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Sakib MN, Saragadam A, Santagata MC, Jolicoeur-Becotte M, Kozyr L, Burhan AM, Hall PA. rTMS for post-covid-19 condition: A sham-controlled case series involving iTBS-300 and iTBS-600. Brain Behav Immun Health 2024; 36:100736. [PMID: 38371381 PMCID: PMC10869745 DOI: 10.1016/j.bbih.2024.100736] [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: 10/06/2023] [Revised: 01/03/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024] Open
Abstract
Post-Covid-19 Condition (PCC) is a syndrome comprised of symptoms persisting 3 months or more beyond SARS-CoV-2 primary infection. It is typically characterized by fatigue, cognitive problems and psychiatric symptoms, as well as cardiac symptoms that contribute to exercise intolerance in many. Despite the high prevalence of PCC among those with a prior SARS-CoV-2 infection, there is currently no widely accepted rehabilitation strategy, and many conventional modalities are movement-based. Non-invasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) may have some potential to alleviate the cognitive and affective symptoms of PCC without reliance on exercise. The purpose of the present study was to explore the feasibility and tolerability of using rTMS to treat symptoms of "brain fog" and affective disturbance among those living with PCC, using a case series design. We enrolled four individuals with PCC following a confirmed SARS-CoV-2 infection, at least 3 months after the resolution of the primary infection. Participants were randomized to 4 sessions of active and 2 sessions of sham intermittent theta-burst stimulation (iTBS); two intensities of iTBS were evaluated: iTBS-300 and iTBS-600. No adverse events occurred in active or sham stimulation; 2 participants reported tingling sensation on the scalp but no other tolerability issues. Trends in symptoms suggested improvements in cognitive interference, quality of life, and anxiety in the majority of participants. In summary, in this case series iTBS was well tolerated among 4 individuals with PCC; active stimulation was associated with positive trends in some primary symptom clusters as compared with sham stimulation. Future studies should examine the effects of iTBS on PCC symptoms in the context of experimental studies and randomized controlled trials.
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Affiliation(s)
- Mohammad Nazmus Sakib
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Ashish Saragadam
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Mariella C. Santagata
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Marie Jolicoeur-Becotte
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Lena Kozyr
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Peter A. Hall
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Ontario, Canada
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Burhan AM. Editorial: Impact of apathy on aging and age-related neuropsychiatric disorders. Front Psychiatry 2023; 14:1341182. [PMID: 38152356 PMCID: PMC10751326 DOI: 10.3389/fpsyt.2023.1341182] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Lai KSP, Waxman R, Blumberger DM, Giacobbe P, Hasey G, McMurray L, Milev R, Palaniyappan L, Ramasubbu R, Rybak YE, Sacevich T, Vila-Rodriguez F, Burhan AM. Competencies for Repetitive Transcranial Magnetic Stimulation in Postgraduate Medical Education: Expert Consensus Using a Modified Delphi Process. Can J Psychiatry 2023; 68:916-924. [PMID: 36959745 PMCID: PMC10657584 DOI: 10.1177/07067437231164571] [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] [Indexed: 03/25/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery. OBJECTIVE The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes. METHODS A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process. RESULTS Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement. CONCLUSIONS This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.
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Affiliation(s)
- Ka Sing Paris Lai
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Waxman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Hasey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lisa McMurray
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | | | | | - Yuri E. Rybak
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Tegan Sacevich
- Clinical Sciences Division, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M. Burhan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
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Espiritu AI, Hara T, Tolledo JK, Blair M, Burhan AM. Repetitive transcranial magnetic stimulation for apathy in patients with neurodegenerative conditions, cognitive impairment, stroke, and traumatic brain injury: a systematic review. Front Psychiatry 2023; 14:1259481. [PMID: 38034914 PMCID: PMC10684725 DOI: 10.3389/fpsyt.2023.1259481] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background We aimed to determine the effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) on apathy in patients with neurodegenerative conditions, mild cognitive impairment (MCI), stroke, and traumatic brain injury (TBI) via systematic review. Methods We conducted a systematic search in major electronic health databases, including PubMed, Scopus, and PsycINFO, covering the period from inception to June 2023. Comparative clinical trials and cohort studies, and studies with before-after designs were considered for inclusion. We used the Cochrane Risk of Bias and the National Institutes of Health (NIH) tools to assess methodological quality. Results Out of 258 records identified, 14 studies met our eligibility criteria (11 randomized controlled trials (RCT) and 3 studies utilized before-and-after designs) with a total of 418 patients (overall female-to-male ratio 1:1.17) included in the review. The overall methodological quality of the included studies was assessed to be fair to good. The stimulation parameters used varied considerably across the studies. The summary findings of our review indicate the following observations on the effects of rTMS on apathy: (1) the results of all included studies in Alzheimer's disease investigating the effects of rTMS on apathy have consistently shown a positive impact on apathy; (2) the majority of studies conducted in Parkinson's disease have not found statistically significant results; (3) a single study (RCT) on patients with primary progressive aphasia demonstrated significant beneficial effects of rTMS on apathy; (4) the trials conducted on individuals with MCI yielded varying conclusions; (5) one study (RCT) in chronic stroke suggested that rTMS might have the potential to improve apathy; (6) one study conducted on individuals with mild TBI did not find a significant favorable association on apathy; and (7) the use of different rTMS protocols on the populations described is generally safe. Conclusion The feasibility of utilizing rTMS as a treatment for apathy has been suggested in this review. Overall, limited evidence suggests that rTMS intervention may have the potential to modify apathy among patients with AD, PPA, MCI and chronic stroke, but less so in PD and mild TBI. These findings require confirmation by larger, well-designed clinical trials.
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Affiliation(s)
- Adrian I. Espiritu
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry and Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Mervin Blair
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Lawson Research Institute, London, ON, Canada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Hall PA, Burhan AM, MacKillop JC, Duarte D. Next-generation cognitive assessment: Combining functional brain imaging, system perturbations and novel equipment interfaces. Brain Res Bull 2023; 204:110797. [PMID: 37875208 DOI: 10.1016/j.brainresbull.2023.110797] [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: 08/09/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
Conventional cognitive assessment is widely used in clinical and research settings, in educational institutions, and in the corporate world for personnel selection. Such approaches involve having a client, a patient, or a research participant complete a series of standardized cognitive tasks in order to challenge specific and global cognitive abilities, and then quantify performance for the desired end purpose. The latter may include a diagnostic confirmation of a disease, description of a state or ability, or matching cognitive characteristics to a particular occupational role requirement. Metrics derived from cognitive assessments are putatively informative about important features of the brain and its function. For this reason, the research sector also makes use of cognitive assessments, most frequently as a stimulus for cognitive activity from which to extract functional neuroimaging data. Such "task-related activations" form the core of the most widely used neuroimaging technologies, such as fMRI. Much of what we know about the brain has been drawn from the interleaving of cognitive assessments of various types with functional brain imaging technologies. Despite innovation in neuroimaging (i.e., quantifying the neural response), relatively little innovation has occurred on task presentation and volitional response measurement; yet these together comprise the core of cognitive performance. Moreover, even when cognitive assessment is interleaved with functional neuroimaging, this is most often undertaken in the research domain, rather than the primary applications of cognitive assessment in diagnosis and monitoring, education and personnel selection. There are new ways in which brain imaging-and even more importantly, brain modulation-technologies can be combined with automation and artificial intelligence to deliver next-generation cognitive assessment methods. In this review paper, we describe some prototypes for how this can be done and identify important areas for progress (technological and otherwise) to enable it to happen. We will argue that the future of cognitive assessment will include semi- and fully-automated assessments involving neuroimaging, standardized perturbations via neuromodulation technologies, and artificial intelligence. Furthermore, the fact that cognitive assessments take place in a social/interpersonal context-normally between the patient and clinician-makes the human-machine interface consequential, and this will also be discussed.
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Affiliation(s)
- Peter A Hall
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada; Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Amer M Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James C MacKillop
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Seniors Mental Health Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada
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Giacobbe P, Burhan AM, Waxman R, Ng E. Interventional Psychiatry and Neurotechnologies: Education and Ethics Training. Can J Neurol Sci 2023; 50:s10-s16. [PMID: 37160678 DOI: 10.1017/cjn.2023.27] [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] [Indexed: 05/11/2023]
Abstract
The last two decades have seen dramatic growth in the application of procedurally based interventions for treating refractory psychiatric conditions, leading to interest in developing the foundations for the subspecialty of "Interventional Psychiatry." However, there is cause for concern that the rate of expansion of clinical advances in this field may be outpacing the ability of postgraduate curricula to provide sufficient exposure to and teaching and supervision of these treatments. The paucity of adequately trained practitioners in Interventional Psychiatry further exacerbates inequities in the ability of eligible patients to access and benefit from these approaches. This paper explores the rates of utilization of Interventional Psychiatry treatments, the current state of education in these treatments, and the role that training can play in translating scientific advances in this area to ensure equitable access and maximum impact at a population level. The majority of the discussion is centered on electroconvulsive therapy (ECT), the most established and available of these treatments, highlighting how enhancing education and training in ECT can reduce barriers to its utilization. It is argued that innovations in pedagogical approaches for disseminating the learning of these procedures are needed to increase the current low rates of competency in these treatments and can facilitate the more rapid dissemination of other Interventional Psychiatry approaches and neurotechnologies, such as repetitive transcranial magnetic stimulation, ketamine, deep brain stimulation, and focused ultrasound.
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Affiliation(s)
- Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amer M Burhan
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
| | - Robyn Waxman
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
| | - Enoch Ng
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
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Burhan AM, Paris Lai KS, Waxman R. Expert consensus on brain stimulation competencies in postgraduate medical education. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Montero‐Odasso M, Almeida QJ, Burhan AM, Camicioli R, Li K, Liu‐Ambrose T, Middleton LE, Doyon J, Fraser S, Hunter SW, McIlroy B, Morais JA, Pieruccini‐Faria F, Shoemaker K, Speechley MR, Vasudev A, Zou GY, Berryman N, Lussier M, Vanderhaeghe L, Bherer L. The SYNERGIC Trial: A Randomized Controlled Trial Assessing Multimodal Interventions to Improve Cognition in Mild Cognitive Impairment in Older Adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.061616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences Whitby ON Canada
| | | | - Karen Li
- Concordia University Montreal QC Canada
| | | | | | - Julien Doyon
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM) Montreal QC Canada
| | | | | | | | - José A Morais
- McGill University Montreal QC Canada
- McGill University Health Centre Montreal QC Canada
| | - Frederico Pieruccini‐Faria
- Gait and Brain Laboratory, Parkwood Institute London ON Canada
- Gait & Brain Lab; Lawson Research Institute; Schulich School of Medicine& Dentistry, Division of Geriatric Medicine, Western University London ON Canada
| | | | | | - Akshya Vasudev
- University of Western Ontario; Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario London ON Canada
| | - G Y Zou
- University of Wester Ontario London ON Canada
| | | | - Maxime Lussier
- University of Montreal Montreal QC Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM) Montreal QC Canada
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Rhodus EK, Kryscio RJ, Barber JM, Burhan AM, Jicha GA. Feasibility of community‐based remote, biometric data collection in persons with Alzheimer’s disease and behavioral symptoms. Alzheimers Dement 2022. [DOI: 10.1002/alz.068135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Elizabeth K. Rhodus
- University of Kentucky Lexington KY USA
- Sanders‐Brown Center on Aging Lexington KY USA
| | | | | | - Amer M. Burhan
- University of Toronto Toronto ON Canada
- Ontario Shores Centre for Mental Health Sciences Whitby ON Canada
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Jeremian R, Malinowski A, Chaudhary Z, Srivastava A, Qian J, Zai C, Adanty C, Fischer CE, Burhan AM, Kennedy JL, Borlido C, Gerretsen P, Graff A, Remington G, Vincent JB, Strauss JS, De Luca V. Epigenetic age dysregulation in individuals with bipolar disorder and schizophrenia. Psychiatry Res 2022; 315:114689. [PMID: 35849977 DOI: 10.1016/j.psychres.2022.114689] [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: 02/28/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022]
Abstract
Bipolar disorder (BD) and schizophrenia (SCZ) are debilitating disorders that are associated with significant burden and reduced quality of life. In this study, we leveraged microarray data derived from both the Illumina HumanMethylation450 platform to investigate the epigenetic age of individuals with SCZ (n = 40), BD (n = 40), and healthy controls (n = 38), across five epigenetic clocks. Various statistical metrics were used to identify discrepancies between epigenetic and chronological age across the three groups. We observed a significant increase in epigenetic age compared to chronological age in the BD group. Mean epigenetic age acceleration was also higher in individuals with bipolar disorder compared to healthy controls across four different epigenetic clocks (p<0.05). Despite the study's relatively small sample size, these findings suggest that both individuals with bipolar disorder and schizophrenia may have epigenetic markers associated with a premature aging phenotype, which could be suggestive of negative outcomes associated with the disease. In our future studies, we hope to elucidate this finding further by elucidating the precise link between epigenetic age, symptomatology and disease progression.
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Affiliation(s)
| | | | - Zanib Chaudhary
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Jessica Qian
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Clement Zai
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | | | | | - James L Kennedy
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Carol Borlido
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Ariel Graff
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Gary Remington
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - John B Vincent
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - John S Strauss
- Nanaimo Regional General Hospital, Vancouver Island Health Authority, British Columbia
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada; St Michael's Hospital, Toronto, Canada.
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Cakmak JD, Liu L, Poirier SE, Schaefer B, Poolacherla R, Burhan AM, Sabesan P, St. Lawrence K, Théberge J, Hicks JW, Finger E, Palaniyappan L, Anazodo UC. The functional and structural associations of aberrant microglial activity in major depressive disorder. J Psychiatry Neurosci 2022; 47:E197-E208. [PMID: 35654450 PMCID: PMC9343118 DOI: 10.1503/jpn.210124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/13/2021] [Accepted: 03/13/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a debilitating mental illness that has been linked to increases in markers of inflammation, as well as to changes in brain functional and structural connectivity, particularly between the insula and the subgenual anterior cingulate cortex (sgACC). In this study, we directly related inflammation and dysconnectivity in treatment-resistant MDD by concurrently measuring the following: microglial activity with [18F]N-2-(fluoroethoxyl)benzyl-N-(4phenoxypyridin-3-yl)acetamide ([18F]FEPPA) positron emission tomography (PET); the severity of MDD; and functional or structural connectivity among insula or sgACC nodes. METHODS Twelve patients with treatment-resistant MDD (8 female, 4 male; mean age ± standard deviation 54.9 ± 4.5 years and 23 healthy controls (11 female, 12 male; 60.3 ± 8.5 years) completed a hybrid [18F]FEPPA PET and MRI acquisition. From these, we extracted relative standardized uptake values for [18F]FEPPA activity and Pearson r-to-z scores representing functional connectivity from our regions of interest. We extracted diffusion tensor imaging metrics from the cingulum bundle, a key white matter bundle in MDD. We performed regressions to relate microglial activity with functional connectivity, structural connectivity and scores on the 17-item Hamilton Depression Rating Scale. RESULTS We found significantly increased [18F]FEPPA uptake in the left sgACC in patients with treatment-resistant MDD compared to healthy controls. Patients with MDD also had a reduction in connectivity between the sgACC and the insula. The [18F]FEPPA uptake in the left sgACC was significantly related to functional connectivity with the insula, and to the structural connectivity of the cingulum bundle. [18F]FEPPA uptake also predicted scores on the Hamilton Depression Rating Scale.Limitations: A relatively small sample size, lack of functional task data and concomitant medication use may have affected our findings. CONCLUSION We present preliminary evidence linking a network-level dysfunction relevant to the pathophysiology of depression and related to increased microglial activity in MDD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Lena Palaniyappan
- From the Department of Neuroscience, Western University, London, Ont. (Cakmak, Schaefer, Sabesan, Palaniyappan); the Robarts Research Institute, Western University, London, Ont. (Cakmak, Palaniyappan); the Lawson Health Research Institute, London, Ont. (Liu, Poirier, Burhan, St. Lawrence, Théberge, Hicks, Finger, Anazodo); the Department of Medical Biophysics, Western University, London, Ont. (Poirier, Sabesan, St. Lawrence, Théberge, Hicks, Anazodo); the London Health Sciences Centre, London, Ont. (Schaefer, Poolacherla, Palaniyappan); the Department of Psychiatry, Western University, London, Ont. (Burhan, Théberge, Palaniyappan); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Burhan); the Ontario Shores Centre for Mental Health Sciences, Whitby, Ont. (Burhan); the Department of Clinical Neurological Sciences, Western University, London, Ont. (Finger); the Department of Anesthesia and Perioperative Medicine, Western University, London, Ont. (Poolacherla)
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Jagtap S, Romanowska S, Leibovitz T, Onno KA, Burhan AM, Best MW. Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions. Schizophr Res Cogn 2022; 28:100238. [PMID: 35242607 PMCID: PMC8861417 DOI: 10.1016/j.scog.2022.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/21/2022] Open
Abstract
Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.
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Kronick J, Sabesan P, Burhan AM, Palaniyappan L. Assessment of treatment resistance criteria in non-invasive brain stimulation studies of schizophrenia. Schizophr Res 2022; 243:349-360. [PMID: 34183208 DOI: 10.1016/j.schres.2021.06.009] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 01/17/2023]
Abstract
Novel treatment modalities, such as non-invasive brain stimulation (NIBS), typically focus on patient groups that have failed multiple treatment interventions. Despite its promise, the clinical translation of NIBS in schizophrenia has been limited. One important obstacle to implementation is the inconsistent reporting of treatment resistance in the clinical trial literature contributing to heterogeneity in reported effects. In response, we develop a numerical approach to synthesize quality of assessment of Treatment-Resistant Schizophrenia (TRS) and apply this to studies investigating therapeutic response to NIBS in patients with schizophrenia. Literature search conducted through PubMed database identified 119 studies investigating Transcranial Magnetic Stimulation and Transcranial Electrical Stimulation in treating resistant schizophrenia symptoms. A quality score out of 11 was assigned to each study based on adherence to the international consensus guidelines for TRS developed by the Treatment Response and Resistance in Psychosis (TRRIP) group. Results revealed an overall paucity of studies with thorough assessment and/or reporting of TRS phenomenon, as evidenced by a mean quality score of 3.38/11 (SD: 1.01) for trials and 5.16/11 (SD: 1.57) for case reports, though this improved minimally since the publication of consensus criteria. Most studies considered treatment-resistance as a single dimensional construct by reporting resistance of a single symptom, and failed to establish treatment adherence, resistance time course and functional impairment. We conclude that the current NIBS literature in schizophrenia do not reflect its true effects on treatment-resistance. There is an urgent need to improve assessment and reporting standards of clinical trials that target TRS.
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Affiliation(s)
- Jami Kronick
- Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C1, Canada.
| | - Priyadharshini Sabesan
- Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Amer M Burhan
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario M5T 1R8, Canada; Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 5S9, Canada; Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Lena Palaniyappan
- Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Robarts Research Institute, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; Lawson Health Research Institute, 750 Base Line Road East Suite 300, London, Ontario N6C 2R5, Canada.
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14
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Hall PA, Burhan AM. Commentary on Song et al: Brain stimulation for addictions- optimizing impact via strategic interleaving with pharmacotherapy, cognitive behavioral therapy, and restructuring the micro-environment. Addiction 2022; 117:1256-1257. [PMID: 35037323 DOI: 10.1111/add.15797] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Peter A Hall
- School of Public Health Sciences, University of Waterloo, Canada
| | - Amer M Burhan
- Ontario Shores Centre for Mental Health Sciences, Canada
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15
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Zarei S, Colman S, Rostas A, Burhan AM, Chu L, Davies SJ, Derkach P, Elmi S, Hussain M, Gerretsen P, Graff-Guerrero A, Ismail Z, Kim D, Krisman L, Moghabghab R, Mulsant BH, Nair V, Pollock BG, Rej S, Simmons J, Van Bussel L, Rajji TK, Kumar S. The Rationale and Design of Behavioral Interventions for Management of Agitation in Dementia in a Multi-Site Clinical Trial. J Alzheimers Dis 2022; 86:827-840. [PMID: 35147535 DOI: 10.3233/jad-215261] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings. OBJECTIVE To describe the rationale and design of structured behavioral interventions in the StaN study. METHODS Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility. RESULTS The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and to integrate them with pharmacotherapy. CONCLUSION Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.
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Affiliation(s)
- Shadi Zarei
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Colman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Aviva Rostas
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Burhan
- Department of Psychiatry, Western University, London, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada
| | - Li Chu
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Simon Jc Davies
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Derkach
- Ukrainian Canadian Care Centre, Toronto, Ontario, Canada
| | - Sarah Elmi
- Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada
| | - Maria Hussain
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Philip Gerretsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Donna Kim
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Linda Krisman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rola Moghabghab
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vasavan Nair
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Bruce G Pollock
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jyll Simmons
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lisa Van Bussel
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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16
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Vaithianathan T, Blair M, Soares V, Rybak YE, Palaniyappan L, Richardson JD, Burhan AM. Bilateral sequential theta burst stimulation in depressed veterans with service related posttraumatic stress disorder: a feasibility study. BMC Psychiatry 2022; 22:81. [PMID: 35114979 PMCID: PMC8811967 DOI: 10.1186/s12888-022-03729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression comorbid with posttraumatic stress disorder (PTSD) can be disabling and treatment resistant. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS), may have a role in helping these patients. There are only few published studies using different rTMS paradigms including bilateral intermittent theta burst (iTBS) and low frequency rTMS. METHODS In this small cohort observation study, we examined the efficacy of bilateral sequential theta-burst stimulation (bsTBS) in 8 treatment resistant depression (TRD) military veterans with PTSD comorbidity stemming from military service experience. RESULTS bsTBS was generally well tolerated and resulted in 25% and 38% remission and response rates on Depression scores respectively; 25% remission and response rate on PTSD scores. DISCUSSION This study demonstrates preliminary feasibility and safety of bsTBS in TRD with comorbid military service related PTSD. We concluded that this paradigm might hold promise as a therapeutic tool to help patients with TRD co-morbid with military service related PTSD. Further adequately powered studies to compare rTMS treatment paradigms in this patient group are warranted.
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Affiliation(s)
- Thelepa Vaithianathan
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada
| | - Mervin Blair
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada
| | - Vanessa Soares
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada ,grid.55614.330000 0001 1302 4958MacDonald Franklin OSI Research Centre, London, Ontario Canada
| | - Yuri E. Rybak
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada
| | - Lena Palaniyappan
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada ,grid.39381.300000 0004 1936 8884Robarts Research Institute, University of Western Ontario, London, Ontario Canada
| | - J Don Richardson
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada ,grid.55614.330000 0001 1302 4958MacDonald Franklin OSI Research Centre, London, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada
| | - Amer M. Burhan
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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17
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Choudhury S, Ghodasara S, Stiffel M, Fischer CE, Tang-Wai DF, Smith EE, Massoud F, Robin Hsiung GY, Lee L, Bruneau MA, Laforce RJ, Ismail Z, Burhan AM, Kumar S. Informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders: Systematic review and report from a CCCDTD5 Working Group. Int J Geriatr Psychiatry 2022; 37. [PMID: 35043452 DOI: 10.1002/gps.5678] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 01/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE As part of the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, we assessed the literature on informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders (NCDs) to provide evidence-based recommendations for clinicians and researchers. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards guidelines. Publications that validated the informant-based tools or described their key properties were reviewed. Quality of the studies was assessed using the modified Quality Assessment tool for Diagnostic Accuracy Studies. RESULTS Out of 386 publications identified through systematic search, 34 that described 19 informant-based tools were included in the final review. Most of these tools are backed by good-quality studies and are appropriate to use in clinical care or research. The tools vary in their psychometric properties, domains covered, comprehensiveness, completion time, and ability to detect longitudinal change. Based on these properties, we identify different tools that may be appropriate for primary care, specialized memory clinic, or research settings. We also identify barriers to use of these tools in routine clinical practice. CONCLUSION There are several good-quality tools available to collect informant-report for assessment and monitoring of cognition, behavior, or function in patients with NCDs. Clinicians and researchers may choose a particular tool based on their specific needs such as domains of interest, desired psychometric properties, and feasibility. Further work is needed to make the tools more user-friendly and to adopt them into routine clinical care.
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Affiliation(s)
- Samira Choudhury
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sheena Ghodasara
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Michael Stiffel
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Corinne E Fischer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David F Tang-Wai
- Department of Medicine (Neurology & Geriatric Medicine), University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network Memory Clinic, Toronto, Ontario, Canada
| | - Eric Edward Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Fadi Massoud
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Ging-Yuek Robin Hsiung
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Andrée Bruneau
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada.,Geriatric Institute of Montreal Research Center, Montreal, Quebec, Canada
| | - Robert Jr Laforce
- Département des Sciences Neurologiques, Clinique Interdisciplinaire de Mémoire du CHU de Québec, Université Laval, Quebec, Quebec, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Amer M Burhan
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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18
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Guan LT, Sekhon R, Kaur S, Chen H, K.V. VW, Burhan AM, Colman S, Derkach P, Elmi S, Hussain M, Krisman L, Nair V, Rej S, Rostas A, Streiner D, Van Bussel L, Rajji TK, Kumar S, Ismail Z. Novel measures to assess the association of IPA agitation criteria domains with cognition, caregiver burden and quality of life in dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.055872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Amer M. Burhan
- Parkwood Institute‐Mental Health, Western University London ON Canada
| | - Sarah Colman
- Centre for Addiction and Mental Health Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | - Sarah Elmi
- Ontario Shores Center for Mental Health Sciences Toronto ON Canada
| | | | - Linda Krisman
- Centre for Addiction and Mental Health Toronto ON Canada
| | - Vasavan Nair
- Douglas Mental Health Institute, McGill University Montreal QC Canada
| | - Soham Rej
- McGill University Montreal QC Canada
| | - Aviva Rostas
- Centre for Addiction and Mental Health Toronto ON Canada
| | | | - Lisa Van Bussel
- Parkwood Institute‐Mental Health, Western University London ON Canada
| | - Tarek K. Rajji
- Centre for Addiction and Mental Health Toronto ON Canada
- University of Toronto Toronto ON Canada
- Toronto Dementia Research Alliance Toronto ON Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary Calgary AB Canada
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19
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Zarei S, Choudhury S, Burhan AM, Chu L, Colman S, Derkach P, Elmi S, Hussain M, Ismail Z, Zarei S, Nair V, Rej S, Rostas A, Rajji TK, Streiner D, Kumar S. Determinants of polypharmacy in patients with behavioral and psychological symptoms of dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.055644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shadi Zarei
- Center for Mental Health and Addiction Toronto ON Canada
| | | | - Amer M. Burhan
- Parkwood Institute‐Mental Health, Western University London ON Canada
| | - Li Chu
- Center for Mental Health and Addiction Toronto ON Canada
| | - Sarah Colman
- Centre for Addiction and Mental Health Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | - Sarah Elmi
- Ontario Shores Center for Mental Health Sciences Toronto ON Canada
| | | | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary Calgary AB Canada
| | - Shadi Zarei
- Center for Mental Health and Addiction Toronto ON Canada
| | - Vasavan Nair
- Douglas Mental Health Institute ‐ McGill Montreal QC Canada
| | - Soham Rej
- McGill University Montreal QC Canada
| | - Aviva Rostas
- Centre for Addiction and Mental Health Toronto ON Canada
| | - Tarek K. Rajji
- Centre for Addiction and Mental Health Toronto ON Canada
- University of Toronto Toronto ON Canada
- Toronto Dementia Research Alliance Toronto ON Canada
| | | | - Sanjeev Kumar
- Centre for Addiction and Mental Health Toronto ON Canada
- University of Toronto Toronto ON Canada
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20
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Hara T, Shanmugalingam A, McIntyre A, Burhan AM. Evidence for NIBS in facilitating rehabilitation of cognitive function after stroke. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Liu JJW, Nazarov A, Easterbrook B, Plouffe RA, Le T, Forchuk C, Brandwood A, St Cyr K, Auger E, Balderson K, Bilodeau M, Burhan AM, Enns MW, Smith P, Hosseiny F, Dupuis G, Roth M, Mota N, Lavoie V, Richardson JD. Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy. JMIR Res Protoc 2021; 10:e33151. [PMID: 34694228 PMCID: PMC8576591 DOI: 10.2196/33151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations. OBJECTIVE This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD. METHODS This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes. RESULTS The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021. CONCLUSIONS This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations. TRIAL REGISTRATION PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33151.
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Affiliation(s)
- Jenny J W Liu
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Anthony Nazarov
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Bethany Easterbrook
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Rachel A Plouffe
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Tri Le
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Callista Forchuk
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Alec Brandwood
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Kate St Cyr
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edouard Auger
- Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Ken Balderson
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- St. Joseph's Operational Stress Injury Clinic, Toronto, ON, Canada
| | - Mathieu Bilodeau
- Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Amer M Burhan
- Ontario Shores Centre of Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Murray W Enns
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Winnipeg Operational Stress Injury Clinic, Winnipeg, ON, Canada
| | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada
| | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada
| | - Gabrielle Dupuis
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada
| | - Maya Roth
- St. Joseph's Operational Stress Injury Clinic, Toronto, ON, Canada
- Yeates School of Graduate Studies, Ryerson University, Toronto, ON, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, ON, Canada
| | - Vicky Lavoie
- Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - J Don Richardson
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- St. Joseph's Operational Stress Injury Clinic, London, ON, Canada
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22
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Bao Z, Howidi B, Burhan AM, Frewen P. Self-Referential Processing Effects of Non-invasive Brain Stimulation: A Systematic Review. Front Neurosci 2021; 15:671020. [PMID: 34177450 PMCID: PMC8223877 DOI: 10.3389/fnins.2021.671020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/22/2021] [Accepted: 05/07/2021] [Indexed: 12/03/2022] Open
Abstract
Systematic reviews of neuroimaging studies confirm stimulus-induced activity in response to verbal and non-verbal self-referential processing (SRP) in cortical midline structures, temporoparietal cortex and insula. Whether SRP can be causally modulated by way of non-invasive brain stimulation (NIBS) has also been investigated in several studies. Here we summarize the NIBS literature including 27 studies of task-based SRP comparing response between verbal and non-verbal SRP tasks. The studies differed in design, experimental tasks and stimulation parameters. Results support the role of left inferior parietal lobule (left IPL) in verbal SRP and for the medial prefrontal cortex when valenced stimuli were used. Further, results support roles for the bilateral parietal lobe (IPL, posterior cingulate cortex), the sensorimotor areas (the primary sensory and motor cortex, the premotor cortex, and the extrastriate body area) and the insula in non-verbal SRP (bodily self-consciousness). We conclude that NIBS may differentially modulate verbal and non-verbal SRP by targeting the corresponding brain areas.
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Affiliation(s)
- Zhongjie Bao
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, ON, Canada.,Interdisciplinary Program in Neuroscience, Western University, London, ON, Canada
| | - Belal Howidi
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, ON, Canada.,Interdisciplinary Program in Neuroscience, Western University, London, ON, Canada
| | - Amer M Burhan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, ON, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.,Department of Psychiatry, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Frewen
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, ON, Canada.,Interdisciplinary Program in Neuroscience, Western University, London, ON, Canada
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Vasudev A, Arena A, Burhan AM, Ionson E, Hirjee H, Maldeniya P, Wetmore S, Newman RI. A training programme involving automatic self-transcending meditation in late-life depression: preliminary analysis of an ongoing randomised controlled trial - RETRACTION. BJPsych Open 2021; 7:e105. [PMID: 34030756 PMCID: PMC8167708 DOI: 10.1192/bjo.2021.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ionson E, Limbachia J, Rej S, Puka K, Newman RI, Wetmore S, Burhan AM, Vasudev A. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression - RETRACTION. Br J Psychiatry 2021; 220:1. [PMID: 35049463 DOI: 10.1192/bjp.2021.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rybak YE, Lai KSP, Ramasubbu R, Vila‐Rodriguez F, Blumberger DM, Chan P, Delva N, Giacobbe P, Gosselin C, Kennedy SH, Iskandar H, McInerney S, Ravitz P, Sharma V, Zaretsky A, Burhan AM. Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment. Depress Anxiety 2021; 38:456-467. [PMID: 33528865 PMCID: PMC8049072 DOI: 10.1002/da.23135] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. METHODS This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. RESULTS Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. CONCLUSIONS TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients.
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Affiliation(s)
- Yuri E. Rybak
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | - Ka S. P. Lai
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | | | - Fidel Vila‐Rodriguez
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Peter Chan
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nicholas Delva
- Department of PsychiatryQueen's UniversityKingstonOntarioCanada
| | - Peter Giacobbe
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Caroline Gosselin
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Hani Iskandar
- Department of PsychiatryMcGill UniversityMontrealQuebecCanada
| | - Shane McInerney
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Paula Ravitz
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Verinder Sharma
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | - Ari Zaretsky
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health SciencesWhitbyOntarioCanada,Department of PsychiatryUniversity of Toronto Temerty Faculty of MedicineTorontoOntarioCanada
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26
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Burhan AM, Knuff A, Seitz D. Actigraphy as a proxy biomarker for motoric agitation in Alzheimer disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.038869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Amer M. Burhan
- Parkwood Institute‐Mental Health/Western University London ON Canada
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Tang‐Wai DF, Smith EE, Bruneau M, Burhan AM, Chatterjee A, Chertkow H, Choudhury S, Dorri E, Ducharme S, Fischer CE, Ghodasara S, Herrmann N, Hsiung GR, Kumar S, Laforce R, Lee L, Massoud F, Shulman KI, Stiffel M, Gauthier S, Ismail Z. CCCDTD5 recommendations on early and timely assessment of neurocognitive disorders using cognitive, behavioral, and functional scales. Alzheimers Dement (N Y) 2020; 6:e12057. [PMID: 33209972 PMCID: PMC7657153 DOI: 10.1002/trc2.12057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Earlier diagnosis of neurocognitive disorders and neurodegenerative disease is needed to implement preventative interventions, minimize harm, and reduce risk of exploitation in the context of undetected disease. Along the spectrum from subjective cognitive decline (SCD) to dementia, evidence continues to emerge with respect to detection, staging, and monitoring. Updates to previous guidelines are required for clinical practice. METHODS A subcommittee of the 5th Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed emerging evidence to address the following: (1) Is there a role for screening at-risk patients without clinical concerns? In what context is assessment for dementia appropriate? (2) What tools can be used to evaluate patients in whom cognitive decline is suspected? (3) What important information can be gained from an informant, using which measures? (4) What instruments can be used to get more in-depth information to diagnose mild cognitive impairment (MCI) or dementia? (5) What is the approach to those with cognitive concerns but without objective changes (ie, SCD)? (6) How do we track response to treatment and change over time? The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate quality of the evidence and strength of the recommendations. RESULTS We recommend instruments to assess and monitor cognition, behavior, and function across the cognitive spectrum, including reports from patient and informant. We recommend against screening asymptomatic older adults but recommend investigation for self- or informant reports of changes in cognition, emergence of behavioral or psychiatric symptoms, or decline in function or self-care. Standardized assessments should be used for cognitive and behavioral change that have sufficient validity for use in clinical practice. DISCUSSION The CCCDTD5 provides evidence-based recommendations for detection, assessment, and monitoring of neurocognitive disorders. Although these guidelines were developed for use in Canada, they may also be useful in other jurisdictions.
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Affiliation(s)
- David F. Tang‐Wai
- Department of Medicine, Divisions of Neurology and Geriatric MedicineUniversity of Toronto, University Health Network Memory Clinic, Krembil Brain InstituteTorontoOntarioCanada
| | - Eric E. Smith
- Department of Clinical Neurosciences and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Marie‐Andrée Bruneau
- Department of Psychiatry and AddictologyUniversity of Montreal, Geriatric Institute of Montreal Research CenterMontrealQuebecCanada
| | - Amer M. Burhan
- Department of PsychiatrySchulich School of Medicine and DentistryWestern Universityand Parkwood Institute‐Mental HealthLondonOntarioCanada
| | - Atri Chatterjee
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Howard Chertkow
- Department of Medicine NeurologyRotman Research InstituteUniversity of TorontoTorontoOntarioCanada
| | - Samira Choudhury
- Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
| | - Ehsan Dorri
- Department of PsychiatryUniversity of AlbertaEdmontonAlbertaCanada
| | - Simon Ducharme
- Department of Psychiatry, Montreal QC, McConnell Brain ImagingMcGill University Health CentreMcGill University, Montreal Neurological InstituteMontrealQuebecCanada
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical ScienceSt. Michael's HospitalLi Ka Shing Knowledge Institute, University of TorontoTorontoOntarioCanada
| | - Sheena Ghodasara
- Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Nathan Herrmann
- Sunnybrook Health Sciences CentreDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | | | - Sanjeev Kumar
- Centre for Addiction and Mental Health, University of TorontoTorontoOntarioCanada
| | - Robert Laforce
- Clinique Interdisciplinaire de MémoireDépartement des Sciences NeurologiquesCHU de Québec, Université LavalQuebecCanada
| | - Linda Lee
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Fadi Massoud
- Centre Hospitalier Charles LeMoyne and Institut Universitaire de Gériatrie de Montréal, Department of MedicineUniversity of Sherbrooke and Department of MedicineUniversity of MontrealMontrealQuebecCanada
| | - Kenneth I. Shulman
- Sunnybrook Health Sciences CentreDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | | | - Serge Gauthier
- McGill Center for Studies in AgingAlzheimer Disease Research UnitMontrealQuebecCanada
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, Community Health SciencesHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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Burhan AM, Patience JA, Teselink JGP, Marlatt NM, Babapoor-Farrokhran S, Palaniyappan L. Bilateral sequential theta burst stimulation for multiple-therapy-resistant depression: A naturalistic observation study. J Psychiatr Res 2020; 130:342-346. [PMID: 32882575 DOI: 10.1016/j.jpsychires.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/04/2020] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 01/29/2023]
Abstract
Depression is a significant health issue with treatment resistance reported in about one third of patients. Treatment resistance results in significant disability, impaired quality of life, and increased healthcare costs. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for treatment resistant depression (TRD) with response and remission rates in open-label studies being as high as 58% and 37% respectively. Theta-burst is a faster and novel rTMS paradigm that has shown promise as a treatment for TRD in some preliminary studies. In a naturalistic design, we evaluated the response, remission and tolerability of bilateral sequential (right then left) prefrontal theta-burst rTMS (bsTBS) in 50 patients with TRD (600 pulses/session, 20 sessions, 100% of resting motor threshold (80% if intolerant to 100%, n = 2), F4/F3 of 10-20-20 EEG localization). Data was collected over 36 months from a specialized academic TMS clinic. Patients had multiple-treatment resistance with at least two failed trials of different antidepressants with 20% also having failed electroconvulsive therapy and 66% having received professional therapy. We found a 28% remission rate (HAMD-17 score of ≤7) and a 52% response rate (≥50% reduction in HAMD-17) with a 42% reduction in average HAMD-17 score. The treatment was well tolerated, with muscle contractions, mild pain or discomfort, headache, scalp irritation, and changes to vitals being captured as occasional adverse events with two instances of syncope (0.22% of treatments). This naturalistic study shows that bsTBS is a promising paradigm for a multiple-TRD patient population with approximately one-third of treatments achieving remission and over half achieving significant response.
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Affiliation(s)
- Amer M Burhan
- Therapeutic Brain Stimulation Clinic, Parkwood Institute-Mental Health Building, 550 Wellington Road, N6C 0A7, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - James A Patience
- Therapeutic Brain Stimulation Clinic, Parkwood Institute-Mental Health Building, 550 Wellington Road, N6C 0A7, London, Ontario, Canada
| | | | - Nicole M Marlatt
- Therapeutic Brain Stimulation Clinic, Parkwood Institute-Mental Health Building, 550 Wellington Road, N6C 0A7, London, Ontario, Canada
| | - Sahand Babapoor-Farrokhran
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute & Robarts Research Institute, London, Ontario, Canada
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Lai KSP, Watt C, Ionson E, Baruss I, Forchuk C, Sukhera J, Burhan AM, Vasudev A. Breath Regulation and yogic Exercise An online Therapy for calm and Happiness (BREATH) for frontline hospital and long-term care home staff managing the COVID-19 pandemic: A structured summary of a study protocol for a feasibility study for a randomised controlled trial. Trials 2020; 21:648. [PMID: 32665041 PMCID: PMC7359429 DOI: 10.1186/s13063-020-04583-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Objective 1: To determine if it is feasible to conduct an RCT of online Sudarshan Kriya Yoga (SKY) for frontline hospital and long-term care home staff under the constraints imposed by the COVID-19 pandemic and need for remote trial monitoring. Objective 2: To assess whether online versions of SKY and/or Health Enhancement Program (HEP) result in improvement in self-rated measures of insomnia, anxiety, depression, and resilience. TRIAL DESIGN This is an open-label feasibility randomized controlled trial (RCT), comparing an online breath based yogic intervention SKY versus an online control mind-body intervention HEP in frontline hospital and long-term care home staff managing the COVID-19 pandemic. PARTICIPANTS Participants will include frontline hospital and long-term care home staff that are involved in the management of COVID-19 patients in London, Ontario, Canada. Participants will be willing and able to attend via online video conferencing software to participate in the study interventions. Participants must have an adequate understanding of English and be able to sit without physical discomfort for 60 minutes. INTERVENTION AND COMPARATOR Sudarshan Kriya Yoga (SKY): The online version of SKY will be delivered by at least one certified Canadian SKY teacher, with at least one back up teacher at all times, under the supervision of Ms. Ronnie Newman, Director of Research and Health Promotion, Art of Living Foundation, USA. The online version of SKY for healthcare workers has a total duration of 3 hours. Phase I will consist of 5 self-paced online modules of 4-10 minutes each to learn the breath control techniques. Participants will be sent an online survey in REDCap requesting that they self-confirm completion of the Phase I modules. In Phase II, 2 interactive online sessions of 1 hour each will be held on consecutive days with a certified SKY teacher, during which participants will learn the fast, medium and slow breaths. For ease of scheduling, multiple time windows will be offered for Phase II. There will be at least one back up teacher at all times. Both Phase I and II will be completed in the first week. Health Enhancement Program (HEP): The active control arm, HEP, will consist of time-matched online self-paced modules for Phase I. Phase II will consist of mindfulness-based meditation sessions delivered by mental health staff. HEP will be an active treatment program that incorporates mind-body interventions. HEP will consist of time-matched online self-paced modules with psychoeducation on healthy active living as well as interactive modules comprising of guided de-stressing exercises including music therapy, mindfulness and progressive muscle relaxation. Weekly follow up sessions will be offered to all recruited participants for 30 minutes each for the subsequent 4 weeks in both study arms. MAIN OUTCOMES The following feasibility outcomes will be measured at the end of the study: (1) rate of participant recruitment, (2) rate of retention, (3) completeness of data entry, (4) cost of interventions, and (5) unexpected costs. Such measures will be collected on a daily basis through-out the study and tabulated 5 weeks later at the end of the study. RANDOMISATION Participants will be randomized after they have electronically signed the consent form and the research staff have confirmed eligibility. We will use REDCap to perform randomization in a 1:1 ratio as well as allocation concealment. REDCap is widely used by health researchers worldwide to significantly reduce data entry and study management errors to improve data fidelity. BLINDING (MASKING) All study participants will be blinded to the study hypotheses so as to prevent any expectation bias. Group allocation will be masked during analysis. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) This study will randomize a total of 60 participants in a 1:1 ratio to either SKY or HEP interventions. TRIAL STATUS Protocol version number 2.0 (June 5, 2020). Recruitment is currently ongoing (starting June 25, 2020). We anticipate to complete recruitment by June 30, 2021 and complete the study by September 30, 2021. TRIAL REGISTRATION ClinicalTrials.gov protocol ID NCT04368676 (posted April 30, 2020). FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Ka Sing Paris Lai
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Christine Watt
- Department of Psychiatry, Parkwood Institute of Mental Health, 550 Wellington Rd, London, ON N6C 5J1 Canada
| | - Emily Ionson
- Department of Psychiatry, Parkwood Institute of Mental Health, 550 Wellington Rd, London, ON N6C 5J1 Canada
| | - Imants Baruss
- Department of Psychology, King’s University College at Western University, 266 Epworth Ave, London, ON N6A 2M3 Canada
| | - Cheryl Forchuk
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Javeed Sukhera
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Amer M. Burhan
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Akshya Vasudev
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
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Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, Fraser S, Muir-Hunter S, Li KZH, Liu-Ambrose T, McIlroy W, Middleton L, Morais JA, Sakurai R, Speechley M, Vasudev A, Beauchet O, Hausdorff JM, Rosano C, Studenski S, Verghese J. Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA). J Gerontol A Biol Sci Med Sci 2020; 74:897-909. [PMID: 30101279 PMCID: PMC6521916 DOI: 10.1093/gerona/gly148] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions. Methods Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects. Results From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the “Core-battery” of tests. The expert panel also recommended a “Minimum-battery” of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B. Conclusions A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Address correspondence to: Manuel Montero-Odasso MD, PhD, AGSF, FRCPC, FGSA, Gait and Brain Lab, Parkwood Institute, University of Western Ontario and Lawson Health Research Institute, 550 Wellington Road, London, Ontario N6C 0A7, Canada. E-mail:
| | - Quincy J Almeida
- Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
- Department of Medicine, University of Montreal, Quebec, Canada
- Montreal Heart Institute, Research Centre, Quebec, Canada
| | - Amer M Burhan
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Richard Camicioli
- Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Quebec, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Susan Muir-Hunter
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada
| | - Karen Z H Li
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - José A Morais
- Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada
| | - Ryota Sakurai
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
- RUIS McGill Centre of Excellence on Aging and Chronic Disease – CEViMaC, Montréal, Quebec, Canada
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Stephanie Studenski
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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Patience J, Lai KSP, Russell E, Vasudev A, Montero-Odasso M, Burhan AM. Relationship Between Mood, Thinking, and Walking: A Systematic Review Examining Depressive Symptoms, Executive Function, and Gait. Am J Geriatr Psychiatry 2019; 27:1375-1383. [PMID: 31420232 DOI: 10.1016/j.jagp.2019.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/22/2019] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
Prior literature has proposed that the coexistence of late-life depression, executive dysfunction and impaired gait speed may constitute a specific phenotype in older adults with a possible shared brain mechanism. All three conditions are independently associated with negative health outcomes including impaired function, risk of falling, and reduced quality of life. However, the existence, etiology, and implications of having all three conditions as a unitary triad remain unclear. This systematic review examined the literature to assess the consistency of this triad and to explore the possible role of frontal-subcortical circuitry in its etiology. English language literature that assessed mood, executive function, and gait speed using a validated tool in human participants over age 65 were included for this review. Following the PRISMA guidelines, 15 studies including 11,213 participants met criteria for inclusion in this study. The triad's existence was supported by 12 of the 15 studies (80%), including 4 longitudinal studies involving 368 participants. A prevalence of 17% was reported in one population study. The three included intervention studies provided mixed results regarding the benefit of pharmacologic and exercise interventions. Two studies assessed the association between presence of white matter hyperintensities and the triad, with one study finding a significant longitudinal relationship with periventricular white matter hyperintensities. Vascular risk factors were also commonly associated with this triad. Taken together, the relationship between this triad, the vascular depression hypothesis, and frontal-subcortical pathology is suggested. Further longitudinal research is needed to further clarify the etiology and clinical relevance of this concomitant prescence oflate-life depression, executive dysfunction and impaired gait speed.
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Affiliation(s)
- James Patience
- Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada
| | - Ka Sing Paris Lai
- Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada
| | - Elizabeth Russell
- Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada
| | - Akshya Vasudev
- Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada
| | - Manuel Montero-Odasso
- Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada
| | - Amer M Burhan
- Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada.
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Knuff A, Leung RH, Seitz DP, Pallaveshi L, Burhan AM. Use of Actigraphy to Measure Symptoms of Agitation in Dementia. Am J Geriatr Psychiatry 2019; 27:865-869. [PMID: 30952608 DOI: 10.1016/j.jagp.2019.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/11/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and validity of actigraphy as a measurement of agitation in dementia. METHODS Participants aged 65 and older, diagnosed with dementia, residing in a geriatric psychiatry inpatient unit or long-term care facility were included in a cross-sectional study. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI). Actigraphy was measured over seven days and compared across groups categorized as low or high agitation based on a CMAI cutoff score of 50. RESULTS Twenty participants were enrolled (mean age = 74.3 years, standard deviation [SD] = 8.69). The 24-hour mean motor activity as measured with actigraphy was significantly different between the low and high agitation groups (180.23, SD = 86.34 versus 81.51, SD = 30.29, Z = 2.29; p = 0.02). Most actigraph variables had significant correlations with CMAI and NPI scores. CONCLUSION Actigraphy was highly correlated with informant-based methods for measuring agitation in individuals with dementia and actigraphy may be useful tool for measuring agitation.
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Affiliation(s)
- Amber Knuff
- Centre for Neuroscience Studies (AK, DPS), Queen's University, Kingston; Hamilton Health Sciences Centre (AK), Hamilton
| | - Roxanne H Leung
- Department of Psychiatry (RHL, DPS), School of Medicine, Queen's University, Kingston
| | - Dallas P Seitz
- Centre for Neuroscience Studies (AK, DPS), Queen's University, Kingston; Department of Psychiatry (RHL, DPS), School of Medicine, Queen's University, Kingston.
| | - Luljeta Pallaveshi
- Department of Psychiatry (LP, AMB), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Amer M Burhan
- Department of Psychiatry (LP, AMB), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Rudak PT, Gangireddy R, Choi J, Burhan AM, Summers KL, Jackson DN, Inoue W, Haeryfar SMM. Stress-elicited glucocorticoid receptor signaling upregulates TIGIT in innate-like invariant T lymphocytes. Brain Behav Immun 2019; 80:793-804. [PMID: 31108170 DOI: 10.1016/j.bbi.2019.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/24/2018] [Revised: 03/22/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022] Open
Abstract
Stress is known to impede certain host defense mechanisms, including those governed by conventional T lymphocytes. However, whether innate-like T lymphocytes, such as invariant natural killer T (iNKT) and mucosa-associated invariant T (MAIT) cells, are impacted by stress is unclear. Herein, we report that prolonged psychological stress caused by physical confinement results in robust upregulation of T cell immunoreceptor with immunoglobulin and ITIM domains (TIGIT), an immune checkpoint receptor that controls antitumor and antiviral immune responses. Elevated TIGIT expression was found not only on NK and conventional T cells, but also on iNKT and MAIT cells. Stress-provoked TIGIT upregulation was reversed through treatment with the glucocorticoid receptor (GR) antagonist RU486, but not with 6-hydroxydopamine that induces chemical sympathectomy. A Cre/Lox gene targeting model in which GR was ablated in cells expressing Lck under its proximal promoter revealed that TIGIT upregulation in stressed animals stems from direct GR signaling in T and iNKT cells. In fact, long-term oral administration of exogenous corticosterone (CS) to wild-type C57BL/6 (B6) mice was sufficient to increase TIGIT expression levels on T and iNKT cells. In vitro treatment with CS also potently and selectively upregulated TIGIT, but not CTLA-4 or LAG-3, on mouse iNKT and MAIT hybridomas. These results were recapitulated using primary hepatic iNKT and MAIT cells from wild-type B6 and B6.MAITCAST mice, respectively. Subjecting B6.MAITCAST mice to physical restraint also raised the frequency of TIGIT+ cells among hepatic MAIT cells in a GR-dependent manner. Finally, we found that TIGIT is similarly upregulated in a chronic variable stress model in which animals are exposed to unpredictable heterotypic stressors without developing habituation. Taken together, our findings link, for the first time to our knowledge, GR signaling to TIGIT expression. We propose that glucocorticoid hormones dampen immune responses, in part, by enhancing TIGIT expression across multiple critical subsets of effector lymphocytes, including innate-like T cells. Therefore, TIGIT may constitute an attractive target in immune-enhancing interventions for sustained physiological stress.
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Affiliation(s)
- Patrick T Rudak
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Rakshith Gangireddy
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Joshua Choi
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Amer M Burhan
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Kelly L Summers
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Dwayne N Jackson
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Wataru Inoue
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - S M Mansour Haeryfar
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada; Department of Medicine, Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada; Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada.
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Kumar S, Shanbhag A, Davies S, Kim D, Gerretsen P, Graff-Guerrero A, Colman S, Awan S, Simmons J, Burhan AM, Pollock BG, Mulsant B, Rajji TK. P4-222: INTEGRATED CARE PATHWAY FOR AGITATION IN ALZHEIMER'S DEMENTIA. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sanjeev Kumar
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Amruta Shanbhag
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Simon Davies
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Donna Kim
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Philip Gerretsen
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Ariel Graff-Guerrero
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Sarah Colman
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Saima Awan
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Jyll Simmons
- Centre for Addiction and Mental Health; Toronto ON Canada
| | | | - Bruce G. Pollock
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Benoit Mulsant
- University of Toronto; Toronto ON Canada
- Centre for Addiction and Mental Health; Toronto ON Canada
| | - Tarek K. Rajji
- Centre for Addiction and Mental Health; Toronto ON Canada
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Ionson E, Limbachia J, Rej S, Puka K, Newman RI, Wetmore S, Burhan AM, Vasudev A. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression. Br J Psychiatry 2019; 214:218-224. [PMID: 30482255 DOI: 10.1192/bjp.2018.265] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 01/21/2023]
Abstract
BACKGROUND Late-life depression (LLD) is a disabling disorder and antidepressants are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for development of subsequent cardiovascular disease. Meditation-based techniques are of interest based on positive findings in other samples.AimsWe aimed to assess the efficacy of Sahaj Samadhi meditation (SSM), an underevaluated, standardised and manualised meditation intervention, on HRV and depressive symptoms. METHOD Eighty-three men and women aged 60-85 years, with mild to moderate depression and receiving treatment as usual (TAU) were randomised to either the SSM or TAU arm. Those allocated to SSM attended 4 consecutive days of group meditation training, using personalised mantras followed by 11 weekly reinforcement sessions. HRV and Hamilton Rating Scale for Depression (HRSD; 17-item) score were measured at baseline and 12 weeks. RESULTS All time and frequency domain measures of HRV did not significantly change in either arm. However, there was significant improvement in the SSM arm, compared with TAU, on the HRSD (difference in mean, 2.66; 95% CI 0.26-5.05; P = 0.03). CONCLUSIONS Compared with TAU, SSM is associated with improvements in depressive symptoms but does not significantly improve HRV in patients with LLD. These results need to be replicated in subsequent studies incorporating a group-based, active control arm.Declaration of interestR.I.N. is the Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing Sahaj Samadhi meditation. S.R. has received research funding from Satellite Healthcare for a mindfulness meditation trial in patients on haemodialysis. The remaining authors report no financial or other relationship relevant to the subject of this article.
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Affiliation(s)
- Emily Ionson
- Research Assistant,Department of Psychiatry,London Health Sciences Centre,Canada
| | - Jayneel Limbachia
- Research Assistant,Schulich School of Medicine and Dentistry, Western University,Canada
| | - Soham Rej
- Geriatric Psychiatrist,Department of Psychiatry,Lady Davis Institute/Jewish General Hospital, McGill University,Canada
| | - Klajdi Puka
- Master's student,Department of Epidemiology & Biostatistics,Western University,Canada
| | - Ronnie I Newman
- Director,Department of Research and Health Promotion,International Association of Human Values, Washington DC, USA and Faculty, Lifelong Learning Institute,Health Professions Division,Nova Southeastern University,Florida,US
| | - Stephen Wetmore
- Chair/Chief,Department of Family Medicine,Schulich School of Medicine and Dentistry, Western University,Canada
| | - Amer M Burhan
- (Psychiatry and Geriatric Psychiatry),Associate Professor,Department of Psychiatry,Schulich School of Medicine and Dentistry,Western University and Associate Scientist, Lawson Health Research Institute,Canada
| | - Akshya Vasudev
- Associate Professor of Psychiatry,Department of Psychiatry,Schulich School of Medicine and Dentistry,Western University and Associate Scientist, Lawson Health Research Institute,Canada
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Naidu AS, Vasudev A, Burhan AM, Ionson E, Montero-Odasso M. Does Dual-Task Gait Differ in those with Late-Life Depression versus Mild Cognitive Impairment? Am J Geriatr Psychiatry 2019; 27:62-72. [PMID: 30420282 DOI: 10.1016/j.jagp.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/17/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare the dual-task gait performance of older adults with Late-Life Depression (LLD) versus Mild Cognitive Impairment (MCI). DESIGN Cross-sectional study with three matched groups: LLD, MCI and non-depressed and cognitively intact (NDCI). SETTING LLD group participants were recruited from geriatric psychiatry clinics in London, Ontario. Matched participants meeting criteria for the MCI or NDCI groups were previously recruited for other research studies from geriatric clinics and the community. PARTICIPANTS Individuals aged 60-85 who met criteria for mild-moderate LLD (N=23) without a diagnosis of a neurocognitive disorder. MEASUREMENTS Participants completed questionnaires regarding mood, cognition and physical activity. Gait speed was recorded using an electronic walkway during simple and dual-task gait (walking while naming animals aloud). Dual-task cost (DTC) is the percentage change in gait speed between simple and dual-task gait. It is a clinically relevant indicator of fall risk and is strongly associated with cognitive decline. For comparison, 23 MCI and 23 NDCI participants, matched with respect to age, sex and comorbidities, were randomly selected from existing research databases. RESULTS Each group had 8 males and 15 females, with mean age of 69.0-69.6 years. The mean (±SD) DTC of the NDCI, LLD and MCI groups were statistically different at 2.4±11.4%, 11.8±9.9% and 22.2±16.7%, respectively. CONCLUSION Older adults with LLD perform worse on dual-task gait than NDCI; however, they are less impaired than those with MCI. The elevated DTC seen in LLD is likely because of underlying executive dysfunction that is less significant than in those with MCI.
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Affiliation(s)
- Anish S Naidu
- Gait and Brain Lab, Lawson Health Research Institute, London, ON; Parkwood Institute, St. Joseph's Health Care, London, ON; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Akshya Vasudev
- Gait and Brain Lab, Lawson Health Research Institute, London, ON; Parkwood Institute, St. Joseph's Health Care, London, ON; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London, ON
| | - Amer M Burhan
- Gait and Brain Lab, Lawson Health Research Institute, London, ON; Parkwood Institute, St. Joseph's Health Care, London, ON; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London, ON
| | - Emily Ionson
- Gait and Brain Lab, Lawson Health Research Institute, London, ON; Parkwood Institute, St. Joseph's Health Care, London, ON; Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London, ON
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Lawson Health Research Institute, London, ON; Parkwood Institute, St. Joseph's Health Care, London, ON; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Division of Geriatric Medicine, Department of Medicine, University of Western Ontario, London, ON.
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Kumar S, Shanbhag A, Davies S, Kim D, Gerretsen P, Graff-Guerrero A, Colman S, Awan S, Simmons J, Burhan AM, Pollock BG, Mulsant BH, Rajji TK. F4‐02‐01: ALGORITHMIC APPROACH TO THE MANAGEMENT OF AGITATION AND AGGRESSION IN ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sanjeev Kumar
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Amruta Shanbhag
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Simon Davies
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Donna Kim
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Philip Gerretsen
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Sarah Colman
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Saima Awan
- Centre for Addiction and Mental HealthTorontoONCanada
| | - Jyll Simmons
- Centre for Addiction and Mental HealthTorontoONCanada
| | | | - Bruce G. Pollock
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
| | - Tarek K. Rajji
- Centre for Addiction and Mental HealthTorontoONCanada
- University of TorontoTorontoONCanada
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Davies SJC, Burhan AM, Kim D, Gerretsen P, Graff-Guerrero A, Woo VL, Kumar S, Colman S, Pollock BG, Mulsant BH, Rajji TK. Sequential drug treatment algorithm for agitation and aggression in Alzheimer's and mixed dementia. J Psychopharmacol 2018; 32:509-523. [PMID: 29338602 PMCID: PMC5944080 DOI: 10.1177/0269881117744996] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. METHODS A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer's and mixed Alzheimer's/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. RESULTS After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. CONCLUSION This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer's/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.
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Affiliation(s)
- Simon JC Davies
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Amer M Burhan
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Geriatric Psychiatry, Western University, London, ON, Canada
| | - Donna Kim
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Philip Gerretsen
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vincent L Woo
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Kumar
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Colman
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bruce G Pollock
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Montero-Odasso M, Almeida QJ, Burhan AM, Camicioli R, Doyon J, Fraser S, Li K, Liu-Ambrose T, Middleton L, Muir-Hunter S, McIlroy W, Morais JA, Pieruccini-Faria F, Shoemaker K, Speechley M, Vasudev A, Zou GY, Berryman N, Lussier M, Vanderhaeghe L, Bherer L. SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in Gait and Cognition) a multi-Centre randomized controlled double blind trial to improve gait and cognition in mild cognitive impairment. BMC Geriatr 2018; 18:93. [PMID: 29661156 PMCID: PMC5902955 DOI: 10.1186/s12877-018-0782-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Physical exercise, cognitive training, and vitamin D are low cost interventions that have the potential to enhance cognitive function and mobility in older adults, especially in pre-dementia states such as Mild Cognitive Impairment (MCI). Aerobic and progressive resistance exercises have benefits to cognitive performance, though evidence is somewhat inconsistent. We postulate that combined aerobic exercise (AE) and progressive resistance training (RT) (combined exercise) will have a better effect on cognition than a balance and toning control (BAT) intervention in older adults with MCI. We also expect that adding cognitive training and vitamin D supplementation to the combined exercise, as a multimodal intervention, will have synergistic efficacy. Methods The SYNERGIC trial (SYNchronizing Exercises, Remedies in GaIt and Cognition) is a multi-site, double-blinded, five-arm, controlled trial that assesses the potential synergic effect of combined AE and RT on cognition and mobility, with and without cognitive training and vitamin D supplementation in older adults with MCI. Two-hundred participants with MCI aged 60 to 85 years old will be randomized to one of five arms, four of which include combined exercise plus combinations of dual-task cognitive training (real vs. sham) and vitamin D supplementation (3 × 10,000 IU/wk. vs. placebo) in a quasi-factorial design, and one arm which receives all control interventions. The primary outcome measure is the ADAS-Cog (13 and plus modalities) measured at baseline and at 6 months of follow-up. Secondary outcomes include neuroimaging, neuro-cognitive performance, gait and mobility performance, and serum biomarkers of inflammation (C reactive protein and interleukin 6), neuroplasticity (brain-derived neurotropic factor), endothelial markers (vascular endothelial growth factor 1), and vitamin D serum levels. Discussion The SYNERGIC Trial will establish the efficacy and feasibility of a multimodal intervention to improve cognitive performance and mobility outcomes in MCI. These interventions may contribute to new approaches to stabilize and reverse cognitive-mobility decline in older individuals with MCI. Trial Registration Identifier: NCT02808676. https://www.clinicaltrials.gov/ct2/show/NCT02808676. Electronic supplementary material The online version of this article (10.1186/s12877-018-0782-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada. .,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Canada.
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Canada
| | - Amer M Burhan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Richard Camicioli
- Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Montreal, Canada
| | - Sarah Fraser
- Department of Psychology-University of Ottawa, Ottawa, Canada
| | - Karen Li
- Department of Psychology and PERFORM Centre, Concordia University, Montreal, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Centre for Hip Health and Mobility, and Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Vancouver, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Susan Muir-Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto. Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - José A Morais
- Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montreal, Canada
| | - Frederico Pieruccini-Faria
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Canada
| | - Kevin Shoemaker
- Department of Kinesiology, University of Western Ontario, London, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Division of Geriatric Psychiatry and Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - G Y Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.,Robarts Clinical Trials Inc, London, Canada
| | - Nicolas Berryman
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Department of Sports Studies, Bishop's University, Sherbrooke, Canada
| | - Maxime Lussier
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Faculty of Medicine, University of Montreal, Montréal, Canada
| | | | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montreal, Canada.,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Faculty of Medicine, University of Montreal, Montréal, Canada.,Montreal Heart Institute, Research Centre, Montreal, Canada
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Hall PA, Lowe CJ, Safati AB, Li H, Klassen EB, Burhan AM. Effects of left dlPFC modulation on social cognitive processes following food sampling. Appetite 2018; 126:73-79. [PMID: 29601918 DOI: 10.1016/j.appet.2018.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/25/2017] [Revised: 03/09/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND The dorsolateral prefrontal cortex (dlPFC) plays a central role in the inhibition of eating, but also the modulation of conscious thought processes that might precede, accompany or follow initial food tasting. The latter might be particularly important to the extent that post-tasting cognitions may drive prolonged eating beyond the satiety point. However, we know very little about the effect of the dlPFC on conation following initial food sampling. This investigation compared the effects of dlPFC attenuation using repetitive transcranial magnetic stimulation (rTMS) on social cognition following (Study 1) and prior to (Study 2) a food consumption opportunity. METHODS In Study 1, participants (N = 21; Mage = 21 years) were randomized to active or sham continuous theta-burst stimulation (cTBS; an inhibitory variant of rTMS) targeting the left dlPFC followed by an interference task. Participants subsequently completed measures of attitudes, norms and perceived control following a mock taste test. In Study 2, a second sample of right handed participants (N = 37; Mage = 21 years) were assigned to active or sham cTBS, followed by an interference task and two measures of attitudes (implicit and explicit), both assessed prior to the same taste test paradigm. RESULTS In Study 1, findings revealed a reliable effect of cTBS on post-tasting attitudes (t(1,19) = 3.055, p = .007; d = 1.34), such that attitudes towards calorie dense snack foods were significantly more positive following active stimulation than following sham stimulation. Similar effects were found for social norms (t(1,19) = 3.024, p = .007, d = 1.31) and perceived control (t(1,20) = 19.247, p < .001, d = 0.50). In Study 2, no effects of cTBS were observed on pre-consumption attitudes, despite reliable effects on interference scores and subsequent consumption. CONCLUSIONS The left dlPFC may selectively modulate facilitative social cognition following initial food sampling (but not pre-consumption).
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Affiliation(s)
| | | | | | | | | | - Amer M Burhan
- Western University and Parkwood Institute-Mental Health, Canada
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McIntyre A, Mirkowski M, Thompson S, Burhan AM, Miller T, Teasell R. A Systematic Review and Meta-Analysis on the Use of Repetitive Transcranial Magnetic Stimulation for Spasticity Poststroke. PM R 2017; 10:293-302. [PMID: 29045857 DOI: 10.1016/j.pmrj.2017.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/08/2017] [Accepted: 10/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spasticity is a common and potentially debilitating complication that develops after stroke, arising in approximately 30% of patients. OBJECTIVE To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in improving spasticity after stroke. DESIGN Meta-analysis and systematic review. SETTING Not applicable. PATIENTS A total of 273 poststroke (hemorrhagic = 123, ischemic = 150) participants were included with sample sizes ranging from 5 to 80. The majority of participants were male (66.0%) with a mean age ranging from 55.0 to 64.6 years. Mean stroke duration ranged from 6 months to 10 years. METHODS A literature search of multiple databases was conducted for articles published in English from January 1980 to April 2015 using select keywords. Studies were included if (1) the population included was >50% stroke patients; (2) the sample size included ≥4 subjects; (3) the intervention applied was rTMS; and (4) upper extremity spasticity was assessed pre- and postintervention. Randomized controlled trials (RCTs) were assessed for methodologic quality with the Physiotherapy Evidence Database tool. All research designs were given a level of evidence according to a modified Sackett Scale. MAIN OUTCOME MEASUREMENTS Modified Ashworth Scale (MAS). RESULTS Ten studies met the inclusion criteria: 2 RCTs (Physiotherapy Evidence Database scores 8-9) and 8 pre-post studies. Meta-analyses of primarily uncontrolled pre-post studies found significant improvements in MAS for elbow (P < .001), wrist (P < .001), and finger flexors (P < .001). However, a meta-analysis of the 2 available RCTs failed to find a significant rTMS treatment effect on MAS for the wrist (standardized difference = .34, P = .30). CONCLUSIONS There is limited available evidence to support the use of rTMS in improving spasticity poststroke. Despite the positive findings reported, better powered and appropriately controlled trials are necessary. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Amanda McIntyre
- Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.,St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, Parkwood Institute, London; St Joseph's Health Care, Parkwood Institute, London; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Magdalena Mirkowski
- Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.,St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, Parkwood Institute, London; St Joseph's Health Care, Parkwood Institute, London; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Spencer Thompson
- Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.,St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, Parkwood Institute, London; St Joseph's Health Care, Parkwood Institute, London; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Amer M Burhan
- Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.,St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, Parkwood Institute, London; St Joseph's Health Care, Parkwood Institute, London; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Tom Miller
- Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.,St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, Parkwood Institute, London; St Joseph's Health Care, Parkwood Institute, London; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Robert Teasell
- Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.,St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, Parkwood Institute, London; St Joseph's Health Care, Parkwood Institute, London; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Vasudev A, Arena A, Burhan AM, Ionson E, Hirjee H, Maldeniya P, Wetmore S, Newman RI. A training programme involving automatic self-transcending meditation in late-life depression: preliminary analysis of an ongoing randomised controlled trial. BJPsych Open 2016; 2:195-198. [PMID: 27703774 PMCID: PMC4995575 DOI: 10.1192/bjpo.bp.115.002394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/10/2016] [Accepted: 03/23/2016] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Late-life depression affects 2-6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression. DECLARATION OF INTEREST R.I.N. is Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing ASTM training. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Akshya Vasudev
- , MBBS, MD, MRCPsych, Divisions of Geriatric Psychiatry and Clinical Pharmacology, Departments of Psychiatry and Medicine, Western University, London, Ontario, Canada
| | - Amanda Arena
- , PhD, Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada
| | - Amer M Burhan
- , MD, Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada
| | - Emily Ionson
- , HBSc, DCTM, Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada
| | - Hussein Hirjee
- , MMath, Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada
| | - Pramudith Maldeniya
- , MD, Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada
| | - Stephen Wetmore
- , MD, Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
| | - Ronnie I Newman
- , EdM, CAS, Art of Living Foundation, Canada; Nova Southeastern University Lifelong Learning Institute, Davie, FL, USA
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Burhan AM, Marlatt NM, Palaniyappan L, Anazodo UC, Prato FS. Role of Hybrid Brain Imaging in Neuropsychiatric Disorders. Diagnostics (Basel) 2015; 5:577-614. [PMID: 26854172 PMCID: PMC4728476 DOI: 10.3390/diagnostics5040577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 10/05/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 01/09/2023] Open
Abstract
This is a focused review of imaging literature to scope the utility of hybrid brain imaging in neuropsychiatric disorders. The review focuses on brain imaging modalities that utilize hybrid (fusion) techniques to characterize abnormal brain molecular signals in combination with structural and functional changes that have been observed in neuropsychiatric disorders. An overview of clinical hybrid brain imaging technologies for human use is followed by a selective review of the literature that conceptualizes the use of these technologies in understanding basic mechanisms of major neuropsychiatric disorders and their therapeutics. Neuronal network abnormalities are highlighted throughout this review to scope the utility of hybrid imaging as a potential biomarker for each disorder.
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Affiliation(s)
- Amer M Burhan
- St. Joseph's Health Care London, Parkwood Institute, 550 Wellington Road, London, ON N6C 0A7, Canada.
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6C 2R6, Canada.
| | - Nicole M Marlatt
- St. Joseph's Health Care London, Parkwood Institute, 550 Wellington Road, London, ON N6C 0A7, Canada.
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6C 2R6, Canada.
| | | | - Frank S Prato
- Lawson Health Research Institute, London, ON N6C 2R5, Canada.
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Amtul Z, Arena A, Hirjee H, Khan ZU, Maldeniya PM, Newman RI, Burhan AM, Wetmore S, Vasudev A. A randomized controlled longitudinal naturalistic trial testing the effects of automatic self transcending meditation on heart rate variability in late life depression: study protocol. Altern Ther Health Med 2014; 14:307. [PMID: 25134497 PMCID: PMC4147184 DOI: 10.1186/1472-6882-14-307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/14/2014] [Indexed: 01/09/2023]
Abstract
Background The prevalence and socioeconomic cost of late life depression (LLD) is on the rise, while the response rate to antidepressant trials remains poor. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective, yet little is known regarding the effectiveness of such therapies to improve LLD symptoms. Among the mind-body therapies currently in practice, the results of our pilot study have shown that a particular meditation technique called Sahaj Samadhi Meditation, which belongs to the category of meditation termed automatic self-transcending meditation (ASTM) may have some promise in improving cardiovascular autonomic disturbances associated with LLD as well as ameliorating symptoms of depression and anxiety. Methods/Design Patients between the ages of 60 and 85 with LLD will be randomized either to ASTM plus treatment as usual (TAU) or TAU alone to assess changes in cardiovascular autonomic parameters, neuropsychological symptoms of depression and anxiety as well as quality of life. The instructional phase of the intervention consists of 4 consecutive days of meditation training, after which participants are encouraged to meditate twice daily for twenty minutes each time at home. The intervention also includes once weekly follow up sessions for the subsequent 11 weeks. The planned study has one and a half year recruitment period. Participants will be assessed at baseline and at 4, 8, 12 and 24 weeks post intervention. Discussion This study should provide a unique data source from a randomized, controlled, longitudinal trial to investigate the effects of a form of ASTM on cardiovascular autonomic and neuropsychological health in LLD. Trial registration Clinicaltrials.gov NCT02149810, date registered: 05/28/2014.
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Burhan AM, Bartha R, Bocti C, Borrie M, Laforce R, Rosa-Neto P, Soucy JP. Role of emerging neuroimaging modalities in patients with cognitive impairment: a review from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers Res Ther 2013; 5:S4. [PMID: 24565285 PMCID: PMC3981649 DOI: 10.1186/alzrt200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) was held 3 to 4 May 2012 in Montreal, Quebec, Canada. A group of neuroimaging experts were assigned the task of reviewing and summarizing the literature on clinical and research applications of different neuroimaging modalities in cognitive disorders. This paper summarizes the literature and recommendations made to the conference regarding the role of several emerging neuroimaging modalities in cognitive disorders. Functional magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and diffusion tensor imaging are discussed in detail within this paper. Other emergent neuroimaging modalities such as positron emission tomography with novel ligands, high-field MRI, arterial spin labeling MRI and noncerebral blood flow single-photon emission computerized tomography are only discussed briefly. Neuroimaging modalities that were recommended at the CCCDTD4 for both clinical and research applications such as amyloid and flurodeoxyglucose positron emission tomography, computerized tomography and structural MRI are discussed in a separate paper by the same authors. A literature search was conducted using the PubMed database including articles in English that involved human subjects and covered the period from the last CCCDTD publication (CCCDTD3; January 2006) until April 2012. Search terms included the name of the specific modality, dementia, Alzheimer's disease, and mild cognitive impairment. A separate search used the same parameters but was restricted to review articles to identify recent evidence-based reviews. Case studies and small case series were not included. Papers representing current evidence were selected, reviewed, and summarized, and the results were presented at the CCCDTD4 meeting with recommendations regarding the utility of various neuroimaging modalities in cognitive disorders. The evidence was graded according to the Oxford Centre for Evidence Based Medicine guidelines. Due to the limitations of current evidence, the neuroimaging modalities discussed in this paper were not recommended for clinical investigation of patients presenting with cognitive impairment. However, in the research setting, each modality provides a unique contribution to the understanding of basic mechanisms and neuropathological markers of cognitive disorders, to the identification of markers for early detection and for the risk of conversion to dementia in the at-risk populations, to the differentiation between different types of cognitive disorders, and to the identification of treatment targets and indicators of treatment response. In conclusion, for all of the neuroimaging modalities discussed in this paper, further studies are needed to establish diagnostic utility such as validity, reliability, and predictive and prognostic value. More multicenter studies are therefore needed with standardized image acquisition, experimental protocols, definition of the clinical population studied, larger numbers of participants, and longer duration of follow-up to allow generalizability of the results to the individual patient.
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Soucy JP, Bartha R, Bocti C, Borrie M, Burhan AM, Laforce R, Rosa-Neto P. Clinical applications of neuroimaging in patients with Alzheimer's disease: a review from the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers Res Ther 2013; 5:S3. [PMID: 24565260 PMCID: PMC3980588 DOI: 10.1186/alzrt199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In May 2012, the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia brought together in Montreal experts from around Canada to update Canadian recommendations for the diagnosis and management of patients with neurodegenerative conditions associated with deterioration of cognition. Multiple topics were discussed. The present paper is a highly condensed version of those recommendations that were produced to support discussions in the field of neuroimaging for clinical diagnosis of those conditions.
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Affiliation(s)
- Jean-Paul Soucy
- PET Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada H3A 2B4
| | - Robert Bartha
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Christian Bocti
- Service de Neurologie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Borrie
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Amer M Burhan
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Université Lava, Quebec, Quebec, Canada
| | - Pedro Rosa-Neto
- Translational Neuroinmaging Laboratory, McGill Centre for Studies in Aging, Douglas Research Institute, McGill University, Montreal, Quebec, Canada
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Levy-Cooperman N, Burhan AM, Rafi-Tari S, Kusano M, Ramirez J, Caldwell C, Black SE. Frontal lobe hypoperfusion and depressive symptoms in Alzheimer disease. J Psychiatry Neurosci 2008; 33:218-26. [PMID: 18592038 PMCID: PMC2441884] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Depressive symptoms of varying severity are prevalent in up to 63% of Alzheimer disease (AD) patients and often result in greater cognitive decline and increased caregiver burden. The current study aimed to determine the neural correlates of depressive symptoms in a sample of AD patients. METHODS Using the Cornell Scale for Depression in Dementia, we assessed 56 patients who met criteria for probable AD. Data obtained from Technetium-99m ethyl cysteinate dimer single photon emission computed tomography (SPECT) were analyzed with the use of a magnetic resonance imaging-derived region of interest (ROI) anatomic template before and after atrophy correction and statistical parametric mapping (SPM). The following 4 frontal ROIs were investigated bilaterally: middle frontal gyrus (Brodmann's area [BA] 46), orbitofrontal cortex (BA 11), superior prefrontal (BA 8/9) and anterior cingulate (BA 24/25/32/33). RESULTS Depressive symptoms were present in 27 of the AD patients (48%). Patients with depressive symptoms showed less perfusion in the right superior and bilateral middle frontal gyri (p < 0.005), left superior frontal (p < 0.05) and anterior cingulate gyri (p < 0.005) before atrophy correction. SPM analyses revealed significantly lower perfusion in bilateral dorsolateral and superior prefrontal cortex of patients with depressive symptoms (right, p < 0.005; left, p < 0.05). SPECT ROI analyses with atrophy correction revealed trends similar to data without atrophy correction but did not reach statistical significance. CONCLUSION In this study, depressive symptoms in AD patients were associated with relative hypoperfusion in the prefrontal cortex when they were compared with AD patients without depressive symptoms. These findings are consistent with previous reports in studies of primary depression suggesting that these regions are involved in affect and emotional regulation.
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Affiliation(s)
- Naama Levy-Cooperman
- Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario.
| | - Amer M. Burhan
- Levy-Cooperman, Rafi-Tari, Ramirez, Black — Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto; Burhan — Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London; Kusano — Department of Imaging Research; Ramirez, Black — Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre; Black — Division of Neurology, Department of Medicine; Caldwell — Department of Medical Physics; Ramirez, Caldwell, Black — Institute of Medical Science, University of Toronto, Toronto, Ont.
| | - Shahryar Rafi-Tari
- Levy-Cooperman, Rafi-Tari, Ramirez, Black — Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto; Burhan — Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London; Kusano — Department of Imaging Research; Ramirez, Black — Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre; Black — Division of Neurology, Department of Medicine; Caldwell — Department of Medical Physics; Ramirez, Caldwell, Black — Institute of Medical Science, University of Toronto, Toronto, Ont.
| | - Maggie Kusano
- Levy-Cooperman, Rafi-Tari, Ramirez, Black — Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto; Burhan — Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London; Kusano — Department of Imaging Research; Ramirez, Black — Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre; Black — Division of Neurology, Department of Medicine; Caldwell — Department of Medical Physics; Ramirez, Caldwell, Black — Institute of Medical Science, University of Toronto, Toronto, Ont.
| | - Joel Ramirez
- Levy-Cooperman, Rafi-Tari, Ramirez, Black — Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto; Burhan — Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London; Kusano — Department of Imaging Research; Ramirez, Black — Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre; Black — Division of Neurology, Department of Medicine; Caldwell — Department of Medical Physics; Ramirez, Caldwell, Black — Institute of Medical Science, University of Toronto, Toronto, Ont.
| | - Curtis Caldwell
- Levy-Cooperman, Rafi-Tari, Ramirez, Black — Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto; Burhan — Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London; Kusano — Department of Imaging Research; Ramirez, Black — Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre; Black — Division of Neurology, Department of Medicine; Caldwell — Department of Medical Physics; Ramirez, Caldwell, Black — Institute of Medical Science, University of Toronto, Toronto, Ont.
| | - Sandra E. Black
- Levy-Cooperman, Rafi-Tari, Ramirez, Black — Linda C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto; Burhan — Division of Geriatric Psychiatry, Department of Psychiatry, University of Western Ontario, London; Kusano — Department of Imaging Research; Ramirez, Black — Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre; Black — Division of Neurology, Department of Medicine; Caldwell — Department of Medical Physics; Ramirez, Caldwell, Black — Institute of Medical Science, University of Toronto, Toronto, Ont.
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Cain NN, Davidson PW, Burhan AM, Andolsek ME, Baxter JT, Sullivan L, Florescue H, List A, Deutsch L. Identifying bipolar disorders in individuals with intellectual disability. J Intellect Disabil Res 2003; 47:31-38. [PMID: 12558693 DOI: 10.1046/j.1365-2788.2003.00458.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM-IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses. METHODS A retrospective chart review was done of a convenience sample of adult patients seen over a 3-year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM-IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups. RESULTS Subjects with clinical symptoms of BPD had significantly more DSM-IV mood-related and non-mood-related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups. CONCLUSIONS Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM-IV criteria can be useful in the diagnosis of BPD.
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Affiliation(s)
- N N Cain
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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49
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Sadikot AF, Burhan AM, Bélanger MC, Sasseville R. NMDA receptor antagonists influence early development of GABAergic interneurons in the mammalian striatum. Brain Res Dev Brain Res 1998; 105:35-42. [PMID: 9497077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurotransmitters influence a wide variety of developmental processes. We hypothesize that N-methyl-D-aspartate (NMDA) glutamate receptors influence proliferation of populations of forebrain neurons. As our model, we use a subclass of GABAergic striatal interneurons that express the calcium binding protein parvalbumin (PV). To separate proliferative and post-proliferative effects of NMDA receptor antagonists on PV neurons, we first determined the birth-date of rat striatum PV neurons at the coronal level selected for analysis. Dividing striatal progenitor cells were marked by intraperitoneal injections of 5'-bromodeoxyuridine (BrdU) given to timed pregnant rats at selected time points between embryonic days (E) 12-22. Double immunohistochochemistry for BrdU and PV was used in adult progeny to determine the time course of neurogenesis of striatal PV neurons. The results of the neurogenetic analysis were then used for rational timing of treatment with competitive (CGS 19755) and non-competitive (MK-801) NMDA receptor antagonists. In comparison to pair-fed and vehicle-injected controls, gestational rats given CGS-19755 and MK-801 during the proliferative phase (E15-E18) showed a marked reduction of striatal PV neuron cell density as adults. In contrast, animals given NMDA antagonists during the post-proliferative period (E18-E21) showed no significant reduction in PV neuron cell density compared to pair-fed controls. These results suggest that glutamate influences cell proliferation of a population of striatal neurons by an NMDA-mediated mechanism, providing evidence for a novel role for excitatory amino acids in early forebrain development.
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Affiliation(s)
- A F Sadikot
- Department of Neurology and Neurosurgery, Montreal Neurological Institute McGill University, Quebec, Canada
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