brain regions was analyzed. The association between the NPS at baseline and subsequent change in nutritional status and the association between the changes in the severity of NPS and nutritional status were examined using generalized linear mixed models. RESULTS Increased cCBF in the left putamen was associated with malnutrition, general NPS, affective symptoms, and hyperactivity (P < 0.05). The presence of general NPS (β = -1.317, P = 0.003), affective symptoms (β = -1.887, P < 0.001), and appetite/eating disorders (β = -1.714, P < 0.001) at baseline were associated with a decline in the MNA scores during follow-up. The higher scores of general NPI (β = -0.048), affective symptoms (β = -0.181), and appetite/eating disorders (β = -0.416; all P < 0.001) were longitudinally associated with lower MNA scores after adjusting for confounding factors. CONCLUSIONS We found that baseline NPS were predictors of a decline in nutritional status on the AD continuum. The worse the severity of affective symptoms and appetite/eating disorders, the poorer the nutritional status. Furthermore, abnormal perfusion of the putamen may regulate the association between malnutrition and NPS, which suggests their potentially common neural regulatory basis.
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Affiliation(s)
- Jiwei Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Shirui Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Wenyi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Tianlin Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Linlin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Mengfan Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Min Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xinying Zou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
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11
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Zhang A, Song Z, Di A, Zhou Z, Zheng L, Zhuang L. Acupuncture for the Treatment of Neuropsychiatric Symptoms in Parkinson's Disease: A Systematic Review and Meta-Analysis. Complement Ther Med 2024; 80:103020. [PMID: 38185400 DOI: 10.1016/j.ctim.2024.103020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) of Parkinson's disease (PD) have received increasing attention, but effective treatment options remain limited. Acupuncture may have clinical benefits for NPSs in PD patients, but high-quality evidence supporting this possibility still needs to be discovered. Therefore, we conducted a meta-analysis to evaluate the effect of acupuncture treatment on NPSs in PD patients. METHODS Randomized controlled trials (RCTs) of acupuncture treatment for PD retrieved from the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and Scopus, were used to evaluate NPSs of PD patients. The Cochrane Intervention System Evaluation Manual assessed the methodological quality. RESULTS A total of 13 RCTs involving 719 patients were included. The results showed that compared with medication alone or sham acupuncture, acupuncture improved sleep quality in PD patients, with Parkinson's Disease Sleep Scale (PDSS) [standardized mean difference (SMD)= 0.48, 95% confidence interval (CI)= 0.242 to 0.793, P = 0.001]. The I scores and total scores on Unified Parkinson's Disease Rating Scale (UPDRS) indicated acupuncture treatment was effective (SMD=-0.66, 95%CI=-0.66 to -0.18, P = 0.042; SMD=-0.77, 95%CI=-1.31 to -0.23, P = 0.005). Results of the Epworth Sleepiness Scale (ESS) and Parkinson's Disease Questionnaire-39 (PDQ-39) showed no statistically significant differences (SMD=-0.27, 95%CI=-0.08 to 0.62, P = 0.128; SMD=-0.20, 95%CI=-0.42 to 0.01, P = 0.554). Anxiety and depression research had no significant differences due to the excessive inter-study bias. CONCLUSION Acupuncture treatment can improve sleep quality, psychological and behavioral alterations, and the overall condition of PD patients. However, the study revealed no significant positive intervention effects on anxiety, depression, and quality of life, underscoring the necessity for continued research to elucidate these domains' intricacies and develop productive therapeutic approaches.
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Affiliation(s)
- Anxin Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zefeng Song
- Medical Department, Dalian University of Technology, Dalian 116024, China
| | - Anqi Di
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zelin Zhou
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Liang Zheng
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Lixing Zhuang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
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12
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Mai AS, Lee YS, Yong JH, Teo DCYJ, Wan YM, Tan EK. Treatment of apathy in Parkinson's disease: A bayesian network meta-analysis of randomised controlled trials. Heliyon 2024; 10:e26107. [PMID: 38440294 PMCID: PMC10909723 DOI: 10.1016/j.heliyon.2024.e26107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
Background Apathy is an important but unrecognised aspect of Parkinson's disease (PD). The optimal therapeutic options for apathy remain unclear. Early recognition and treatment of apathy can reduce the significant burden of disease for patients and their caregivers. Here we conducted a meta-analysis to evaluate the comparative efficacy of different treatment modalities of apathy in PD (CRD42021292099). Methods We screened Medline, Embase, and PsycINFO databases for articles on therapies for apathy in PD. The outcome of interest is the reduction in apathy scores post-intervention and is measured by standardised mean differences (SMD) with 95% credible intervals (CrI). We included only randomised controlled trials examining interventions targeted at reducing apathy. Results Nineteen studies involving 2372 patients were included in the quantitative analysis. The network meta-analysis found pharmacotherapy to be the most efficacious treatment, significantly better than brain stimulation (SMD -0.43, 95% CrI -0.78 to -0.07), exercise-based interventions (SMD -0.66, 95% CrI -1.25 to -0.08), supplements (SMD -0.33, 95% CrI -0.67 to 0), and placebo (SMD -0.38, 95% CrI -0.56 to -0.23). Subgroup analysis of pharmacotherapy versus placebo found similar efficacy of dopamine agonists (SMD -0.36, 95% CI -0.59 to -0.12, P = 0.003) and alternative medications (SMD -0.42, 95% CI -0.61 to -0.23, P < 0.001). The remaining comparisons and subgroup analyses did not demonstrate any significant treatment effects. Conclusion Our meta-analysis of randomised controlled trials showed that pharmacotherapy is the most efficacious treatment option, with dopamine agonists having similar efficacy as other medications. Further research is needed to determine the optimal management strategy.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Siang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jung Hahn Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yi-Min Wan
- Department of Psychiatry, Ng Teng Fong General Hospital, Singapore
| | - Eng-King Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
- Neuroscience and Behavioural Programme, Duke-NUS Medical School, Singapore
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Gjestad E, Nerdal V, Saltvedt I, Lydersen S, Kliem E, Ryum T, Grambaite R. Delirium in acute stroke is associated with increased cognitive and psychiatric symptoms over time: The Nor-COAST study. J Stroke Cerebrovasc Dis 2024; 33:107667. [PMID: 38423153 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Delirium, an acute and fluctuating mental disturbance of attention, cognition, and consciousness, commonly occurs in acute stroke. Research on long-term outcomes of stroke patients experiencing delirium is limited, especially regarding cognitive and psychiatric symptoms. METHODS As part of the Nor-COAST study, 373 patients were screened for delirium using the Confusion Assessment Method (CAM) in the acute phase of stroke. Patients were included in the mixed-model linear regression analyses if they had available data from the follow-ups at three, 18 or 36 months, totaling 334 (44.6 % women, mean (SD) age: 72.1 (12.5) years, 17 (5.1 %) diagnosed with delirium). Global cognition was measured using the Montreal Cognitive Assessment (MoCA). Psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). RESULTS At three months, delirium was associated with a higher NPI-Q score (Mean (SD) 2.9 (3.6) vs 1.4 (2.2)). At 18 and 36 months, delirium was associated with a lower MoCA score (Mean (SD) 19.7 (6.6) vs 24.3 (5.0), and 20.6 (7.6) vs 24.6 (4.8)), higher HADS anxiety symptoms (5.0 (4.3) vs 3.3 (3.3), and 5.9 (4.1) vs 3.4 (3.6)), higher HADS depression symptoms (7.2 (4.7) vs 3.4 (3.3), and 6.6 (5.1) vs 3.7 (3.7)), and higher NPI-Q score (2.4 (4.4) vs 1.7 (2.3), 2.6 (4.5) vs 1.0 (1.9)). Delirium significantly predicted the psychiatric symptoms hallucinations and agitation. CONCLUSIONS Patients with delirium in the acute phase of stroke may be particularly vulnerable to developing cognitive and psychiatric symptoms in the chronic phase.
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Affiliation(s)
- Elise Gjestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vilde Nerdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Kliem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
| | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ramune Grambaite
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
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14
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van Amerongen S, Pulukuri SV, Tuz-Zahra F, Tripodis Y, Cherry JD, Bernick C, Geda YE, Wethe JV, Katz DI, Alosco ML, Adler CH, Balcer LJ, Ashton NJ, Blennow K, Zetterberg H, Daneshvar DH, Colasurdo EA, Iliff JJ, Li G, Peskind ER, Shenton ME, Reiman EM, Cummings JL, Stern RA. Inflammatory biomarkers for neurobehavioral dysregulation in former American football players: findings from the DIAGNOSE CTE Research Project. J Neuroinflammation 2024; 21:46. [PMID: 38336728 PMCID: PMC10854026 DOI: 10.1186/s12974-024-03034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Traumatic encephalopathy syndrome (TES) is defined as the clinical manifestation of the neuropathological entity chronic traumatic encephalopathy (CTE). A core feature of TES is neurobehavioral dysregulation (NBD), a neuropsychiatric syndrome in repetitive head impact (RHI)-exposed individuals, characterized by a poor regulation of emotions/behavior. To discover biological correlates for NBD, we investigated the association between biomarkers of inflammation (interleukin (IL)-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α) in cerebrospinal fluid (CSF) and NBD symptoms in former American football players and unexposed individuals. METHODS Our cohort consisted of former American football players, with (n = 104) or without (n = 76) NBD diagnosis, as well as asymptomatic unexposed individuals (n = 55) from the DIAGNOSE CTE Research Project. Specific measures for NBD were derived (i.e., explosivity, emotional dyscontrol, impulsivity, affective lability, and a total NBD score) from a factor analysis of multiple self-report neuropsychiatric measures. Analyses of covariance tested differences in biomarker concentrations between the three groups. Within former football players, multivariable linear regression models assessed relationships among log-transformed inflammatory biomarkers, proxies for RHI exposure (total years of football, cumulative head impact index), and NBD factor scores, adjusted for relevant confounding variables. Sensitivity analyses tested (1) differences in age subgroups (< 60, ≥ 60 years); (2) whether associations could be identified with plasma inflammatory biomarkers; (3) associations between neurodegeneration and NBD, using plasma neurofilament light (NfL) chain protein; and (4) associations between biomarkers and cognitive performance to explore broader clinical symptoms related to TES. RESULTS CSF IL-6 was higher in former American football players with NBD diagnosis compared to players without NBD. Furthermore, elevated levels of CSF IL-6 were significantly associated with higher emotional dyscontrol, affective lability, impulsivity, and total NBD scores. In older football players, plasma NfL was associated with higher emotional dyscontrol and impulsivity, but also with worse executive function and processing speed. Proxies for RHI exposure were not significantly associated with biomarker concentrations. CONCLUSION Specific NBD symptoms in former American football players may result from multiple factors, including neuroinflammation and neurodegeneration. Future studies need to unravel the exact link between NBD and RHI exposure, including the role of other pathophysiological pathways.
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Affiliation(s)
- Suzan van Amerongen
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Surya V Pulukuri
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Yonas E Geda
- Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Douglas I Katz
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Michael L Alosco
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Colasurdo
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
| | - Jeffrey J Iliff
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Gail Li
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System Geriatric Research, Seattle, WA, USA
| | - Elaine R Peskind
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Harvard Medical School, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Robert A Stern
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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15
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Cui Y, Liu L, Chu M, Xie K, Chen Z, Nan H, Kong Y, Xia T, Wang Y, Wang Y, He Q, Wu L. Application of the mild behavioral impairment checklist in Chinese patients with the behavioral variant of frontotemporal dementia. Neurol Sci 2024; 45:557-564. [PMID: 37668827 PMCID: PMC10791978 DOI: 10.1007/s10072-023-07049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The mild behavioral impairment checklist (MBI-C) designed to capture neuropsychiatric symptoms in the whole spectrum of elder with or without dementia, have been verified in mild behavioral impairment, mild cognitive impairment and Alzheimer's Disease, but never used in the behavioral variant of frontotemporal dementia (bvFTD). METHODS Fifty-two patients with bvFTD (mild, n = 30; moderate-severe, n = 22) and 82 community-dwelling elderly individuals (HCs) were enrolled. All subjects were assessed with a full neuropsychological scale including the MBI-C, Neuropsychiatric Inventory Questionnaire (NPI-Q), and Frontal Behavioral Inventory (FBI). Receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the MBI-C, NPI-Q, and FBI, and cutoff points were determined using the Youden index. RESULTS The MBI-C and domain scores in all patients with bvFTD were significantly higher than those in HCs. The most common symptoms of bvFTD were apathy (82.7%) and impulse dyscontrol (80.8%). The MBI-C score was positively correlated with the NPI-Q, FBI, and Activities of Daily Living. For differentiating patients with both bvFTD and mild bvFTD from HCs, the optimal MBI-C cutoff point was 5.5 with a sensitivity of 100% and specificity of 82%, and its sensitivity was higher than that of the NPI-Q and FBI. CONCLUSION The MBI-C is a sensitive tool for screening behavioral and psychological symptoms in patients with bvFTD, even in the early stages of the disease.
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Affiliation(s)
- Yue Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Li Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Min Chu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Kexin Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Haitian Nan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Yu Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Tianxinyu Xia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Yingtao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Yihao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Qianqian He
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China.
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Tondelli M, Chiari A, Vinceti G, Galli C, Salemme S, Filippini T, Carbone C, Minafra C, De Luca C, Prandi R, Tondelli S, Zamboni G. Greenness and neuropsychiatric symptoms in dementia. Environ Res 2024; 242:117652. [PMID: 37980996 DOI: 10.1016/j.envres.2023.117652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES It is acknowledged that living in a green environment may help mental well-being and this may be especially true for vulnerable people. However, the relationship between greenness and neuropsychiatric symptoms in dementia has not been explored yet. METHODS We collected clinical, neuropsychiatric, and residential data from subjects with dementia living in the province of Modena, Northern Italy. Neuropsychiatric symptoms were measured with the Neuropsychiatry Inventory, a questionnaire administered to the caregiver who assesses the presence and severity of neuropsychiatric symptoms, including delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, euphoria/elation, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviors, sleep disturbances, and appetite/eating changes. Normalized Difference Vegetation Index (NDVI) was used as a proxy of greenness. Regression models were constructed to study the association between greenness and neuropsychiatric features. RESULTS 155 patients with dementia were recruited. We found that greenness is variably associated with the risk of having neuropsychiatric symptoms. The risk of apathy was lower with lower levels of greenness (OR = 0.42, 95% CI 0.19-0.91 for NDVI below the median value). The risk of psychosis was higher with lower levels of greenness but with more imprecise values (OR = 1.77, 95% CI 0.84-3.73 for NDVI below the median value). CONCLUSION Our results suggest a possible association between greenness and neuropsychiatric symptoms in people with dementia. If replicated in larger samples, these findings will pave the road for identifying innovative greening strategies and interventions that can improve mental health in dementia.
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Affiliation(s)
- Manuela Tondelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, Baggiovara Hospital, AOU Modena, Modena, Italy.
| | - Annalisa Chiari
- Neurology Unit, Baggiovara Hospital, AOU Modena, Modena, Italy
| | - Giulia Vinceti
- Neurology Unit, Baggiovara Hospital, AOU Modena, Modena, Italy
| | - Chiara Galli
- Primary Care Department, AUSL Modena, Modena, Italy
| | - Simone Salemme
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Chiara Carbone
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Minafra
- Department of Architecture, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudia De Luca
- Department of Architecture, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Riccardo Prandi
- Department of Biological, Geological and Environmental Sciences (BiGeA), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simona Tondelli
- Department of Architecture, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giovanna Zamboni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, Baggiovara Hospital, AOU Modena, Modena, Italy
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Kor PPK, Parial LL, Yu CTK, Liu JYW, Liu DPM, Hon JMK. Effects of a Family Caregiver-Delivered MultiSensory Cognitive Stimulation Intervention for Older People With Dementia During Coronavirus 2019: A Randomized Controlled Trial. Gerontologist 2024; 64:gnad054. [PMID: 37179458 DOI: 10.1093/geront/gnad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Many community dementia services such as home-visiting services and center-based activities were suspended during the coronavirus 2019 pandemic. This study investigated the efficacy of a caregiver-delivered cognitive stimulation therapy (CDCST) on people with dementia during the pandemic. RESEARCH DESIGN AND METHODS This was a 2-arm randomized controlled trial involving 241 patient-caregiver dyads assigned to a 15-week CDCST or control group (usual care). We hypothesized that CDCST would facilitate significant improvements among people with dementia (cognition, behavioral/psychiatric symptoms, and quality of life) and their caregivers (caregiving appraisal, attitudes, and psychological well-being) at postintervention (T1) and at the 12-week follow-up (T2). Generalized estimating equations evaluated the study outcomes. RESULTS A total of 230 dyads completed the study, with good program adherence (93%). Participants in the CDCST showed significant improvements in cognition (p < .001), behavioral and psychiatric symptoms (p =. 027), and quality of life (p =.001) at the 3-month follow-up period. Family caregivers had improved positive aspects of caregiving (p = .008; p = .049) and decreased negative attitudes toward people with dementia (p =. 013; p < .001) at both T1 and T2. There were nonsignificant changes in the caregivers' perceived burden, distress, and psychological well-being. DISCUSSION AND IMPLICATIONS Family caregivers could be trained to provide cognitive stimulation at home for people with dementia, which could benefit both parties. CDCST could manage to improve the cognition, neuropsychiatric symptoms, and quality of life of people with dementia, while also improving caregiving appraisal and negative attitudes among family caregivers. CLINICAL TRIAL REGISTRATION NUMBER NCT03803592.
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Affiliation(s)
- Patrick Pui Kin Kor
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Clare Tsz Kiu Yu
- Division of Psychiatry, University of College London, London, UK
| | - Justina Yat Wah Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Denise Pik Mei Liu
- Ming Yue District Elderly Community Centre, Hong Kong Young Women's Christian Association, Hong Kong SAR, China
| | - Joan Mo King Hon
- Hong Kong Young Women's Christian Association, Hong Kong SAR, China
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Matuskova V, Veverova K, Jester DJ, Matoska V, Ismail Z, Sheardova K, Horakova H, Cerman J, Laczó J, Andel R, Hort J, Vyhnalek M. Mild behavioral impairment in early Alzheimer's disease and its association with APOE and BDNF risk genetic polymorphisms. Alzheimers Res Ther 2024; 16:21. [PMID: 38279143 PMCID: PMC10811933 DOI: 10.1186/s13195-024-01386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Mild behavioral impairment (MBI) has been commonly reported in early Alzheimer's disease (AD) but rarely using biomarker-defined samples. It is also unclear whether genetic polymorphisms influence MBI in such individuals. We thus aimed to examine the association between the cognitive status of participants (amnestic mild cognitive impairment (aMCI-AD) vs cognitively normal (CN) older adults) and MBI severity. Within aMCI-AD, we further examined the association between APOE and BDNF risk genetic polymorphisms and MBI severity. METHODS We included 62 aMCI-AD participants and 50 CN older adults from the Czech Brain Aging Study. The participants underwent neurological, comprehensive neuropsychological examination, APOE and BDNF genotyping, and magnetic resonance imaging. MBI was diagnosed with the Mild Behavioral Impairment Checklist (MBI-C), and the diagnosis was based on the MBI-C total score ≥ 7. Additionally, self-report instruments for anxiety (the Beck Anxiety Inventory) and depressive symptoms (the Geriatric Depression Scale-15) were administered. The participants were stratified based on the presence of at least one risk allele in genes for APOE (i.e., e4 carriers and non-carriers) and BDNF (i.e., Met carriers and non-carriers). We used linear regressions to examine the associations. RESULTS MBI was present in 48.4% of the aMCI-AD individuals. Compared to the CN, aMCI-AD was associated with more affective, apathy, and impulse dyscontrol but not social inappropriateness or psychotic symptoms. Furthermore, aMCI-AD was related to more depressive but not anxiety symptoms on self-report measures. Within the aMCI-AD, there were no associations between APOE e4 and BDNF Met and MBI-C severity. However, a positive association between Met carriership and self-reported anxiety appeared. CONCLUSIONS MBI is frequent in aMCI-AD and related to more severe affective, apathy, and impulse dyscontrol symptoms. APOE and BDNF polymorphisms were not associated with MBI severity separately; however, their combined effect warrants further investigation.
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Affiliation(s)
- Veronika Matuskova
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Katerina Veverova
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Dylan J Jester
- Women's Operational Military Exposure Network (WOMEN), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Vaclav Matoska
- Department of Clinical Biochemistry, Hematology and Immunology, Homolka Hospital, Prague, Czech Republic
| | - Zahinoor Ismail
- Departments of Psychiatry and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Katerina Sheardova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Hana Horakova
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
- Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic
| | - Jiri Cerman
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Jan Laczó
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Ross Andel
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Jakub Hort
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic.
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Gharat R, Dixit G, Khambete M, Prabhu A. Targets, trials and tribulations in Alzheimer therapeutics. Eur J Pharmacol 2024; 962:176230. [PMID: 38042464 DOI: 10.1016/j.ejphar.2023.176230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by abnormal accumulation of extracellular amyloid beta senile plaques and intracellular neurofibrillary tangles in the parts of the brain responsible for cognition. The therapeutic burden for the management of AD relies solely on cholinesterase inhibitors that provide only symptomatic relief. The urgent need for disease-modifying drugs has resulted in intensive research in this domain, which has led to better understanding of the disease pathology and identification of a plethora of new pathological targets. Currently, there are over a hundred and seventy clinical trials exploring disease modification, cognitive enhancement, and reduction of neuro-psychiatric complications. However, the path to developing safe and efficacious AD therapeutics has not been without challenges. Several clinical trials have been terminated in advanced stages due to lack of therapeutic translation or increased incidence of adverse events. This review presents an in-depth look at the various therapeutic targets of AD and the lessons learnt during their clinical assessment. Comprehensive understanding of the implication of modulating various aspects of Alzheimer brain pathology is crucial for development of drugs with potential to halt disease progression in Alzheimer therapeutics.
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Affiliation(s)
- Ruchita Gharat
- SVKM's Dr. Bhanuben Nanavati College of Pharmacy, VM Road, Vile Parle (West), Mumbai, 400056, Maharashtra, India
| | - Gargi Dixit
- SVKM's Dr. Bhanuben Nanavati College of Pharmacy, VM Road, Vile Parle (West), Mumbai, 400056, Maharashtra, India
| | - Mihir Khambete
- Department of Chemistry, Yale University, New Haven, CT, USA
| | - Arati Prabhu
- SVKM's Dr. Bhanuben Nanavati College of Pharmacy, VM Road, Vile Parle (West), Mumbai, 400056, Maharashtra, India.
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罗 芷, 吴 佳, 宋 优, 梅 春, 杜 戎. [Systemic lupus erythematosus associated macrophage activation syndrome with neuropsychiatric symptoms: A report of 2 cases]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:1111-1117. [PMID: 38101797 PMCID: PMC10723996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 12/17/2023]
Abstract
Systemic lupus erythematosus (SLE) associated macrophage activation syndrome (MAS) is clinically severe, with a high mortality rate and rare neuropsychiatric symptoms. In the course of diagnosis and treatment, it is necessary to actively determine whether the neuropsychiatric symptoms in patients are caused by neuropsychiatric systemic lupus erythematosus (NPSLE) or macrophage activation syndrome. This paper retrospectively analyzed the clinical data of 2 cases of SLE associated MAS with neuropsychiatric lesions, Case 1: A 30-year-old female had obvious alopecia in 2019, accompanied by emaciation, fatigue and dry mouth. In March 2021, she felt weak legs and fell down, followed by fever and chills without obvious causes. After completing relevant examinations, she was diagnosed with SLE and given symptomatic treatments such as hormones and anti-infection, but the patient still had fever. The relevant examinations showed moderate anemia, elevated ferritin, elevated triglycerides, decreased NK cell activity, and a perforin positivity rate of 4.27%, which led to the diagnosis of "pre-hemophagocytic syndrome (HPS)". In May 2021, the patient showed mental trance and babble, and was diagnosed with "SLE-associated MAS"after completing relevant examinations. After treatment with methylprednisolone, anti-infection and psychotropic drugs, the patient's temperature was normal and mental symptoms improved. Case 2: A 30-year-old female patient developed butterfly erythema on both sides of the nose on her face and several erythema on her neck in June 2019, accompanied by alopecia, oral ulcers, and fever. She was diagnosed with "SLE" after completing relevant examinations, and her condition was relieved after treatment with methylprednisolone and human immunoglobulin. In October 2019, the patient showed apathy, no lethargy, and fever again, accompanied by dizziness and vomiting. The relevant examination indicated moderate anemia, decreased NK cell activity, elevated triglycerides, and elevated ferritin. The patient was considered to be diagnosed with "SLE, NPSLE, and SLE-associated MAS". After treatment with hormones, human immunoglobulin, anti-infection, rituximab (Mabthera), the patient's condition improved and was discharged from the hospital. After discharge, the patient regularly took methylprednisolone tablets (Medrol), and her psychiatric symptoms were still intermittent. In November 2019, she developed symptoms of fever, mania, and delirium, and later turned to an apathetic state, and was given methylprednisolone intravenous drip and olanzapine tablets (Zyprexa) orally. After the mental symptoms improved, she was treated with rituximab (Mabthera). Later, due to repeated infections, she was replaced with Belizumab (Benlysta), and she was recovered from her psychiatric anomalies in March 2021. Through the analysis of clinical symptoms, imaging examination, laboratory examination, treatment course and effect, it is speculated that the neuropsychiatric symptoms of case 1 are more likely to be caused by MAS, and that of case 2 is more likely to be caused by SLE. At present, there is no direct laboratory basis for the identification of the two neuropsychiatric symptoms. The etiology of neuropsychiatric symptoms can be determined by clinical manifestations, imaging manifestations, cerebrospinal fluid detection, and the patient's response to treatment. Early diagnosis is of great significance for guiding clinical treatment, monitoring the condition and judging the prognosis. The good prognosis of the two cases in this paper is closely related to the early diagnosis, treatment and intervention of the disease.
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Affiliation(s)
- 芷筠 罗
- />华中科技大学同济医学院附属协和医院风湿免疫科, 武汉 430022Department of Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - 佳佳 吴
- />华中科技大学同济医学院附属协和医院风湿免疫科, 武汉 430022Department of Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - 优 宋
- />华中科技大学同济医学院附属协和医院风湿免疫科, 武汉 430022Department of Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - 春丽 梅
- />华中科技大学同济医学院附属协和医院风湿免疫科, 武汉 430022Department of Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - 戎 杜
- />华中科技大学同济医学院附属协和医院风湿免疫科, 武汉 430022Department of Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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He C, Kong X, Li J, Wang X, Chen X, Wang Y, Zhao Q, Tao Q. Predictors for quality of life in older adults: network analysis on cognitive and neuropsychiatric symptoms. BMC Geriatr 2023; 23:850. [PMID: 38093173 PMCID: PMC10720074 DOI: 10.1186/s12877-023-04462-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Quality of life (QoL) of older adults has become a pivotal concern of the public and health system. Previous studies found that both cognitive decline and neuropsychiatric symptoms (NPS) can affect QoL in older adults. However, it remains unclear how these symptoms are related to each other and impact on QoL. Our aim is to investigate the complex network relationship between cognitive and NPS symptoms in older adults, and to further explore their association with QoL. METHODS A cross-sectional study was conducted in a sample of 389 older individuals with complaints of memory decline. The instruments included the Neuropsychiatric Inventory, the Mini Mental State Examination, and the 36-item Short Form Health Survey. Data was analyzed using network analysis and mediation analysis. RESULTS We found that attention and agitation were the variables with the highest centrality in cognitive and NPS symptoms, respectively. In an exploratory mediation analysis, agitation was significantly associated with poor attention (β = -0.214, P < 0.001) and reduced QoL (β = -0.137, P = 0.005). The indirect effect of agitation on the QoL through attention was significant (95% confidence interval (CI) [-0.119, -0.035]). Furthermore, attention served as a mediator between agitation and QoL, accounting for 35.09% of the total effect. CONCLUSIONS By elucidating the NPS-cognition-QoL relationship, the current study provides insights for developing rehabilitation programs among older adults to ensure their QoL.
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Affiliation(s)
- Chaoqun He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China
- Division of Medical Psychology and Behaviour Science, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Xiangyi Kong
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, 130031, China
| | - Jinhui Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China
- Division of Medical Psychology and Behaviour Science, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Xingyi Wang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, 130031, China
| | - Xinqiao Chen
- The First Bethune Hospital of Jilin University, Jilin University, Changchun, 130021, China
| | - Yuanyi Wang
- The First Hospital of Jilin University, Jilin University, Changchun, 130021, China
| | - Qing Zhao
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, 130031, China.
| | - Qian Tao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China.
- Division of Medical Psychology and Behaviour Science, School of Medicine, Jinan University, Guangzhou, 510632, China.
- Neuroscience and Neurorehabilitation Institute, University of Health and Rehabilitation Science, Qingdao, 266071, China.
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Kan CN, Huang X, Zhang L, Hilal S, Reilhac A, Tanaka T, Venketasubramanian N, Chen C, Xu X. Comorbid amyloid with cerebrovascular disease in domain-specific cognitive and neuropsychiatric disturbances: a cross-sectional memory clinic study. Neurobiol Aging 2023; 132:47-55. [PMID: 37729769 DOI: 10.1016/j.neurobiolaging.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023]
Abstract
Dementia is a multifactorial disorder that is likely influenced by both Alzheimer's disease (AD) and vascular pathologies. We evaluated domain-specific cognitive and neuropsychiatric dysfunction using a two-neuroimaging biomarker construct (beta-amyloid [Aβ] and cerebrovascular disease [CeVD]). We analyzed data from 216 memory clinic participants (mean age = 75.9 ± 6.9; 56.5% female) with neuropsychological and neuropsychiatric assessments, 3T-MRI, and Aβ-PET imaging. Structural equation modeling showed that the largest Aβ (A+) effect was on memory (B = -1.50) and apathy (B = 0.26), whereas CeVD effects were largest on language (B = -1.62) and hyperactivity (B = 0.32). Group comparisons showed that the A+C+ group had greater memory impairment (B = -1.55), hyperactivity (B = 0.79), and apathy (B = 0.74) compared to A-C+; and greater language impairment (B = -1.26) compared to A+C-. These potentially additive effects of Aβ and CeVD burden underline the importance of early detection and treatment of Aβ alongside optimal control of vascular risk factors as a potential strategy in preventing cognitive and neurobehavioral impairment.
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Affiliation(s)
- Cheuk Ni Kan
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xuhua Huang
- School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Liwen Zhang
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Anthonin Reilhac
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Xu
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.
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Amrapala A, Sabé M, Solmi M, Maes M. Neuropsychiatric disturbances in mild cognitive impairment: A scientometric analysis. Ageing Res Rev 2023; 92:102129. [PMID: 37981054 DOI: 10.1016/j.arr.2023.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) have been extensively studied in dementia than its prodromal stage, known as mild cognitive impairment (MCI). A scientometric study on BPSD in MCI would be valuable in synthesizing the existing body of research and providing insights into the trends, networks, and influencers within this area. We searched for related literature in the Web of Science database and extracted complete text and citation records of each publication. The primary objective was to map the research evolution of BPSD in MCI and highlight dominant research themes. The secondary objective was to identify research network characteristics (authors, journals, countries, and institutions) and abundances. A total of 12,369 studies published between 1980 and 2022 were included in the analysis. We found 51 distinct clusters from the co-cited reference network that were highly credible with significant modularity (Q = 0.856) and silhouette scores (S = 0.932). Five major research domains were identified: symptoms, diagnosis, brain substrates, biochemical pathways, and interventions. In recent years, the research focus in this area has been on gut microbiota, e-health, COVID-19, cognition, and delirium. Collectively, findings from this scientometric analysis can help clarify the scope and direction of future research and clinical practices.
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Affiliation(s)
- Arisara Amrapala
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Digital and AI for Mental Health, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
| | - Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv and Technological Center for Emergency Medicine, Plovdiv, Bulgaria; Kyung Hee University, Seoul, Republic of Korea; Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria; Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China.
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Zhou Y, Yao X, Han W, Li Y, Xue J, Li Z. Measurement of neuropsychiatric symptoms in the older adults with mild cognitive impairment based on speech and facial expressions: a cross-sectional observational study. Aging Ment Health 2023:1-10. [PMID: 37970813 DOI: 10.1080/13607863.2023.2280913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To examine the association between speech and facial features with depression, anxiety, and apathy in older adults with mild cognitive impairment (MCI). METHODS Speech and facial expressions of 319 MCI patients were digitally recorded via audio and video recording software. Three of the most common neuropsychiatric symptoms (NPS) were evaluated by the Public Health Questionnaire, General Anxiety Disorder, and Apathy Evaluation Scale, respectively. Speech and facial features were extracted using the open-source data analysis toolkits. Machine learning techniques were used to validate the diagnostic power of extracted features. RESULTS Different speech and facial features were associated with specific NPS. Depression was associated with spectral and temporal features, anxiety and apathy with frequency, energy, spectral, and temporal features. Additionally, depression was associated with facial features (action unit, AU) 10, 12, 15, 17, 25, anxiety with AU 10, 15, 17, 25, 26, 45, and apathy with AU 5, 26, 45. Significant differences in speech and facial features were observed between males and females. Based on machine learning models, the highest accuracy for detecting depression, anxiety, and apathy reached 95.8%, 96.1%, and 83.3% for males, and 87.8%, 88.2%, and 88.6% for females, respectively. CONCLUSION Depression, anxiety, and apathy were characterized by distinct speech and facial features. The machine learning model developed in this study demonstrated good classification in detecting depression, anxiety, and apathy. A combination of audio and video may provide objective methods for the precise classification of these symptoms.
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Affiliation(s)
- Ying Zhou
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Xiuyu Yao
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yingxin Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jiajun Xue
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Chejor P, Atee M, Cain P, Whiting D, Morris T, Porock D. Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service. BMC Geriatr 2023; 23:729. [PMID: 37950203 PMCID: PMC10636936 DOI: 10.1186/s12877-023-04447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs. METHODS This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively. RESULTS Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen's d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants. CONCLUSION This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.
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Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Mustafa Atee
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
- The Dementia Centre, HammondCare, Osborne Park, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
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Hung CC, Chao YP, Lee Y, Huang CW, Huang SH, Chang CC, Cheng CH. Cingulate white matter mediates the effects of fecal Ruminococcus on neuropsychiatric symptoms in patients with amyloid-positive amnestic mild cognitive impairment. BMC Geriatr 2023; 23:720. [PMID: 37936084 PMCID: PMC10631051 DOI: 10.1186/s12877-023-04417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Microbiota-gut-brain axis interacts with one another to regulate brain functions. However, whether the impacts of gut dysbiosis on limbic white matter (WM) tracts contribute to the neuropsychiatric symptoms (NPS) in patients with amyloid-positive amnestic mild cognitive impairment (aMCI+), have not been explored yet. This study aimed to investigate the mediation effects of limbic WM integrity on the association between gut microbiota and NPS in patients with aMCI+. METHODS Twenty patients with aMCI + and 20 healthy controls (HCs) were enrolled. All subjects underwent neuropsychological assessments and their microbial compositions were characterized using 16S rRNA Miseq sequencing technique. Amyloid deposition inspected by positron emission tomography imaging and limbic WM tracts (i.e., fornix, cingulum, and uncinate fasciculus) detected by diffusion tensor imaging were additionally measured in patients with aMCI+. We employed a regression-based mediation analysis using Hayes's PROCESS macro in this study. RESULTS The relative abundance of genera Ruminococcus and Lactococcus was significantly decreased in patients with aMCI + versus HCs. The relative abundance of Ruminococcus was negatively correlated with affective symptom cluster in the aMCI + group. Notably, this association was mediated by WM integrity of the left cingulate gyrus. CONCLUSIONS Our findings suggest Ruminococcus as a potential target for the management of affective impairments in patients with aMCI+.
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Affiliation(s)
- Chun-Che Hung
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, No. 259, Wenhua 1st Road, 333, Taoyuan, Taiwan
- Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Chi-Wei Huang
- Department of Neurology, Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung university College of Medicine, No. 123 Ta-Pei Rd., Niau-Sung Dist, 833, Kaohsiung, Taiwan
| | - Shu-Hua Huang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung university College of Medicine, No. 123 Ta-Pei Rd., Niau-Sung Dist, 833, Kaohsiung, Taiwan.
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, No. 259, Wenhua 1st Road, 333, Taoyuan, Taiwan.
- Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Therrien S, Turnbull A, Anthony M, Conwell Y, Lin FV. Influence of affective states on informant impression of neuropsychiatric symptoms in people living with MCI. Aging Ment Health 2023; 27:2128-2133. [PMID: 36995269 PMCID: PMC10544672 DOI: 10.1080/13607863.2023.2191928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
Objectives: Alzheimer's disease (AD) and mild cognitive impairment (MCI) are often accompanied by neuropsychiatric symptoms (NPS; e.g. depression/apathy/irritability) causing challenges for people living with dementia/caregivers and predicting worse disease progression. Accurately assessing NPS is critical to research on AD/MCI. However, there are limitations to both self-reports and clinician evaluations; the field often relies on informants to assess NPS. Informants' perception of NPS are influenced by disease and caregiver factors that may lead to biased assessments. We aimed to assess the relationship between participants self-reported affective states (valence/arousal) and informant-reported NPS.Methods: Data from a double-blinded intervention design (primarily testing neurostimulation's effect on NPS) were used to examine the relationship between participant-reported affective states and informant-reported NPS over 1 month. Forty participants (24 females) with MCI and NPS (mean age = 71.7, SD = 7) were enrolled along with informants (primarily spouses/partners) who regularly interact with participants. NPS assessment occurred weekly and at pre- and post-intervention, and participant-reported affective states were assessed at 14 timepoints.Results: Generalized Estimating Equations showed that participant levels of arousal, but not valence, were significantly related to corresponding informant-reported NPS at weekly (arousal: B= -0.59, SE = 0.27, Wald's χ2 = 4.61, p=.032; valence: B = 0.17, SE = 0.19, Wald's χ2 = 0.80, p=.37) and pre-/post- (arousal: B= -4.00, SE = 1.58, Wald's χ2 = 6.42, p=.011; valence: B= -3.34, SE = 1.80, Wald's χ2 = 3.43, p=.06) assessments.Conclusion: The findings indicate that informant-reported NPS may be more strongly influenced by arousal, and informants may be less attuned to valence in people living with MCI.
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Affiliation(s)
- Sarah Therrien
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
| | - Adam Turnbull
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
- Department of Brain and Cognitive Sciences, University of Rochester, NY 14627, USA
| | - Mia Anthony
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
- Department of Brain and Cognitive Sciences, University of Rochester, NY 14627, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester, NY 14627, USA
| | - Feng Vankee Lin
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
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Gillis K, van Diermen L, Lahaye H, De Witte M, De Wit Y, Roelant E, Lips D, Zhiri A, Hockley J, Van Bogaert P. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers' distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 2023; 14:1083-1096. [PMID: 37405630 DOI: 10.1007/s41999-023-00825-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD. METHODS A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8 weeks. In the time group, formal caregivers spent 'extra time'. In the standard care group, it was 'care as usual'. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers' distress. RESULTS Need-based interventions had a significant effect on residents' levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never). CONCLUSION Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers' distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia. TRIAL REGISTRY Trial registration number B300201942084 (18/11/2019).
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Affiliation(s)
- Katrin Gillis
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium.
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium.
| | - Linda van Diermen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Psychiatric Centre Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Hilde Lahaye
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
| | - Marianne De Witte
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Yentl De Wit
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Ella Roelant
- Center for Statistics, StatUa, University of Antwerp, Prinsstraat 13, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium
| | - Dirk Lips
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Abdesselam Zhiri
- R&D Department, Pranarôm International S.A. 37, Avenue des Artisans, 7822, Ghislenghien, Belgium
- Plant Biotechnology Research Unit, Université Libre de Bruxelles (ULB), Plant Biotechnology Research Unit, CP 300, Rue Prof. Jeener & Brachet 12, 6041, Gosselies, Belgium
| | - Jo Hockley
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium
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Cuoco S, Ponticorvo S, Abate F, Tepedino MF, Erro R, Manara R, Di Salle G, Di Salle F, Pellecchia MT, Esposito F, Barone P, Picillo M. Frequency and imaging correlates of neuropsychiatric symptoms in Progressive Supranuclear Palsy. J Neural Transm (Vienna) 2023; 130:1259-1267. [PMID: 37535119 PMCID: PMC10480260 DOI: 10.1007/s00702-023-02676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
Neuropsychiatric symptoms are intrinsic to Progressive Supranuclear Palsy (PSP) and a spoonful of studies investigated their imaging correlates. Describe (I) the frequency and severity of neuropsychiatric symptoms in PSP and (II) their structural imaging correlates. Twenty-six PSP patients underwent Neuropsychiatric Inventory (NPI) and brain 3D T1-weighted MRI. Spearman's rho with Bonferroni correction was used to investigate correlations between NPI scores and volumes of gray matter regions. More than 80% of patients presented at least one behavioral symptom of any severity. The most frequent and severe were depression/dysphoria, apathy, and irritability/lability. Significant relationships were found between the severity of irritability and right pars opercularis volume (p < 0.001) as well as between the frequency of agitation/aggression and left lateral occipital volume (p < 0.001). Depression, apathy, and irritability are the most common neuropsychiatric symptoms in PSP. Moreover, we found a relationship between specific positive symptoms as irritability and agitation/aggression and greater volume of the right pars opercularis cortex and lower volume of the left occipital cortex, respectively, which deserve further investigations.
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Affiliation(s)
- Sofia Cuoco
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Sara Ponticorvo
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, 2021 6th St. SE, Minneapolis, MN, 55455, USA
| | - Filomena Abate
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Maria Francesca Tepedino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Renzo Manara
- Department of Neurosciences, Neuroradiology Unit, University of Padua, 35128, Padua, Italy
| | - Gianfranco Di Salle
- Scuola Superiore Di Studi Universitari E Perfezionamento Sant'Anna, Classe Di Scienze Sperimentali, Pisa, Italy
| | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Marina Picillo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy.
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Ding S, Ling S, Liang L, Qiu W, Zhang H, Chen T, Zhan X, Xu F, Gu X, Han L. Late-onset cblC defect: clinical, biochemical and molecular analysis. Orphanet J Rare Dis 2023; 18:306. [PMID: 37770946 PMCID: PMC10536707 DOI: 10.1186/s13023-023-02890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND cblC defect is the most common type of methylmalonic acidemia in China. Patients with late-onset form (>1 year) are often misdiagnosed due to heterogeneous symptoms. This study aimed to describe clinical characteristics and evaluate long-term outcomes of Chinese patients with late-onset cblC defect. METHODS A total of 85 patients with late-onset cblC defect were enrolled. Clinical data, including manifestations, metabolites, molecular diagnosis, treatment and outcome, were summarized and analyzed. RESULTS The age of onset ranged from 2 to 32.8 years old (median age 8.6 years, mean age 9.4 years). The time between first symptoms and diagnosis ranged from a few days to 20 years (median time 2 months, mean time 20.7 months). Neuropsychiatric symptoms were presented as first symptoms in 68.2% of cases, which were observed frequently in schoolchildren or adolescents. Renal involvement and cardiovascular disease were observed in 20% and 8.2% of cases, respectively, which occurred with the highest prevalence in preschool children. Besides the initial symptoms, the disease progressed in most patients and cognitive decline became the most frequent symptom overall. The levels of propionylcarnitine, propionylcarnitine / acetylcarnitine ratio, methylmalonic acid, methylcitric acid and homocysteine, were decreased remarkably after treatment (P<0.001). Twenty-four different mutations of MMACHC were identified in 78 patients, two of which were novel. The c.482G>A variant was the most frequent mutated allele in this cohort (25%). Except for 16 patients who recovered completely, the remaining patients were still left with varying degrees of sequelae in a long-term follow-up. The available data from 76 cases were analyzed by univariate analysis and multivariate logistic regression analysis, and the results showed that the time from onset to diagnosis (OR = 1.025, P = 0. 024) was independent risk factors for poor outcomes. CONCLUSIONS The diagnosis of late-onset cblC defect is often delayed due to poor awareness of its various and nonspecific symptoms, thus having an adverse effect on the prognosis. It should be considered in patients with unexplained neuropsychiatric and other conditions such as renal involvement, cardiovascular diseases or even multiple organ damage. The c.482G>A variant shows the highest frequency in these patients. Prompt treatment appears to be beneficial.
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Affiliation(s)
- Si Ding
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Shiying Ling
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Lili Liang
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Wenjuan Qiu
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Huiwen Zhang
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Ting Chen
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Xia Zhan
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Feng Xu
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Xuefan Gu
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China
| | - Lianshu Han
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China.
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Helvik AS, Bergh S, Šaltytė Benth J, Borza T, Husebø B, Tevik K. Pain and quality of life in nursing home residents with dementia after admission - a longitudinal study. BMC Health Serv Res 2023; 23:1032. [PMID: 37759201 PMCID: PMC10537464 DOI: 10.1186/s12913-023-10041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Pain in nursing home (NH) residents with dementia is commonly reported and may affect Quality of Life (QoL) negatively. Few longitudinal studies have explored how pain and QoL develop in NH residents with dementia starting from their admission to the NH. AIM The aim was to explore pain, QoL, and the association between pain and QoL over time in persons with dementia admitted to a NH. METHODS A convenience sample, drawn from 68 non-profit NHs, included a total of 996 Norwegian NH residents with dementia (mean age 84.5 years, SD 7.6, 36.1% men) at NH admission (A1), with annual follow-ups for two years (A2 and A3). Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively, at all assessments. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the prescription of psychotropic drugs and analgesics (opioids and/or paracetamol) were also assessed at all assessments. RESULTS Mean (SD) MOBID-2 pain intensity scores were 2.1 (2.1), 2.2 (2.2), and 2.4 (2.1) at A1, A2, and A3, respectively. Participants who were prescribed analgesics had higher pain intensity scores at all assessments than participants not prescribed analgesics. The mean (SD) QUALID scores at each assessment were 19.8 (7.1), 20.8 (7.2), and 22.1 (7.5) at A1, A2, and A3, respectively. In the adjusted linear mixed model, higher pain intensity score, prescription of opioids, and prescription of paracetamol were associated with poorer QoL (higher QUALID total score and higher scores in the QoL dimensions of sadness and tension) when assessed simultaneously. No time trend in QoL was found in these adjusted analyses. CONCLUSION NH residents with dementia who have higher pain intensity scores or are prescribed analgesics are more likely to have poorer QoL. Clinicians, NH administrators, and national healthcare authorities need to look into strategies and actions for pharmacological and non-pharmacological pain treatment to reduce pain intensity while simultaneously avoiding negative side effects of pain treatment that hamper QoL.
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Affiliation(s)
- Anne-S Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, Box 8905, NO-7491 Trondheim.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Borza
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bettina Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Neuro-SysMed, University of Bergen, Bergen, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, Box 8905, NO-7491 Trondheim
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Cozza M, Boccardi V. A narrative review on mild behavioural impairment: an exploration into its scientific perspectives. Aging Clin Exp Res 2023; 35:1807-1821. [PMID: 37392350 DOI: 10.1007/s40520-023-02472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
In clinical practice, the admission of patients with late-onset psychological and behavioural symptoms is frequent, regardless of the presence or absence of cognitive decline. These symptoms commonly occur in the prodromal stage of dementia and can precede the onset of dementia. While the concept of Mild Cognitive Impairment (MCI) -which is defined as a level of cognitive impairment insufficient to impact daily functioning- is well established, the notion of Mild Behavioural Impairment (MBI) is not yet widely recognized. However, studies have demonstrated that the presence of MBI in both cognitively normal patients and individuals with MCI is associated with an increased risk of dementia progression. Thus, MBI may serve as a neurobehavioral indicator of pre-dementia risk states. This narrative review aims to discuss the evolution of the term, the relevant clinical aspects, and potential biomarkers that may contribute to the clinical definition of MBI. The objective is to assist clinicians in recognizing the diagnosis and differentiating it from psychiatric syndromes, as well as identifying possible etiologies of neurodegeneration.
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Affiliation(s)
- Mariagiovanna Cozza
- Department of Integration, Intermediate Care Programme, AUSL Bologna, Bologna, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Piazzale Gambuli 1, 06132, Perugia, Italy.
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Campagnolo M, Emmi A, Biundo R, Fiorenzato E, Batzu L, Chaudhuri KR, Antonini A. The pharmacological management of the behavioral aspects of Parkinson's disease: an update. Expert Opin Pharmacother 2023; 24:1693-1701. [PMID: 37493445 DOI: 10.1080/14656566.2023.2240228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Behavioural symptoms are common manifestations of Parkinson's disease and include depression, anxiety, impulse control disorders, hallucinations, psychosis, and cognitive dysfunction. They remain inadequately addressed in many patients despite their relevance for quality of life and disability. This applies also to impulse control disorders where the most common approach in recent literature is to refrain from using dopamine agonists without consideration about their potential benefit on motor complications. AREAS COVERED We conducted a narrative review searching for articles on behavioral symptoms in Parkinson disease and selected those which included involved neurotransmitters such as dopamine, noradrenaline, serotonin, acetylcholine. We specifically focused our search on open-label and randomized double-blind studies and biomarkers which could best characterize these clinical manifestations. EXPERT OPINION Management of Parkinson disease behavioural manifestations lacks clear guidelines and standardized protocols beside general suggestions of dose adjustments in dopamine replacement therapy and use of antidepressants or antipsychotic drugs with little consideration of patients' age, sex, comorbidities, and motor status. We suggest a pragmatic approach which includes education of affected patients and caring people, dealing with complex cases by experienced multidisciplinary teams, use of cognitive behavioural therapy, and psychological counselling to complement drug treatment.
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Affiliation(s)
- Marta Campagnolo
- Parkinson's Disease and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padova, Padova, Italy
- Center for Neurodegenerative Disease Research (CESNE), Department of Neuroscience, University of Padova, Padova, Italy
| | - Aron Emmi
- Center for Neurodegenerative Disease Research (CESNE), Department of Neuroscience, University of Padova, Padova, Italy
- Institute of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Roberta Biundo
- Parkinson's Disease and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padova, Padova, Italy
- Center for Neurodegenerative Disease Research (CESNE), Department of Neuroscience, University of Padova, Padova, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Eleonora Fiorenzato
- Parkinson's Disease and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padova, Padova, Italy
| | - Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padova, Padova, Italy
- Center for Neurodegenerative Disease Research (CESNE), Department of Neuroscience, University of Padova, Padova, Italy
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García-Martín V, de Hoyos-Alonso MC, Delgado-Puebla R, Ariza-Cardiel G, Del Cura-González I. Burden in caregivers of primary care patients with dementia: influence of neuropsychiatric symptoms according to disease stage (NeDEM project). BMC Geriatr 2023; 23:525. [PMID: 37644410 PMCID: PMC10463529 DOI: 10.1186/s12877-023-04234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present. OBJECTIVE Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage. METHODS A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis. RESULTS Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3). CONCLUSIONS The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.
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Affiliation(s)
- Victoria García-Martín
- Epidemiology and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Madrid, Spain.
| | - M Canto de Hoyos-Alonso
- Pedro Laín Entralgo Health Care Center, Primary Care Management, Madrid Health Service, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Rosalía Delgado-Puebla
- Primary Care Management, Horta Health Care Center, Catalonia Health Service, Barcelona, Catalonia, Spain
| | - Gloria Ariza-Cardiel
- Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain
| | - Isabel Del Cura-González
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Alcorcón, Madrid, Spain
- Ageing Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
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Ismail Z, Leon R, Creese B, Ballard C, Robert P, Smith EE. Optimizing detection of Alzheimer's disease in mild cognitive impairment: a 4-year biomarker study of mild behavioral impairment in ADNI and MEMENTO. Mol Neurodegener 2023; 18:50. [PMID: 37516848 PMCID: PMC10386685 DOI: 10.1186/s13024-023-00631-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/05/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Disease-modifying drug use necessitates better Alzheimer disease (AD) detection. Mild cognitive impairment (MCI) leverages cognitive decline to identify the risk group; similarly, mild behavioral impairment (MBI) leverages behavioral change. Adding MBI to MCI improves dementia prognostication over conventional approaches of incorporating neuropsychiatric symptoms (NPS). Here, to determine if adding MBI would better identify AD, we interrogated associations between MBI in MCI, and cerebrospinal fluid biomarkers [β-amyloid (Aβ), phosphorylated-tau (p-tau), and total-tau (tau)-ATN], cross-sectionally and longitudinally. METHODS Data were from two independent referral-based cohorts, ADNI (mean[SD] follow-up 3.14[1.07] years) and MEMENTO (4.25[1.40] years), collected 2003-2021. Exposure was based on three-group stratification: 1) NPS meeting MBI criteria; 2) conventionally measured NPS (NPSnotMBI); and 3) noNPS. Cohorts were analyzed separately for: 1) cross-sectional associations between NPS status and ATN biomarkers (linear regressions); 2) 4-year longitudinal repeated-measures associations of MBI and NPSnotMBI with ATN biomarkers (hierarchical linear mixed-effects models-LMEs); and 3) rates of incident dementia (Cox proportional hazards regressions). RESULTS Of 510 MCI participants, 352 were from ADNI (43.5% females; mean [SD] age, 71.68 [7.40] years), and 158 from MEMENTO (46.2% females; 68.98 [8.18] years). In ADNI, MBI was associated with lower Aβ42 (standardized β [95%CI], -5.52% [-10.48-(-0.29)%]; p = 0.039), and Aβ42/40 (p = 0.01); higher p-tau (9.67% [3.96-15.70%]; p = 0.001), t-tau (7.71% [2.70-12.97%]; p = 0.002), p-tau/Aβ42 (p < 0.001), and t-tau/Aβ42 (p = 0.001). NPSnotMBI was associated only with lower Aβ42/40 (p = 0.045). LMEs revealed a similar 4-year AD-specific biomarker profile for MBI, with NPSnotMBI associated only with higher t-tau. MBI had a greater rate of incident dementia (HR [95%CI], 3.50 [1.99-6.17; p < 0.001). NPSnotMBI did not differ from noNPS (HR 0.96 [0.49-1.89]; p = 0.916). In MEMENTO, MBI demonstrated a similar magnitude and direction of effect for all biomarkers, but with a greater reduction in Aβ40. HR for incident dementia was 3.93 (p = 0.004) in MBI, and 1.83 (p = 0.266) in NPSnotMBI. Of MBI progressors to dementia, 81% developed AD dementia. CONCLUSIONS These findings support a biological basis for NPS that meet MBI criteria, the continued inclusion of MBI in NIA-AA ATN clinical staging, and the utility of MBI criteria to improve identification of patients for enrollment in disease-modifying drug trials or for clinical care.
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Affiliation(s)
- Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK.
| | - Rebeca Leon
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK
| | - Clive Ballard
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK
| | | | - Eric E Smith
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Sabates J, Chiu WH, Loi S, Lampit A, Gavelin HM, Chong T, Launder N, Goh AMY, Brodtmann A, Lautenschlager N, Bahar-Fuchs A. The Associations Between Neuropsychiatric Symptoms and Cognition in People with Dementia: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09608-0. [PMID: 37477839 DOI: 10.1007/s11065-023-09608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
Most people with dementia experience neuropsychiatric symptoms (NPS), including anxiety, depression or disinhibition. There is growing interest in the relationship between NPS and cognitive impairment, but data is still limited. This study aimed to investigate the specific associations between NPS and cognition in people with dementia. MEDLINE, EMBASE and PsycINFO were searched for published, peer-reviewed studies of associations between at least one NPS and one cognitive ability in people with dementia. The quality of the studies was assessed with the NIH National Heart, Lung and Blood Institute's quality assessment tools. A meta-analysis was conducted using Robumeta package for R. Ninety studies were included. We found significant associations between NPS, global cognition and cognitive domains, e.g. apathy was associated with global cognitive and memory impairment; dysphoria was associated with worse attention; delusions with executive dysfunction. Increased NPS in people with dementia are associated with worse cognitive performance. There were few studies looking at associations between some neuropsychiatric clusters and cognitive abilities, and there was little research on causal relationships. Our review was limited by the inclusion of studies that reported associations in specific formats, and most included people with a diagnosis of Alzheimer's disease (AD). However, given the large number of studies, this is unlikely to have biased results. More research is needed that includes diverse people with different dementia syndromes. Registration: PROSPERO 2020 CRD42020165565.
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Affiliation(s)
- Julieta Sabates
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia.
| | - Wei-Hsuan Chiu
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
| | - Samantha Loi
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Royal Melbourne Hospital, Parkville, Australia
| | - Amit Lampit
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
| | - Hanna M Gavelin
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Department of Psychology, Umea University, Umea, Sweden
| | - Terence Chong
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Royal Melbourne Hospital, Parkville, Australia
- St Vincent's Hospital, Melbourne, Australia
| | - Nathalie Launder
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
| | - Anita M Y Goh
- National Ageing Research Institute &, The University of Melbourne, Parkville, Australia
| | - Amy Brodtmann
- Central Clinical School, Cognitive Health Initiative, Monash University, Melbourne, Australia
| | | | - Alex Bahar-Fuchs
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Deakin University, Melbourne, Australia
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Schulte PFJ. Can clozapine be used for treatment-refractory behavioral and psychological symptoms in dementia patients? Schizophr Res 2023:S0920-9964(23)00230-X. [PMID: 37479589 DOI: 10.1016/j.schres.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Peter F J Schulte
- Mental Health Services Noord-Holland-Noord, Alkmaar, the Netherlands.
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Zhao K, Xie H, Fonzo GA, Carlisle N, Osorio RS, Zhang Y. Defining Dementia Subtypes Through Neuropsychiatric Symptom-Linked Brain Connectivity Patterns. bioRxiv 2023:2023.07.02.547427. [PMID: 37461451 PMCID: PMC10349933 DOI: 10.1101/2023.07.02.547427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
BACKGROUND Dementia is highly heterogeneous, with pronounced individual differences in neuropsychiatric symptoms (NPS) and neuroimaging findings. Understanding the heterogeneity of NPS and associated brain abnormalities is essential for effective management and treatment of dementia. METHODS Using large-scale neuroimaging data from the Open Access Series of Imaging Studies (OASIS-3), we conducted a multivariate sparse canonical correlation analysis to identify functional connectivity-informed symptom dimensions. Subsequently, we performed a clustering analysis on the obtained latent connectivity profiles to reveal neurophysiological subtypes and examined differences in abnormal connectivity and phenotypic profiles between subtypes. RESULTS We identified two reliable neuropsychiatric subsyndromes - behavioral and anxiety in the connectivity-NPS linked latent space. The behavioral subsyndrome was characterized by the connections predominantly involving the default mode and somatomotor networks and neuropsychiatric symptoms involving nighttime behavior disturbance, agitation, and apathy. The anxiety subsyndrome was mainly contributed by connections involving the visual network and the anxiety neuropsychiatric symptom. By clustering individuals along these two subsyndromes-linked connectivity latent features, we uncovered three subtypes encompassing both dementia patients and healthy controls. Dementia in one subtype exhibited similar brain connectivity and cognitive-behavior patterns to healthy individuals. However, dementia in the other two subtypes showed different dysfunctional connectivity profiles involving the default mode, frontoparietal control, somatomotor, and ventral attention networks, compared to healthy individuals. These dysfunctional connectivity patterns were associated with differences in baseline dementia severity and longitudinal progression of cognitive impairment and behavioral dysfunction. CONCLUSIONS Our findings shed valuable insights into disentangling the neuropsychiatric and brain functional heterogeneity of dementia, offering a promising avenue to improve clinical management and facilitate the development of timely and targeted interventions for dementia patients.
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Affiliation(s)
- Kanhao Zhao
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
| | - Hua Xie
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Gregory A. Fonzo
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, TX, USA
| | - Nancy Carlisle
- Department of Psychology, Lehigh University, Bethlehem, PA, USA
| | - Ricardo S. Osorio
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Yu Zhang
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA, USA
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Ozzoude M, Varriano B, Beaton D, Ramirez J, Adamo S, Holmes MF, Scott CJM, Gao F, Sunderland KM, McLaughlin P, Goubran M, Kwan D, Roberts A, Bartha R, Symons S, Tan B, Swartz RH, Abrahao A, Saposnik G, Masellis M, Lang AE, Marras C, Zinman L, Shoesmith C, Borrie M, Fischer CE, Frank A, Freedman M, Montero-Odasso M, Kumar S, Pasternak S, Strother SC, Pollock BG, Rajji TK, Seitz D, Tang-Wai DF, Turnbull J, Dowlatshahi D, Hassan A, Casaubon L, Mandzia J, Sahlas D, Breen DP, Grimes D, Jog M, Steeves TDL, Arnott SR, Black SE, Finger E, Rabin J, Tartaglia MC. White matter hyperintensities and smaller cortical thickness are associated with neuropsychiatric symptoms in neurodegenerative and cerebrovascular diseases. Alzheimers Res Ther 2023; 15:114. [PMID: 37340319 PMCID: PMC10280981 DOI: 10.1186/s13195-023-01257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are a core feature of most neurodegenerative and cerebrovascular diseases. White matter hyperintensities and brain atrophy have been implicated in NPS. We aimed to investigate the relative contribution of white matter hyperintensities and cortical thickness to NPS in participants across neurodegenerative and cerebrovascular diseases. METHODS Five hundred thirteen participants with one of these conditions, i.e. Alzheimer's Disease/Mild Cognitive Impairment, Amyotrophic Lateral Sclerosis, Frontotemporal Dementia, Parkinson's Disease, or Cerebrovascular Disease, were included in the study. NPS were assessed using the Neuropsychiatric Inventory - Questionnaire and grouped into hyperactivity, psychotic, affective, and apathy subsyndromes. White matter hyperintensities were quantified using a semi-automatic segmentation technique and FreeSurfer cortical thickness was used to measure regional grey matter loss. RESULTS Although NPS were frequent across the five disease groups, participants with frontotemporal dementia had the highest frequency of hyperactivity, apathy, and affective subsyndromes compared to other groups, whilst psychotic subsyndrome was high in both frontotemporal dementia and Parkinson's disease. Results from univariate and multivariate results showed that various predictors were associated with neuropsychiatric subsyndromes, especially cortical thickness in the inferior frontal, cingulate, and insula regions, sex(female), global cognition, and basal ganglia-thalamus white matter hyperintensities. CONCLUSIONS In participants with neurodegenerative and cerebrovascular diseases, our results suggest that smaller cortical thickness and white matter hyperintensity burden in several cortical-subcortical structures may contribute to the development of NPS. Further studies investigating the mechanisms that determine the progression of NPS in various neurodegenerative and cerebrovascular diseases are needed.
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Affiliation(s)
- Miracle Ozzoude
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Brenda Varriano
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Derek Beaton
- Data Science & Advanced Analytic, St. Michael's Hospital, Toronto, ON, Canada
| | - Joel Ramirez
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Sabrina Adamo
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Melissa F Holmes
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher J M Scott
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Maged Goubran
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Robert Bartha
- Robarts Research Institute, Western University, London, ON, Canada
| | - Sean Symons
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Richard H Swartz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mario Masellis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Connie Marras
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lorne Zinman
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Michael Borrie
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Corinne E Fischer
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew Frank
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Morris Freedman
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Manuel Montero-Odasso
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Lawsone Health Research Institute, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, London, ON, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen Pasternak
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stephen C Strother
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Dallas Seitz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David F Tang-Wai
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - John Turnbull
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Leanne Casaubon
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Healthcare Centre, London, ON, Canada
| | - Demetrios Sahlas
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - David Grimes
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Thomas D L Steeves
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stephen R Arnott
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Rabin
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada.
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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Kirlioglu Balcioglu SS, Zorgor Dindar G, Guclu O, Karabulut N, Ozturk N. A rare clinical presentation after COVID-19: Manic episode with psychotic features. Psychiatry Res Case Rep 2023; 2:100115. [PMID: 37155433 PMCID: PMC10113594 DOI: 10.1016/j.psycr.2023.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
Neuropsychiatric manifestations of the COVID-19, caused by SARS-CoV-2, are under close scrutiny as the virus is shown likely to either directly or indirectly affects the central nervous system although it mainly targets the respiratory tract. Here, we describe a middle-aged male who developed acute psychiatric symptoms after a recent COVID-19 infection with no prior personal or family history of psychiatric disorder. Although there are reported cases of diagnosed psychosis or affective disorders following COVID-19 infection in the literature, to our knowledge, this is the first case where the development of autoimmune encephalitis after COVID-19 was considered and ruled out. This case report describes the comprehensive evaluation of all possible organic etiology. We also aimed to discuss possible biological underpinnings of such an exceptional comorbidity.
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Affiliation(s)
| | - Gulsah Zorgor Dindar
- Department of Neurology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Oya Guclu
- Department of Psychiatry, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nuran Karabulut
- Department of Medical Virology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nalan Ozturk
- Department of Psychiatry, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Eikelboom WS, Singleton EH, van den Berg E, de Boer C, Coesmans M, Goudzwaard JA, Vijverberg EGB, Pan M, Gouw C, Mol MO, Gillissen F, Fieldhouse JLP, Pijnenburg YAL, van der Flier WM, van Swieten JC, Ossenkoppele R, Kors JA, Papma JM. The reporting of neuropsychiatric symptoms in electronic health records of individuals with Alzheimer's disease: a natural language processing study. Alzheimers Res Ther 2023; 15:94. [PMID: 37173801 PMCID: PMC10176879 DOI: 10.1186/s13195-023-01240-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are prevalent in the early clinical stages of Alzheimer's disease (AD) according to proxy-based instruments. Little is known about which NPS clinicians report and whether their judgment aligns with proxy-based instruments. We used natural language processing (NLP) to classify NPS in electronic health records (EHRs) to estimate the reporting of NPS in symptomatic AD at the memory clinic according to clinicians. Next, we compared NPS as reported in EHRs and NPS reported by caregivers on the Neuropsychiatric Inventory (NPI). METHODS Two academic memory clinic cohorts were used: the Amsterdam UMC (n = 3001) and the Erasmus MC (n = 646). Patients included in these cohorts had MCI, AD dementia, or mixed AD/VaD dementia. Ten trained clinicians annotated 13 types of NPS in a randomly selected training set of n = 500 EHRs from the Amsterdam UMC cohort and in a test set of n = 250 EHRs from the Erasmus MC cohort. For each NPS, a generalized linear classifier was trained and internally and externally validated. Prevalence estimates of NPS were adjusted for the imperfect sensitivity and specificity of each classifier. Intra-individual comparison of the NPS classified in EHRs and NPS reported on the NPI were conducted in a subsample (59%). RESULTS Internal validation performance of the classifiers was excellent (AUC range: 0.81-0.91), but external validation performance decreased (AUC range: 0.51-0.93). NPS were prevalent in EHRs from the Amsterdam UMC, especially apathy (adjusted prevalence = 69.4%), anxiety (adjusted prevalence = 53.7%), aberrant motor behavior (adjusted prevalence = 47.5%), irritability (adjusted prevalence = 42.6%), and depression (adjusted prevalence = 38.5%). The ranking of NPS was similar for EHRs from the Erasmus MC, although not all classifiers obtained valid prevalence estimates due to low specificity. In both cohorts, there was minimal agreement between NPS classified in the EHRs and NPS reported on the NPI (all kappa coefficients < 0.28), with substantially more reports of NPS in EHRs than on NPI assessments. CONCLUSIONS NLP classifiers performed well in detecting a wide range of NPS in EHRs of patients with symptomatic AD visiting the memory clinic and showed that clinicians frequently reported NPS in these EHRs. Clinicians generally reported more NPS in EHRs than caregivers reported on the NPI.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Ellen H Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Casper de Boer
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Department of Internal Medicine, Section of Geriatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Everard G B Vijverberg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michel Pan
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Cornalijn Gouw
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Merel O Mol
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Freek Gillissen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jay L P Fieldhouse
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
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Simona K, Veronika M, Zahinoor I, Martin V. Neuropsychiatric symptoms in spinocerebellar ataxias and Friedreich ataxia. Neurosci Biobehav Rev 2023; 150:105205. [PMID: 37137435 DOI: 10.1016/j.neubiorev.2023.105205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/14/2023] [Accepted: 04/29/2023] [Indexed: 05/05/2023]
Abstract
Apart from its role in motor coordination, the importance of the cerebellum in cognitive and affective processes has been recognized in the past few decades. Spinocerebellar ataxias (SCA) and Friedreich ataxia (FRDA) are rare neurodegenerative diseases of the cerebellum presenting mainly with a progressive loss of gait and limb coordination, dysarthria, and other motor disturbances, but also a range of cognitive and neuropsychiatric symptoms. This narrative review summarizes the current knowledge on neuropsychiatric impairment in SCA and FRDA. We discuss the prevalence, clinical features and treatment approaches in the most commonly reported domains of depression, anxiety, apathy, agitation and impulse dyscontrol, and psychosis. Since these symptoms have a considerable impact on patients' quality of life, we argue that further research is mandated to improve the detection and treatment options of neuropsychiatric co-morbidities in ataxia patients.
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Affiliation(s)
- Karamazovova Simona
- Center of Hereditary Ataxias, Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic
| | - Matuskova Veronika
- Center of Hereditary Ataxias, Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic.
| | - Ismail Zahinoor
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Cumming School of Medicine; Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Vyhnalek Martin
- Center of Hereditary Ataxias, Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic
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Mastrorosa I, Del Duca G, Pinnetti C, Lorenzini P, Vergori A, Brita AC, Camici M, Mazzotta V, Baldini F, Chinello P, Mencarini P, Giancola ML, Abdeddaim A, Girardi E, Vaia F, Antinori A. What is the impact of post-COVID-19 syndrome on health-related quality of life and associated factors: a cross-sectional analysis. Health Qual Life Outcomes 2023; 21:28. [PMID: 36949439 PMCID: PMC10031164 DOI: 10.1186/s12955-023-02107-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND After the acute phase, symptoms or sequelae related to post-COVID-19 syndrome may persist for months. In a population of patients, previously hospitalized and not, followed up to 12 months after the acute infection, we aim to assess whether and to what extent post-COVID-19 syndrome may have an impact on health-related quality of life (HRQoL) and to investigate influencing factors. METHODS We present the cross-sectional analysis of a prospective study, including patients referred to the post-COVID-19 service. Questionnaires and scales administered at 3, 6, 12 months were: Short-Form 36-item questionnaire (SF-36); Visual Analogue Scale of the EQ5D (EQ-VAS); in a subgroup, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II) and Pittsburgh Sleep Quality Index (PSQI). Linear regression models were fitted to identify factors associated with HRQoL. RESULTS We considered the first assessment of each participant (n = 572). The mean scores in SF-36 and in EQ-VAS were significantly lower than the Italian normative values and remained stable over time, except the mental components score (MCS) of the SF-36 and EQ-VAS which resulted in lower ratings at the last observations. Female gender, presence of comorbidities, and corticosteroids treatment during acute COVID-19, were associated with lower scores in SF-36 and EQ-VAS; patients previously hospitalized (54%) reported higher MCS. Alterations in BAI, BDI-II, and PSQI (n = 265)were associated with lower ratings in SF-36 and EQ-VAS. CONCLUSIONS This study provides evidence of a significantly bad perception of health status among persons with post-COVID-19 syndrome, associated with female gender and, indirectly, with disease severity. In case of anxious-depressive symptoms and sleep disorders, a worse HRQoL was also reported. A systematic monitoring of these aspects is recommended to properly manage the post-COVID-19 period.
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Affiliation(s)
- Ilaria Mastrorosa
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Giulia Del Duca
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Alessandra Vergori
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Anna Clelia Brita
- Psychology Service, Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Baldini
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierangelo Chinello
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Mencarini
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Letizia Giancola
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Amina Abdeddaim
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Mehak SF, Shivakumar AB, Saraf V, Johansson M, Gangadharan G. Apathy in Alzheimer's disease: A neurocircuitry based perspective. Ageing Res Rev 2023; 87:101891. [PMID: 36871779 DOI: 10.1016/j.arr.2023.101891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In addition to memory deficits and other cognitive disturbances, patients with Alzheimer's disease (AD) experience neuropsychiatric symptoms, notably apathy, which is a state of impaired motivation observed by deficits in goal directed behavior. Apathy is a multifaceted neuropsychiatric condition and appears to be a prognostic indicator, correlating with the progression of AD. Strikingly, recent studies point out that the neurodegenerative pathology of AD may drive apathy independent of cognitive decline. These studies also highlight that neuropsychiatric symptoms, in particular apathy, might manifest early in AD. Here, we review the current understanding of the neurobiological underpinnings of apathy as a neuropsychiatric symptom of AD. Specifically, we highlight the neural circuits and brain regions recognized to be correlated with the apathetic symptomatology. We also discuss the current evidence that supports the notion that apathy and cognitive deficits may develop as independent but concurrent phenomena driven by AD pathology, suggesting its efficacy as an additional outcome measure in Alzheimer's disease clinical trials. The current and prospective therapeutic interventions for apathy in AD from a neurocircuitry based perspective are also reviewed.
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Affiliation(s)
- Sonam Fathima Mehak
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Apoorva Bettagere Shivakumar
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Vikyath Saraf
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, SUS, Sweden; Division of Clinical Sciences, Helsingborg, Department of Clinical Sciences Lund, Lund University, Sweden; Department of Psychiatry, Helsingborg Hospital, Sweden.
| | - Gireesh Gangadharan
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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Hsieh CJ, Li PS, Wang CH, Lin SL, Hsu TC, Tsai CM. Socially Assistive Robots for People Living with Dementia in Long-Term Facilities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gerontology 2023; 69:1027-1042. [PMID: 36871553 PMCID: PMC10407835 DOI: 10.1159/000529849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The purpose of our study was to explore the immediate and long-term effects of socially assistive robots (SARs) on neuropsychiatric symptoms (NPSs), behavioral and psychological symptoms of dementia (BPSD), positive emotional experiences, and social interaction in older people living with dementia. METHODS We set keywords and used Boolean operators to search the CINAHL, Cochrane Library, EMBASE, IEEE Digital Library, MEDLINE, PsycINFO, PubMed, Web of Science, Scopus, and Chinese Electronic Periodical Service from inception to February 2022 for randomized controlled trials. The Cochrane Collaboration bias assessment tool was used to assess article quality, and RevMan 5.4.1 software was used to conduct the meta-analysis. RESULTS A total of 14 studies were included in the meta-analysis. SARs can help people living with dementia reduce their NPS of depression and anxiety, provide happiness from positive emotional experiences, and improve their social interaction through conversation. However, there was no significant improvement in agitation behavior, overall BPSD, or quality of life in people living with dementia. In follow-up, it was found that the effect of SRT was limited. CONCLUSION SARs can reduce depression and increase positive emotions in people living with dementia. They may also reduce the burden on healthcare workers during the COVID-19 pandemic. This research was registered on PROSPERO CRD42020169340.
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Affiliation(s)
- Chia-Jung Hsieh
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pei-Shan Li
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hui Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Ling Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Chi Hsu
- Department of Computer Science and Information Engineering, National Ilan University, Ilan, Taiwan
| | - Chia-Mei Tsai
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- School of Nursing, Department of Nursing, Fooyin University, Kaohsiung, Taiwan
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Jiskoot LC, Russell LL, Greaves CV, van Schaik E, van den Berg E, Poos JM, de Boer L, Donker Kaat L, Seelaar H, Pijnenburg YAL, van Swieten JC, Rohrer JD. Addition of the FTD Module to the Neuropsychiatric Inventory improves classification of frontotemporal dementia spectrum disorders. J Neurol 2023. [PMID: 36811680 DOI: 10.1007/s00415-023-11596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
Most neuropsychiatric symptoms (NPS) common in frontotemporal dementia (FTD) are currently not part of the Neuropsychiatric Inventory (NPI). We piloted an FTD Module that included eight extra items to be used in conjunction with the NPI. Caregivers of patients with behavioural variant FTD (n = 49), primary progressive aphasia (PPA; n = 52), Alzheimer's dementia (AD; n = 41), psychiatric disorders (n = 18), presymptomatic mutation carriers (n = 58) and controls (n = 58) completed the NPI and FTD Module. We investigated (concurrent and construct) validity, factor structure and internal consistency of the NPI and FTD Module. We performed group comparisons on item prevalence, mean item and total NPI and NPI with FTD Module scores, and multinomial logistic regression to determine its classification abilities. We extracted four components, together explaining 64.1% of the total variance, of which the largest indicated the underlying dimension 'frontal-behavioural symptoms'. Whilst apathy (original NPI) occurred most frequently in AD, logopenic and non-fluent variant PPA, the most common NPS in behavioural variant FTD and semantic variant PPA were loss of sympathy/empathy and poor response to social/emotional cues (part of FTD Module). Patients with primary psychiatric disorders and behavioural variant FTD showed the most severe behavioural problems on both the NPI as well as the NPI with FTD Module. The NPI with FTD Module correctly classified more FTD patients than the NPI alone. By quantifying common NPS in FTD the NPI with FTD Module has large diagnostic potential. Future studies should investigate whether it can also prove a useful addition to the NPI in therapeutic trials.
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Burley CV, Casey AN, Chenoweth L, Brodaty H. Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes. Int Psychogeriatr 2023; 35:77-93. [PMID: 36330686 DOI: 10.1017/S1041610222000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study investigated the views of people living with dementia and their families/care partners on (i) what they find helpful or unhelpful regarding behavioral changes, i.e. which coping strategies they used for themselves and/or which responses from others, and (ii) what they consider to be appropriate terminology to describe behavioral changes. DESIGN & SETTING One-on-one semi-structured interviews were conducted with people living with dementia and families/care partners face to face, online, or over the telephone. MEASUREMENTS Data from open-ended questions were analyzed inductively. Common themes were derived from the data using an iterative approach. RESULTS Twenty-one people living with dementia and 20 family members/care partners were interviewed. Four main themes were derived for helpful responses, and three main themes for unhelpful responses. Helpful responses included providing clear professional support pathways and supportive environments where people living with dementia can engage in physical, cognitive, social, and spiritual activities. Unhelpful responses included discriminatory treatment from others and use of medicalized terminology. Views toward terminology varied; people with lived experience most favored using "changed behaviors" over other terminology. Areas for improvement included targeting dementia stigma, societal education on dementia, and building confidence in people living with dementia by focusing on living well with dementia. CONCLUSION Knowledge of the views of people living with dementia may assist healthcare professionals to provide more appropriate care for people living with dementia.
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Abstract
OBJECTIVE Huntington's disease (HD) is an autosomal-dominant neurodegenerative disease resulting in motor disturbances, dementia, and psychiatric symptoms. Apathy is a common manifestation and rated as one of the most impactful by patients and caregivers. It can often be difficult to distinguish from depression because of shared features and frequent overlap. This study examined the longitudinal trajectories and clinical correlates of apathy and depression. METHODS Data were drawn from the Cooperative Huntington Observational Research Trial, a prospective, multicenter observational study that recruited 1,082 patients with HD. Measures of cognition, function, neuropsychiatric symptoms, motor function, and medication use were completed annually over 5 years. RESULTS Overall, 423 patients (39%) showed evidence of apathy at study baseline, and both the prevalence and overall severity of apathy increased over time. Depression, by contrast, affected a similar proportion at baseline, although levels remained relatively stable over the study. Apathy was associated with worse cognition, function, neuropsychiatric symptoms, and motor symptoms. Depression was associated with worse neuropsychiatric symptoms, suicidal ideation, and independence but not other outcomes after control for other variables. CONCLUSIONS Apathy in HD increased over time and was associated with worse clinical outcomes. These associations were independent of depression and other clinical variables. The findings highlight the need to distinguish between apathy and depression given their distinct implications for prognosis and management.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Connors); Sydney School of Public Health, University of Sydney (Teixeira-Pinto, Loy); Brain and Mind Centre, University of Sydney, and The Garvan Institute of Medical Research, Sydney, Australia, and Huntington Disease Service, Westmead Hospital, Westmead, Australia (Loy)
| | - Armando Teixeira-Pinto
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Connors); Sydney School of Public Health, University of Sydney (Teixeira-Pinto, Loy); Brain and Mind Centre, University of Sydney, and The Garvan Institute of Medical Research, Sydney, Australia, and Huntington Disease Service, Westmead Hospital, Westmead, Australia (Loy)
| | - Clement T Loy
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Connors); Sydney School of Public Health, University of Sydney (Teixeira-Pinto, Loy); Brain and Mind Centre, University of Sydney, and The Garvan Institute of Medical Research, Sydney, Australia, and Huntington Disease Service, Westmead Hospital, Westmead, Australia (Loy)
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Saari TT. Empirical and Authoritative Classification of Neuropsychiatric Syndromes in Neurocognitive Disorders. J Neuropsychiatry Clin Neurosci 2023; 35:39-47. [PMID: 35872615 DOI: 10.1176/appi.neuropsych.21100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Neuropsychiatric symptoms of neurocognitive disorders have been classified into higher-order constructs, often called neuropsychiatric syndromes. As with the general psychopathology literature, these classifications have been achieved through two approaches: empirical and authoritative. The authoritative approach relies on expert panels that condense the available evidence into operational criteria, whereas the empirical approach uses statistical methods to discover symptom patterns and possible hierarchies formed by them. In this article, the author reviews the strengths and weaknesses of both approaches using general psychopathology literature as a reference point. The authoritative approach, influenced by the DSM, has led to several sets of criteria, which could aid clinical trials, diagnostics, and communication. However, unknown reliability and the complex relationships between empirical evidence and published criteria may limit the utility of current criteria. The empirical approach has been used to explore syndrome structures on the basis of rating scales for neuropsychiatric symptoms. The structures suggested in these studies have not been replicated easily and have been limited by either small sample sizes, restricted breadth of neuropsychiatric assessment, or both. Suggestions for further development of both approaches are offered. First, neuropsychiatric symptoms and syndromes need to be studied with measures of broad scope and in large samples. These requirements are prerequisites not only for eliciting highly informative empirical classifications but also for understanding these symptoms at a more nuanced level. Second, both approaches could benefit from more transparency. Finally, the reliability of the available authoritative criteria should be examined.
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Affiliation(s)
- Toni Tapani Saari
- Department of Neurology, University of Eastern Finland, Kuopio, and NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
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Fisher DW, Dunn JT, Keszycki R, Rodriguez G, Bennett DA, Wilson RS, Dong H. Unique Transcriptional Signatures Correlate with Behavioral and Psychological Symptom Domains in Alzheimer's Disease. Res Sq 2023:rs.3.rs-2444391. [PMID: 36711772 PMCID: PMC9882691 DOI: 10.21203/rs.3.rs-2444391/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite the significant burden, cost, and worse prognosis of Alzheimer's disease (AD) with behavioral and psychological symptoms of dementia (BPSD), little is known about the molecular causes of these symptoms. Using antemortem assessments of BPSD in AD, we demonstrate that individual BPSD can be grouped into 4 domain factors in our sample: affective, apathy, agitation, and psychosis. Then, we performed a transcriptome-wide analysis for each domain utilizing bulk RNA-seq of post-mortem anterior cingulate cortex (ACC) tissue. Though all 4 domains are associated with a predominantly downregulated pattern of hundreds of differentially expressed genes (DEGs), most DEGs are unique to each domain, with only 22 DEGs being common to all BPSD domains, including TIMP1. Weighted gene co-expression network analysis (WGCNA) yielded multiple transcriptional modules that were shared between BPSD domains or unique to each domain, and NetDecoder was used to analyze context-dependent information flow through the biological network. For the agitation domain, we found that all DEGs and a highly correlated transcriptional module were functionally enriched for ECM-related genes including TIMP1, TAGLN, and FLNA. Another unique transcriptional module also associated with the agitation domain was enriched with genes involved in post-synaptic signaling, including DRD1, PDE1B, CAMK4, and GABRA4. By comparing context-dependent changes in DEGs between cases and control networks, ESR1 and PARK2 were implicated as two high impact genes associated with agitation that mediated significant information flow through the biological network. Overall, our work establishes unique targets for future study of the biological mechanisms of BPSD and resultant drug development.
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Affiliation(s)
- Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine
| | - Jeffrey T. Dunn
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
| | - Rachel Keszycki
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
- Mesulam Center for Cognitive Neurology and
Alzheimer’s Disease, Northwestern University Feinberg School of
Medicine
| | - Guadalupe Rodriguez
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
| | | | | | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
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