1
|
Čepukaitytė G, Newton C, Chan D. Early detection of diseases causing dementia using digital navigation and gait measures: A systematic review of evidence. Alzheimers Dement 2024; 20:3054-3073. [PMID: 38425234 PMCID: PMC11032572 DOI: 10.1002/alz.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
Wearable digital technologies capable of measuring everyday behaviors could improve the early detection of dementia-causing diseases. We conducted two systematic reviews following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to establish the evidence base for measuring navigation and gait, two everyday behaviors affected early in AD and non-AD disorders and not adequately measured in current practice. PubMed and Web of Science databases were searched for studies on asymptomatic and early-stage symptomatic individuals at risk of dementia, with the Newcastle-Ottawa Scale used to assess bias and evaluate methodological quality. Of 316 navigation and 2086 gait records identified, 27 and 83, respectively, were included in the final sample. We highlight several measures that may identify at-risk individuals, whose quantifiability with different devices mitigates the risk of future technological obsolescence. Beyond navigation and gait, this review also provides the framework for evaluating the evidence base for future digital measures of behaviors considered for early disease detection.
Collapse
|
2
|
Ferraro PM, Gervino E, De Maria E, Meo G, Ponzano M, Pardini M, Signori A, Schenone A, Roccatagliata L, Caponnetto C. Mild behavioral impairment as a potential marker of predementia risk states in motor neuron diseases. Eur J Neurol 2023; 30:47-56. [PMID: 36148819 PMCID: PMC10091712 DOI: 10.1111/ene.15570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Mild behavioral impairment (MBI) has been increasingly regarded as the neurobehavioral axis of predementia risk states, but a specific investigation of its detection as a potential marker of prodromal dementia in motor neuron diseases (MNDs) is still lacking. The aims of our study were therefore to explore MBI in MNDs both at onset and over the disease course, and to evaluate its relationship with baseline and longitudinal cognitive features. METHODS Sixty MND patients with cognitive/behavioral, mood, and motor examinations were recruited and followed longitudinally for up to 15 months. Associations between baseline MBI symptoms and clinical features were tested using the Spearman correlation coefficient. Based on longitudinal data, relative deltas of variation for each cognitive measure were generated, and linear regression models were then used to evaluate the role of baseline MBI symptoms in predicting longitudinal rates of cognitive decline. RESULTS At disease onset, the most impaired MBI domain was affective/emotional dysregulation, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms correlated with more severe baseline motor, cognitive/behavioral, and mood disturbances (p values from <0.001 to 0.05). Longitudinally, the greatest decline was observed in the affective/emotional dysregulation domain, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms at onset were significant predictors of more severe longitudinal cognitive decline in both amyotrophic lateral sclerosis (ALS)-specific and ALS-nonspecific functions (p values from <0.001 to 0.03). CONCLUSIONS MBI represents a valuable clinical marker of incident cognitive decline in MNDs, and its evaluation has good potential for detecting dementia in its preclinical/prodromal phase.
Collapse
Affiliation(s)
- Pilar M Ferraro
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ester Gervino
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emiliano De Maria
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Meo
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Angelo Schenone
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | |
Collapse
|
3
|
Wallert J, Rennie A, Ferreira D, Muehlboeck JS, Wahlund LO, Westman E, Ekman U; ADNI consortium, and MemClin steering committee. Cognitive dedifferentiation as a function of cognitive impairment in the ADNI and MemClin cohorts. Aging (Albany NY) 2021; 13:13430-42. [PMID: 34038387 DOI: 10.18632/aging.203108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
The cause of cognitive dedifferentiation has been suggested as specific to late-life abnormal cognitive decline rather than a general feature of aging. This hypothesis was tested in two large cohorts with different characteristics. Individuals (n = 2710) were identified in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) research database (n = 1282) in North America, and in the naturalistic multi-site MemClin Project database (n = 1223), the latter recruiting from 9 out of 10 memory clinics in the greater Stockholm catchment area in Sweden. Comprehensive neuropsychological testing informed diagnosis of dementia, mild cognitive impairment (MCI), or subjective cognitive impairment (SCI). Diagnosis was further collapsed into cognitive impairment (CI: MCI or dementia) vs no cognitive impairment (NCI). After matching, loadings on the first principal component were higher in the CI vs NCI group in both ADNI (53.1% versus 38.3%) and MemClin (33.3% vs 30.8%). Correlations of all paired combinations of individual tests by diagnostic group were also stronger in the CI group in both ADNI (mean inter-test r = 0.51 vs r = 0.33, p < 0.001) and MemClin (r = 0.31 vs r = 0.27, p = 0.042). Dedifferentiation was explained by cognitive impairment when controlling for age, sex, and education. This finding replicated across two separate, large cohorts of older individuals. Knowledge that the structure of human cognition becomes less diversified and more dependent on general intelligence as a function of cognitive impairment should inform clinical assessment and care for these patients as their neurodegeneration progresses.
Collapse
|
4
|
Abbate C, Trimarchi PD, Inglese S, Gallucci A, Tomasini E, Bagarolo R, Giunco F. The Two-Step Strategy Could Be Inadequate and Counteracting to Diagnose Prodromal Dementia or Mild Cognitive Impairment. Front Aging Neurosci 2020; 12:229. [PMID: 32848708 PMCID: PMC7426713 DOI: 10.3389/fnagi.2020.00229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlo Abbate
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Gallucci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | | | | |
Collapse
|
5
|
Koychev I, Lawson J, Chessell T, Mackay C, Gunn R, Sahakian B, Rowe JB, Thomas AJ, Rochester L, Chan D, Tom B, Malhotra P, Ballard C, Chessell I, Ritchie CW, Raymont V, Leroi I, Lengyel I, Murray M, Thomas DL, Gallacher J, Lovestone S. Deep and Frequent Phenotyping study protocol: an observational study in prodromal Alzheimer's disease. BMJ Open 2019; 9:e024498. [PMID: 30904851 PMCID: PMC6475176 DOI: 10.1136/bmjopen-2018-024498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Recent failures of potential novel therapeutics for Alzheimer's disease (AD) have prompted a drive towards clinical studies in prodromal or preclinical states. However, carrying out clinical trials in early disease stages is extremely challenging-a key reason being the unfeasibility of using classical outcome measures of dementia trials (eg, conversion to dementia) and the lack of validated surrogate measures so early in the disease process. The Deep and Frequent Phenotyping (DFP) study aims to resolve this issue by identifying a set of markers acting as indicators of disease progression in the prodromal phase of disease that could be used as indicative outcome measures in proof-of-concept trials. METHODS AND ANALYSIS The DFP study is a repeated measures observational study where participants will be recruited through existing parent cohorts, research interested lists/databases, advertisements and memory clinics. Repeated measures of both established (cognition, positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) markers of pathology, structural MRI markers of neurodegeneration) and experimental modalities (functional MRI, magnetoencephalography and/or electroencephalography, gait measurement, ophthalmological and continuous smartphone-based cognitive and other assessments together with experimental CSF, blood, tear and saliva biomarkers) will be performed. We will be recruiting male and female participants aged >60 years with prodromal AD, defined as absence of dementia but with evidence of cognitive impairment together with AD pathology as assessed using PET imaging or CSF biomarkers. Control participants without evidence of AD pathology will be included at a 1:4 ratio. ETHICS AND DISSEMINATION The study gained favourable ethical opinion from the South Central-Oxford B NHS Research Ethics Committee (REC reference 17/SC/0315; approved on 18 August 2017; amendment 13 February 2018). Data will be shared with the scientific community no more than 1 year following completion of study and data assembly.
Collapse
Affiliation(s)
- Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Tharani Chessell
- IMED Neuroscience, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, UK
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Roger Gunn
- Invicro, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - Barbara Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis Chan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, Cambridge, Cambridgeshire, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Paresh Malhotra
- Department of Neurology, Imperial College London Faculty of Medicine, London, UK
| | | | - Iain Chessell
- IMED Neuroscience, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, UK
| | - Craig W Ritchie
- Department of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Iracema Leroi
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour, and Mental Health, Manchester, UK
| | | | | | - David L Thomas
- Leonard Wolfson Experimental Neurology Centre, University College London Institute of Neurology, London, London, UK
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | |
Collapse
|
6
|
Mortby ME, Ismail Z, Anstey KJ. Prevalence estimates of mild behavioral impairment in a population-based sample of pre-dementia states and cognitively healthy older adults. Int Psychogeriatr 2018; 30:221-32. [PMID: 28931446 DOI: 10.1017/S1041610217001909] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A dearth of population-based epidemiological research examines neuropsychiatric symptom (NPS) in sub-clinical populations across the spectrum from normal aging to mild cognitive impairment (MCI). The construct of mild behavioral impairment (MBI) describes the emergence of sustained and impactful NPS in advance of or in combination with MCI. This is the first epidemiological study to operationalize the recently published diagnostic criteria for MBI and determine prevalence estimates across the spectrum from cognitively normal to MCI. METHODS MBI was assessed in 1,377 older (age range 72-79 years; 52% male; MCI ;= 133; cognitively normal, but-at-risk = 397; cognitively healthy = 847). MBI was assessed in accordance with the ISTAART-AA diagnostic criteria for MBI using the neuropsychiatric inventory. RESULTS 34.1% of participants met the criteria for MBI. High prevalence of MBI across the cognitive spectrum was reported (48.9% vs. 43.1% vs. 27.6%). Irrespective of level of cognitive impairment, impulse dyscontrol (33.8% vs. 28.7% vs. 17.2%) and decreased motivation (32.3% vs. 26.2% vs. 16.3%) were the most frequently met MBI domains. MBI was more prevalent in men (χ2 = 4.98, p = 0.026), especially the domains of decreased motivation and impulse dyscontrol. CONCLUSIONS This study presents the first population-based prevalence estimates for MBI using the recently published ISTAART-AA diagnostic criteria. Findings indicate relatively high prevalence of MBI in pre-dementia clinical states and amongst cognitively healthy older adults. Findings were gender-specific, with MBI affecting more men than women. Knowing the estimates of these symptoms in the population is essential for understanding and differentiating the very early development of clinical disorders.
Collapse
|
7
|
Sheikh F, Ismail Z, Mortby ME, Barber P, Cieslak A, Fischer K, Granger R, Hogan DB, Mackie A, Maxwell CJ, Menon B, Mueller P, Patry D, Pearson D, Quickfall J, Sajobi T, Tse E, Wang M, Smith EE; PROMPT registry investigators. Prevalence of mild behavioral impairment in mild cognitive impairment and subjective cognitive decline, and its association with caregiver burden. Int Psychogeriatr 2018; 30:233-44. [PMID: 28879833 DOI: 10.1017/S104161021700151X] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic. METHODS MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment - Alzheimer's Association (ISTAART-AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden. RESULTS While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001). CONCLUSIONS MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.
Collapse
|
8
|
Cieslak A, Smith EE, Lysack J, Ismail Z. Case series of mild behavioral impairment: toward an understanding of the early stages of neurodegenerative diseases affecting behavior and cognition. Int Psychogeriatr 2018; 30:273-80. [PMID: 29017626 DOI: 10.1017/S1041610217001855] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mild behavioral impairment (MBI) is characterized by later life acquired, sustained, and impactful neuropsychiatric symptoms (NPS) of any severity that cannot be better accounted for by other formal medical and psychiatric nosology. MBI is an "at risk" state for incident cognitive decline and dementia, and for some, MBI is the index manifestation of neurodegeneration, observed in advance of cognitive impairment. Initially described in Frontotemporal Dementia (FTD), MBI evolved to describe a preclinical stage of all cause dementia, and has been operationalized in the International Society to Advance Alzheimer's Research and Treatment-Alzheimer's Association (ISTAART-AA) proposed research diagnostic criteria. Here, we describe three cases in which patients diagnosed with a variety of dementing conditions initially presented with NPS to the Cognitive Neurosciences Clinic at the University of Calgary, Canada. All patients described in our series were given a final diagnosis of dementia; the etiology supported by clinical, cognitive, and neuroimaging findings. In all three cases, the progression to dementia was preceded by NPS that meet criteria for MBI. With these examples, we are able to illustrate that MBI can represent a premonitory stage of dementia of different etiologies. These cases demonstrate early use of the MBI checklist (MBI-C). The cases presented in this series serve as examples of NPS as early manifestations of dementia. Our case examples include both FTD and AD, and demonstrate that before a diagnosis of a neurodegenerative disease is considered, often patients will be diagnosed with and treated for a psychiatric condition. These early NPS can be characterized within the domains outlined in the ISTAART-AA MBI criteria, and detected with the MBI-C, which may help clinicians consider neurodegenerative disease in the differential diagnosis of later life onset psychiatric symptomatology.
Collapse
|
9
|
Abstract
BACKGROUND Apathy, characterized by diminished motivation, is a highly prevalent neuropsychiatric symptom in dementia. However, there is a substantial knowledge gap with regard to prevalence rates, neurobiological underpinnings, and effective treatments for apathy in pre-dementia states, including mild cognitive impairment (MCI) and mild behavioral impairment (MBI). METHODS We conducted a comprehensive literature search using MEDLINE, Embase, and PsycINFO databases to identify available research on apathy in prodromal dementia. RESULTS Apathy has consistently been detected in individuals with MCI with varying prevalence rates, and only recently has literature discussed the prevalence of apathy in MBI. Few pharmacological treatments have been utilized for apathy, with galantamine and risperidone showing mild reductions in apathetic behaviors. Non-pharmacological interventions in prodromal dementia are beginning to be explored and show promise, but few studies have replicated those results. DISCUSSION More comprehensive guidelines for diagnosing apathy and further research investigating neurobiological mechanisms of apathy in MCI and MBI are required in order to effectively treat apathetic patients in prodromal dementia.
Collapse
|
10
|
Ismail Z, Gatchel J, Bateman DR, Barcelos-Ferreira R, Cantillon M, Jaeger J, Donovan NJ, Mortby ME. Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment symptoms of depression, anxiety, irritability, and euphoria. Int Psychogeriatr 2018; 30:185-96. [PMID: 28899446 DOI: 10.1017/S1041610217001880] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. METHODS Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: "mild cognitive impairment," "dementia," "prodromal dementia," "preclinical dementia," "Alzheimer's," "depression," "dysphoria," "mania," "euphoria," "bipolar disorder," and "irritability." RESULTS Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. CONCLUSION Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
Collapse
|
11
|
Seeher KM, Low LF, Reppermund S, Slavin MJ, Draper BM, Kang K, Kochan NA, Trollor JN, Sachdev PS, Brodaty H. Correlates of psychological distress in study partners of older people with and without mild cognitive impairment (MCI) - the Sydney Memory and Ageing Study. Aging Ment Health 2014; 18:694-705. [PMID: 24588692 DOI: 10.1080/13607863.2013.875123] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Psychological effects of supporting someone with mild cognitive impairment (MCI) are often overlooked. We aimed to establish correlates of psychological distress in study partners of individuals with and without nonclinical MCI. METHODS Demographic, psychosocial and health measures were obtained cross-sectionally from 714 participants (39% MCI) and study partners of a longitudinal community-based study on cognitive aging. Study partners (i.e. family members/friends) were categorized as providing support with instrumental everyday activities or not. Psychological distress was measured by the Kessler psychological distress scale. Multiple hierarchical regressions examined determinants of psychological distress within Pearlin's stress process model. RESULTS Psychological distress was generally low and not associated with MCI or whether study partners provided support or not. Instead, distress was greater if participants were male irrespective of study partners' sex and if study partners reported negative reactions to participants' behavioral symptoms, felt burdened by providing support and showed worse coping abilities; overall explaining 37% variance. Self-rated disability and aspects of health-related quality of life explained additional 7%. CONCLUSION Objective impairment measures were not associated with distress in partners or supporters. However, study partners' appraisals of functional and behavioral symptoms were linked to increased distress even in this very mildly affected community cohort.
Collapse
Affiliation(s)
- Katrin M Seeher
- a Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine , University of New South Wales , Sydney , Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1) Alzheimer's disease; 2) vascular dementias; 3) frontotemporal dementias; and 4) dementia with Lewy bodies/Parkinson's disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of pathological burden. Future research goals are outlined, with a call to action for social policy initiatives that promote preventive lifestyle behaviors, and healthcare programs that will support the growing number of individuals affected by dementia.
Collapse
Affiliation(s)
- Jacob HG Grand
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Sienna Caspar
- Interdisciplinary Graduate Studies, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
13
|
Andreescu C, Butters MA, Begley A, Rajji T, Wu M, Meltzer CC, Reynolds CF, Aizenstein H. Gray matter changes in late life depression--a structural MRI analysis. Neuropsychopharmacology 2008; 33:2566-72. [PMID: 18075490 PMCID: PMC2872084 DOI: 10.1038/sj.npp.1301655] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [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: 11/09/2022]
Abstract
Multiple brain morphometric changes have been reported in late-life depression (LLD), mostly in studies comparing volumes of circumscribed brain areas. The aim of our study is to characterize the volumetric changes of multiple gray matter regions in relation to age of onset/duration of illness. We predicted that the association of gray matter volumes with total duration of illness and age of onset would differ depending on whether the region was susceptible to the toxic effects of chronic exposure to cortisol or to the vascular/neurodegenerative changes accompanying prodromal dementia. Seventy-one elderly depressed subjects were studied along with thirty-two comparison subjects. High-resolution T1-weighted brain MRIs were processed using an automated labeling pathway technique. To protect against type-I error, we combined the right and left hemisphere volume data. We sampled 24 regions of interest (ROIs). We used the primary visual cortex volume to normalize for individual variations in brain size. LLD Subjects had smaller volumes than non-depressed subjects in 17 of the 24 examined ROIs. Shorter duration of illness and later age of onset was correlated with smaller volumes of parahippocampal area and parietal inferior area. A later age of onset was also correlated with smaller volumes of several frontal and temporal areas, cingulum, and putamen. Our findings support a dementia prodrome model more strongly than a toxic stress model in this group of subjects. However, it remains likely that both processes as well as other factors contribute to the heterogeneity of volumetric brain changes in LLD.
Collapse
Affiliation(s)
- Carmen Andreescu
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA
| | - Meryl A Butters
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA
| | - Amy Begley
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA
| | - Tarek Rajji
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Minjie Wu
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn C Meltzer
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA,Departments of Radiology, Neurology, Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles F Reynolds
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA
| | - Howard Aizenstein
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA,Department of Bioengineering , University of Pittsburgh, Pittsburgh, PA, USA,Correspondence: Dr H Aizenstein, Department of Psychiatry and Bioengineering, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213, USA, Tel: + 1 412 383 5452, Fax: + 1 412 383 5458, E-mail:
| |
Collapse
|