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Poulin SP, Bergeron D, Dickerson BC. Risk Factors, Neuroanatomical Correlates, and Outcome of Neuropsychiatric Symptoms in Alzheimer's Disease. J Alzheimers Dis 2018; 60:483-493. [PMID: 28869463 DOI: 10.3233/jad-160767] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 01/12/2023]
Abstract
BACKGROUND An integrative model of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) is lacking. OBJECTIVE In this study, we investigated the risk factors, anatomy, biology, and outcomes of NPS in AD. METHODS 181 subjects were included from the Alzheimer's Disease Neuroimaging Study (ADNI). NPS were assessed with the Neuropsychiatric Inventory Questionnaire at baseline and 6 months. NPI >3 was used as a threshold for NPS positivity. Three NPS courses were characterized: 1) minimal/absent (negative at 0 and 6 months, n = 77); 2) fluctuating (positive only at one time point, n = 53); 3) persistent (positive at both time points, n = 51). We examined the association between NPS course and family history of dementia, personal history of psychiatric disorders, cerebrospinal fluid biomarkers, atrophy patterns, as well as longitudinal cognitive and functional measures at 12 and 24 months (MMSE, CDR-SOB, FAQ). RESULTS AD subjects with absent, fluctuating, or persistent NPS had similar CSF amyloid-β and tau levels. AD subjects with minimal/absent NPS had less personal history of psychiatric disorders (35%) than those with fluctuating (57%; p = 0.015) or persistent NPS (47%, not significant). At 24 months, AD subjects with persistent NPS had worse cognitive (MMSE; p = 0.05) and functional (CDR-SOB; p = 0.016) outcomes. Dorsolateral prefrontal atrophy was seen in persistent NPS, but not in fluctuating NPS. CONCLUSIONS Our results suggest that individuals with personal history of psychiatric disorders might be more vulnerable to develop NPS throughout the course of AD. The worst cognitive and functional outcomes associated with NPS in AD underscores the importance of monitoring NPS early in the disease course.
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Affiliation(s)
- Stéphane P Poulin
- Clinique Interdisciplinaire de la Mémoire, Centre Hositalier Universitaire de Québec, Quebec City, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec (CRISUMQ), QC, Canada
| | - David Bergeron
- Clinique Interdisciplinaire de la Mémoire, Centre Hositalier Universitaire de Québec, Quebec City, QC, Canada
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Frontotemporal Dementia Unit, Massachusetts General Hospital, Charlestown, MA, USA.,Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Charlestown, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
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Poulin SP, Dautoff R, Morris JC, Barrett LF, Dickerson BC. Amygdala atrophy is prominent in early Alzheimer's disease and relates to symptom severity. Psychiatry Res 2011; 194:7-13. [PMID: 21920712 PMCID: PMC3185127 DOI: 10.1016/j.pscychresns.2011.06.014] [Citation(s) in RCA: 244] [Impact Index Per Article: 18.8] [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: 12/14/2010] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
Abstract
Despite numerous studies on the role of medial temporal lobe structures in Alzheimer's disease (AD), the magnitude and clinical significance of amygdala atrophy have been relatively sparsely investigated. In this study, we used magnetic resonance imaging (MRI) to compare the level of amygdala atrophy to that of the hippocampus in very mild and mild AD subjects in two large samples (Sample 1 n=90; Sample 2 n=174). Using a series of linear regression analyses, we investigated whether amygdala atrophy is related to global cognitive functioning (Clinical Dementia Rating Sum of Boxes: CDR-SB; Mini Mental State Examination: MMSE) and neuropsychiatric status. Results indicated that amygdala atrophy was comparable to hippocampal atrophy in both samples. MMSE and CDR-SB were strongly related to amygdala atrophy, with amygdala atrophy predicting MMSE scores as well as hippocampal atrophy, but predicting CDR-SB scores less robustly. Amygdala atrophy was related to aberrant motor behavior, with potential relationships to anxiety and irritability. These results suggest that the magnitude of amygdala atrophy is comparable to that of the hippocampus in the earliest clinical stages of AD, and is related to global illness severity. There also appear to be specific relationships between the level of amygdala atrophy and neuropsychiatric symptoms that deserve further investigation.
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Affiliation(s)
- Stéphane P. Poulin
- Department Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca Dautoff
- Department Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John C. Morris
- Department of Neurology and Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Feldman Barrett
- Department Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Psychology, Northeastern University, Boston, MA, USA
| | - Bradford C. Dickerson
- Department Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Frontotemporal Dementia Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Corresponding author: Bradford C. Dickerson, M.D., Frontotemporal Dementia Unit, Massachusetts General Hospital, 149 13th St., Suite 2691, Charlestown, MA 02129, Tel: (617) 726-5571, Fax: (617) 726-5760,
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