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Connors MH, Ames D, Woodward M, Brodaty H. Psychosis and Clinical Outcomes in Alzheimer Disease: A Longitudinal Study. Am J Geriatr Psychiatry 2018; 26:304-313. [PMID: 29174998 DOI: 10.1016/j.jagp.2017.10.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Psychotic symptoms are a common feature in Alzheimer disease (AD), occurring in approximately 40% of patients. These symptoms are associated with worse clinical outcomes. Comparatively little research, however, has distinguished delusions and hallucinations, which may have distinct clinical, neuropathological, and genetic correlates. To address this, the current study examined the clinical outcomes associated with delusions and hallucinations in AD. DESIGN Three-year observational study. SETTING Nine memory clinics in Australia. PARTICIPANTS A total of 445 patients with AD. MEASUREMENTS Measures of neuropsychiatric symptoms, dementia severity, cognition, function, caregiver burden, and medication use were completed annually for 3 years with additional assessments at 3 months and 6 months in the first year. Mortality data were obtained from state registries approximately 5 years after the study. RESULTS Of 445 patients, 102 (22.9%) developed only delusions, 39 (8.8%) developed only hallucinations, and 84 (18.9%) developed both symptoms. Delusions and hallucinations were both associated with greater dementia severity, poorer cognition and function, higher levels of other neuropsychiatric symptoms, and greater caregiver burden. The presence of both symptoms was associated with worse outcomes than only one of these symptoms. Delusions, both by themselves and in combination with hallucinations, predicted institutionalization. Antipsychotic medication use predicted mortality. CONCLUSIONS Delusions and hallucinations independently and in combination are associated with poor clinical outcomes. The findings highlight the challenges managing these patients, particularly given the high levels of caregiver burden associated with psychotic symptoms and the likely mortality arising from antipsychotic medication.
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Affiliation(s)
- Michael H Connors
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
| | - David Ames
- National Ageing Research Institute, Melbourne, Australia; University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia
| | - Michael Woodward
- Aged Care, Austin Hospital, Heidelberg, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia.
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Abstract
The World Alzheimer Report 2016 estimated that 47 million people are living with dementia worldwide (Alzheimer's Disease International, 2016). In the inaugural World Health Organization Ministerial Conference on Global Action against Dementia, six of the top ten research priorities were focused on prevention, identification, and reduction of dementia risk, and on delivery and quality of care for people with dementia and their carers (Shah et al., 2016). While the Lancet Neurology Commission has suggested that even minor advances to delay progression or ameliorate symptoms might have substantial financial and societal benefits (Winblad et al., 2016), advances have been slow.
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Yang W, Chen X, Cohen DS, Rosin ER, Toga AW, Thompson PM, Huang X. Classification of MRI and psychological testing data based on support vector machine. Int J Clin Exp Med 2017; 10:16004-16026. [PMID: 29445429 PMCID: PMC5808983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Alzheimer's disease (AD) is a progressive, and often fatal, brain disease that causes neurodegeneration, resulting in memory loss as well as other cognitive and behavioral problems. Here, we propose a novel multimodal method combining independent components from MRI measures and clinical assessments to distinguish Alzheimer's patients or mild cognitive impairment (MCI) subjects from healthy elderly controls. 70 AD subjects (mean age: 77.15 ± 6.2 years), 98 MCI subjects (mean age: 76.91 ± 5.7 years), and 150 HC subjects (mean age: 75.69 ± 3.8 years) were analyzed. Our method includes the following steps: pre-processing, estimating the number of independent components from the MR image data, extracting effective voxels for classification, and classification using a support vector machine (SVM)-based classifier. As a result, with regards to classifying AD from healthy controls, we achieved a classification accuracy of 97.7%, sensitivity of 99.2%, and specificity of 96.7%; for differentiating MCI from healthy controls, we achieved a classification accuracy of 87.8%, a sensitivity of 86.0%, and a specificity of 89.6; these results are better than those obtained with clinical measurements alone (accuracy of 79.5%, sensitivity of 74.0%, and specificity of 85.1%). We found that (1) both AD patients and MCI subjects showed brain tissue loss, but the volumes of gray matter loss in MCI subjects was far less, supporting the notion that MCI is a prodromal stage of AD; and (2) combining gray matter features from MRI and three commonly used measures of mental status, cognitive function improved classification accuracy, sensitivity, and specificity compared with classification using only independent components or clinical measurements.
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Affiliation(s)
- Wenlu Yang
- Department of Electrical Engineering, Information Engineering College, Shanghai Maritime University, Shanghai, China
| | - Xinyun Chen
- Department of Electrical Engineering, Information Engineering College, Shanghai Maritime University, Shanghai, China
| | - David S Cohen
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Eric R Rosin
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, The Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Paul M Thompson
- Laboratory of Neuro Imaging, The Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Xudong Huang
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
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El Haj M, Roche J, Jardri R, Kapogiannis D, Gallouj K, Antoine P. Clinical and neurocognitive aspects of hallucinations in Alzheimer's disease. Neurosci Biobehav Rev 2017; 83:713-720. [PMID: 28235545 PMCID: PMC5565710 DOI: 10.1016/j.neubiorev.2017.02.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 01/14/2023]
Abstract
Due to their prevalence, hallucinations are considered as one of the most frequent psychotic symptoms in Alzheimer's disease (AD). These psychotic manifestations reduce patients' well-being, increase the burden of caregivers, contribute to early institutionalization, and are related with the course of cognitive decline in AD. Considering their consequences, we provide a comprehensive account of the current state of knowledge about the prevalence and characteristics of hallucinations in AD. We propose a comprehensive and testable theoretical model about hallucinations in AD: the ALZHA (ALZheimer and HAllucinations) model. In this model, neurological, genetic, cognitive, affective, and iatrogenic factors associated with hallucinations in AD are highlighted. According to the ALZHA model, hallucinations in AD first involve trait markers (i.e., cognitive deficits, neurological deficits, genetic predisposition and/or sensory deficits) to which state markers that may trigger these experiences are added (e.g., psychological distress and/or iatrogenic factors). Finally, we provide recommendations for assessment and management of these psychotic manifestations in AD, with the aim to benefit patients, caregivers, and health professionals.
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Affiliation(s)
- Mohamad El Haj
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
| | - Jean Roche
- CHU de Lille, Unité de Psychogériatrie, Pôle de gérontologie, 59037 Lille, France
| | - Renaud Jardri
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | | | - Karim Gallouj
- Department of Geriatrics, Tourcoing Hospital, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
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Cognitive and Functional Correlates of NPI-Q Scores and Symptom Clusters in Mildly Demented Alzheimer Patients. Alzheimer Dis Assoc Disord 2017; 30:145-51. [PMID: 26280379 DOI: 10.1097/wad.0000000000000104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous research has demonstrated an association between the emotional and behavioral symptoms of dementia, known as neuropsychiatric symptoms, and cognitive and functional decline among patients with Alzheimer disease (AD). The present study aimed to identify associations between neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and cognitive and functional performance. Participants were 256 AD patients enrolled in the Alzheimer's Disease and Memory Disorders Center at Baylor College of Medicine. An exploratory factor analysis of the NPI-Q indicated a 2-factor structure consisting of Negative/Oppositional and Anxiety/Restlessness factors. Regression analyses revealed significant associations between greater total severity of neuropsychiatric symptoms and poorer performance on basic and Instrumental Activities of Daily Living. Greater severity of Anxiety/Restlessness symptoms was associated with poor performance on measures of visuospatial functioning and basic and instrumental activities of daily living. The Negative/Oppositional factor was not related to cognition or functioning. In summary, neuropsychiatric symptoms (particularly Anxiety/Restlessness symptoms) were related to cognition and everyday functioning. Proper assessment and treatment of these symptoms is essential for improving cognition and functioning in AD patients.
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Mihelčić M, Šimić G, Babić Leko M, Lavrač N, Džeroski S, Šmuc T. Using redescription mining to relate clinical and biological characteristics of cognitively impaired and Alzheimer's disease patients. PLoS One 2017; 12:e0187364. [PMID: 29088293 PMCID: PMC5663625 DOI: 10.1371/journal.pone.0187364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Based on a set of subjects and a collection of attributes obtained from the Alzheimer's Disease Neuroimaging Initiative database, we used redescription mining to find interpretable rules revealing associations between those determinants that provide insights about the Alzheimer's disease (AD). We extended the CLUS-RM redescription mining algorithm to a constraint-based redescription mining (CBRM) setting, which enables several modes of targeted exploration of specific, user-constrained associations. Redescription mining enabled finding specific constructs of clinical and biological attributes that describe many groups of subjects of different size, homogeneity and levels of cognitive impairment. We confirmed some previously known findings. However, in some instances, as with the attributes: testosterone, ciliary neurotrophic factor, brain natriuretic peptide, Fas ligand, the imaging attribute Spatial Pattern of Abnormalities for Recognition of Early AD, as well as the levels of leptin and angiopoietin-2 in plasma, we corroborated previously debatable findings or provided additional information about these variables and their association with AD pathogenesis. Moreover, applying redescription mining on ADNI data resulted with the discovery of one largely unknown attribute: the Pregnancy-Associated Protein-A (PAPP-A), which we found highly associated with cognitive impairment in AD. Statistically significant correlations (p ≤ 0.01) were found between PAPP-A and clinical tests: Alzheimer's Disease Assessment Scale, Clinical Dementia Rating Sum of Boxes, Mini Mental State Examination, etc. The high importance of this finding lies in the fact that PAPP-A is a metalloproteinase, known to cleave insulin-like growth factor binding proteins. Since it also shares similar substrates with A Disintegrin and the Metalloproteinase family of enzymes that act as α-secretase to physiologically cleave amyloid precursor protein (APP) in the non-amyloidogenic pathway, it could be directly involved in the metabolism of APP very early during the disease course. Therefore, further studies should investigate the role of PAPP-A in the development of AD more thoroughly.
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Affiliation(s)
- Matej Mihelčić
- Division of Electronics, Ruđer Bošković Institute, Zagreb, Croatia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Goran Šimić
- Department for Neuroscience, Croatian Institute for Brain Research, University of Zagreb Medical School, Zagreb, Croatia
| | - Mirjana Babić Leko
- Department for Neuroscience, Croatian Institute for Brain Research, University of Zagreb Medical School, Zagreb, Croatia
| | - Nada Lavrač
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
- Department of Knowledge Technologies, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Sašo Džeroski
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
- Department of Knowledge Technologies, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Tomislav Šmuc
- Division of Electronics, Ruđer Bošković Institute, Zagreb, Croatia
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Gatchel JR, Donovan NJ, Locascio JJ, Becker JA, Rentz DM, Sperling RA, Johnson KA, Marshall GA. Regional 18F-Fluorodeoxyglucose Hypometabolism is Associated with Higher Apathy Scores Over Time in Early Alzheimer Disease. Am J Geriatr Psychiatry 2017; 25:683-693. [PMID: 28410856 PMCID: PMC5906700 DOI: 10.1016/j.jagp.2016.12.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/09/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Apathy is among the earliest and most pervasive neuropsychiatric symptoms in prodromal and mild Alzheimer disease (AD) dementia that correlates with functional impairment and disease progression. We investigated the association of apathy with regional 18F-fluorodeoxyglucose (FDG) metabolism in cognitively normal, mild cognitive impairment, and AD dementia subjects from the Alzheimer's Disease Neuroimaging Initiative database. DESIGN Cross-sectional and longitudinal studies. SETTING 57 North American research sites. PARTICIPANTS 402 community dwelling elders. MEASUREMENTS Apathy was assessed using the Neuropsychiatric Inventory Questionnaire. Baseline FDG metabolism in five regions implicated in the neurobiology of apathy and AD was investigated in relationship to apathy at baseline (cross-sectional general linear model) and longitudinally (mixed random/fixed effect model). Covariates included age, sex, diagnosis, apolipoprotein E genotype, premorbid intelligence, cognition, and antidepressant use. RESULTS Cross-sectional analysis revealed that posterior cingulate hypometabolism, diagnosis, male sex, and antidepressant use were associated with higher apathy scores. Longitudinal analysis revealed that the interaction of supramarginal hypometabolism and time, posterior cingulate hypometabolism, and antidepressant use were associated with higher apathy scores across time; only supramarginal hypometabolism was positively related to rate of increase of apathy. CONCLUSIONS Results support an association of apathy with hypometabolism in parietal regions commonly affected in early stages of AD, rather than medial frontal regions implicated in the neurobiology of apathy in later stages. Further work is needed to substantiate whether this localization is specific to apathy rather than to disease stage, and to investigate the potential role of AD proteinopathies in the pathogenesis of apathy.
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Affiliation(s)
- Jennifer R Gatchel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA.
| | - Nancy J Donovan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J Alex Becker
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dorene M Rentz
- Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Reisa A Sperling
- Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Keith A Johnson
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gad A Marshall
- Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Kolanowski A, Boltz M, Galik E, Gitlin LN, Kales HC, Resnick B, Van Haitsma KS, Knehans A, Sutterlin JE, Sefcik JS, Liu W, Petrovsky DV, Massimo L, Gilmore-Bykovskyi A, MacAndrew M, Brewster G, Nalls V, Jao YL, Duffort N, Scerpella D. Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence. Nurs Outlook 2017; 65:515-529. [PMID: 28826872 DOI: 10.1016/j.outlook.2017.06.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.
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Affiliation(s)
| | - Marie Boltz
- College of Nursing, Penn State, University Park, PA
| | | | - Laura N Gitlin
- Department of Community-Public Health, Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Helen C Kales
- The Program for Positive Aging, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | | | - Kimberly S Van Haitsma
- Program for Person Centered Living Systems of Care, College of Nursing, The Pennsylvania State University, University Park, PA; Polisher Research Institute, Madlyn & Leonard Abramson Center for Jewish Life, North Wales, PA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Health Sciences Library, Research & Learning Commons, Hershey, PA
| | | | | | - Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA
| | | | | | | | - Margaret MacAndrew
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Glenna Brewster
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Danny Scerpella
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Saykin AJ, Shaw LM, Toga AW, Trojanowski JQ. Recent publications from the Alzheimer's Disease Neuroimaging Initiative: Reviewing progress toward improved AD clinical trials. Alzheimers Dement 2017; 13:e1-e85. [PMID: 28342697 DOI: 10.1016/j.jalz.2016.11.007] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) has continued development and standardization of methodologies for biomarkers and has provided an increased depth and breadth of data available to qualified researchers. This review summarizes the over 400 publications using ADNI data during 2014 and 2015. METHODS We used standard searches to find publications using ADNI data. RESULTS (1) Structural and functional changes, including subtle changes to hippocampal shape and texture, atrophy in areas outside of hippocampus, and disruption to functional networks, are detectable in presymptomatic subjects before hippocampal atrophy; (2) In subjects with abnormal β-amyloid deposition (Aβ+), biomarkers become abnormal in the order predicted by the amyloid cascade hypothesis; (3) Cognitive decline is more closely linked to tau than Aβ deposition; (4) Cerebrovascular risk factors may interact with Aβ to increase white-matter (WM) abnormalities which may accelerate Alzheimer's disease (AD) progression in conjunction with tau abnormalities; (5) Different patterns of atrophy are associated with impairment of memory and executive function and may underlie psychiatric symptoms; (6) Structural, functional, and metabolic network connectivities are disrupted as AD progresses. Models of prion-like spreading of Aβ pathology along WM tracts predict known patterns of cortical Aβ deposition and declines in glucose metabolism; (7) New AD risk and protective gene loci have been identified using biologically informed approaches; (8) Cognitively normal and mild cognitive impairment (MCI) subjects are heterogeneous and include groups typified not only by "classic" AD pathology but also by normal biomarkers, accelerated decline, and suspected non-Alzheimer's pathology; (9) Selection of subjects at risk of imminent decline on the basis of one or more pathologies improves the power of clinical trials; (10) Sensitivity of cognitive outcome measures to early changes in cognition has been improved and surrogate outcome measures using longitudinal structural magnetic resonance imaging may further reduce clinical trial cost and duration; (11) Advances in machine learning techniques such as neural networks have improved diagnostic and prognostic accuracy especially in challenges involving MCI subjects; and (12) Network connectivity measures and genetic variants show promise in multimodal classification and some classifiers using single modalities are rivaling multimodal classifiers. DISCUSSION Taken together, these studies fundamentally deepen our understanding of AD progression and its underlying genetic basis, which in turn informs and improves clinical trial design.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Joo SH, Lee CU, Lim HK. Apathy and intrinsic functional connectivity networks in amnestic mild cognitive impairment. Neuropsychiatr Dis Treat 2017; 13:61-67. [PMID: 28096673 PMCID: PMC5207457 DOI: 10.2147/ndt.s123338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although several prior works reported that apathy is associated with conversion to Alzheimer's disease in individuals with amnestic mild cognitive impairment (aMCI), effects of apathy on the functional connectivity (FC) of the brain remain unclear. In this study, we assessed the pattern of association between apathy and default mode network (DMN), salience network and central executive network (CEN) in aMCI subjects. METHODS Fifty subjects with aMCI and 50 controls (CONs) participated in this study. They underwent clinical assessments and magnetic resonance imaging for the structural and resting-state scan. We explored the patterns of association between apathy inventory (IA) total score and the whole-brain voxel-wise FCs of the DMN, salience network and CEN in aMCI subjects. RESULTS We observed that the FCs of the DMN were less and those of CEN were more in the aMCI group than the CON group. Total IA score was negatively correlated with FCs of the anterior cingulate within the DMN, and positively correlated with FCs of the middle frontal, inferior frontal, and supramarginal gyrus within the CEN in the aMCI group. CONCLUSION Our findings suggest that distinctive patterns of association between apathy and FCs in the DMN and CEN in the aMCI group might reflect the putative role of functional network change in the development of apathy in aMCI.
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Affiliation(s)
- Soo Hyun Joo
- Department of Psychiatry, Seoul St Mary's Hospital, Seoul
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St Mary's Hospital, Seoul
| | - Hyun Kook Lim
- Department of Psychiatry, Saint Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
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Kazui H, Takahashi R, Yamamoto Y, Yoshiyama K, Kanemoto H, Suzuki Y, Sato S, Azuma S, Suehiro T, Shimosegawa E, Ishii K, Tanaka T. Neural Basis of Apathy in Patients with Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2016; 55:1403-1416. [DOI: 10.3233/jad-160223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hiroaki Kazui
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryuichi Takahashi
- Departments of Neurology and Cognitive disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Hyogo, Japan
| | - Yuki Yamamoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukiko Suzuki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shingo Azuma
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazunari Ishii
- Department of Radiology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Toshihisa Tanaka
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Moretti R, Signori R. Neural Correlates for Apathy: Frontal-Prefrontal and Parietal Cortical- Subcortical Circuits. Front Aging Neurosci 2016; 8:289. [PMID: 28018207 PMCID: PMC5145860 DOI: 10.3389/fnagi.2016.00289] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
Apathy is an uncertain nosographical entity, which includes reduced motivation, abulia, decreased empathy, and lack of emotional involvement; it is an important and heavy-burden clinical condition which strongly impacts in everyday life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; “emotional affective” apathy may be related to the orbitomedial PFC and ventral striatum; “cognitive apathy” may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of “autoactivation” may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to gray matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. These neural networks are linked to projects, judjing and planning, execution and selection common actions, and through the basolateral amygdala and nucleus accumbens projects to the frontostriatal and to the dorsolateral prefrontal cortex. Therefore, an alteration of these circuitry caused a lack of insight, a reduction of decision-making strategies, and a reduced speedness in action decision, major responsible for apathy. Emergent role concerns also the parietal cortex, with its direct action motivation control. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
| | - Riccardo Signori
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
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63
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Sleep and cognitive aging: emerging bedfellows: Editorial for Carvalho et al. Sleep Med 2016; 32:244-245. [PMID: 28057497 DOI: 10.1016/j.sleep.2016.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 01/03/2023]
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Gotovac K, Nikolac Perković M, Pivac N, Borovečki F. Biomarkers of aggression in dementia. Prog Neuropsychopharmacol Biol Psychiatry 2016; 69:125-30. [PMID: 26952705 DOI: 10.1016/j.pnpbp.2016.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 12/17/2022]
Abstract
Dementia is a clinical syndrome defined by progressive global impairment of acquired cognitive abilities. It can be caused by a number of underlying conditions. The most common types of dementia are Alzheimer's disease (AD), frontotemporal dementia (FTD), vascular cognitive impairment (VCI) and dementia with Lewy bodies (DLB). Despite the fact that cognitive impairment is central to the dementia, noncognitive symptoms, most commonly described nowadays as neuropsychiatric symptoms (NPS) exist almost always at certain point of the illness. Aggression as one of the NPS represents danger both for patients and caregivers and the rate of aggression correlates with the loss of independence, cognitive decline and poor outcome. Therefore, biomarkers of aggression in dementia patients would be of a great importance. Studies have shown that different genetic factors, including monoamine signaling and processing, can be associated with various NPS including aggression. There have been significant and multiple neurotransmitter changes identified in the brains of patients with dementia and some of these changes have been involved in the etiology of NPS. Aggression specific changes have also been observed in neuropathological studies. The current consensus is that the best approach for development of such biomarkers may be incorporation of genetics (polymorphisms), neurobiology (neurotransmitters and neuropathology) and neuroimaging techniques.
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Affiliation(s)
- Kristina Gotovac
- Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, University Hospital Center Zagreb, Šalata 2, 10 000 Zagreb, Croatia.
| | - Matea Nikolac Perković
- Division of Molecular Medicine, Rudjer Boskovic Institute, Bijenicka, 54, HR 10000, Zagreb, Croatia
| | - Nela Pivac
- Division of Molecular Medicine, Rudjer Boskovic Institute, Bijenicka, 54, HR 10000, Zagreb, Croatia
| | - Fran Borovečki
- Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, University Hospital Center Zagreb, Šalata 2, 10 000 Zagreb, Croatia; Department of Neurology, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
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Guercio BJ, Donovan NJ, Munro CE, Aghjayan SL, Wigman SE, Locascio JJ, Amariglio RE, Rentz DM, Johnson KA, Sperling RA, Marshall GA. The Apathy Evaluation Scale: A Comparison of Subject, Informant, and Clinician Report in Cognitively Normal Elderly and Mild Cognitive Impairment. J Alzheimers Dis 2016; 47:421-32. [PMID: 26401564 DOI: 10.3233/jad-150146] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Apathy is a common neuropsychiatric symptom in Alzheimer's disease (AD) dementia and mild cognitive impairment (MCI). Detecting apathy accurately may facilitate earlier diagnosis of AD. The Apathy Evaluation Scale (AES) is a promising tool for measurement of apathy in prodromal and possibly preclinical AD. OBJECTIVE To compare the three AES sub-scales - subject-reported (AES-S), informant-reported (AES-I), and clinician-reported (AES-C) - over time in individuals at risk for AD due to MCI and advanced age (cognitively normal [CN] elderly). METHODS Mixed effects longitudinal models were used to assess predictors of score for each AES sub-scale. Cox proportional hazards models were used to assess which AES sub-scales predict progression from MCI to AD dementia. RESULTS Fifty-seven MCI and 18 CN subjects (ages 53-86) were followed for 1.4 ± 1.2 years and 0.7 ± 0.7 years, respectively. Across the three mixed effects longitudinal models, the common findings were associations between greater apathy and greater years in study, a baseline diagnosis of MCI (compared to CN), and male gender. CN elderly self-reported greater apathy compared to that reported by informants and clinicians, while individuals with MCI under-reported their apathy compared to informants and clinicians. Of the three sub-scales, the AES-C best predicted transition from MCI to AD dementia. CONCLUSION In a sample of CN elderly and elderly with MCI, apathy increased over time, particularly in men and those with MCI. AES-S scores may be more sensitive than AES-I and AES-C scores in CN elderly, but less reliable if subjects have MCI. Moreover, the AES-C sub-scale predicted progression from MCI to AD dementia.
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Affiliation(s)
- Brendan J Guercio
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
| | - Nancy J Donovan
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine E Munro
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah L Aghjayan
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Wigman
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca E Amariglio
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Dorene M Rentz
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Keith A Johnson
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Reisa A Sperling
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Gad A Marshall
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Caroppo P, Habert MO, Durrleman S, Funkiewiez A, Perlbarg V, Hahn V, Bertin H, Gaubert M, Routier A, Hannequin D, Deramecourt V, Pasquier F, Rivaud-Pechoux S, Vercelletto M, Edouart G, Valabregue R, Lejeune P, Didic M, Corvol JC, Benali H, Lehericy S, Dubois B, Colliot O, Brice A, Le Ber I. Lateral Temporal Lobe: An Early Imaging Marker of the Presymptomatic GRN Disease? J Alzheimers Dis 2016; 47:751-9. [PMID: 26401709 PMCID: PMC4923734 DOI: 10.3233/jad-150270] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The preclinical stage of frontotemporal lobar degeneration (FTLD) is not well characterized. We conducted a brain metabolism (FDG-PET) and structural (cortical thickness) study to detect early changes in asymptomatic GRN mutation carriers (aGRN+) that were evaluated longitudinally over a 20-month period. At baseline, a left lateral temporal lobe hypometabolism was present in aGRN+ without any structural changes. Importantly, this is the first longitudinal study and, across time, the metabolism more rapidly decreased in aGRN+ in lateral temporal and frontal regions. The main structural change observed in the longitudinal study was a reduction of cortical thickness in the left lateral temporal lobe in carriers. A limit of this study is the relatively small sample (n = 16); nevertheless, it provides important results. First, it evidences that the pathological processes develop a long time before clinical onset, and that early neuroimaging changes might be detected approximately 20 years before the clinical onset of disease. Second, it suggests that metabolic changes are detectable before structural modifications and cognitive deficits. Third, both the baseline and longitudinal studies provide converging results implicating lateral temporal lobe as early involved in GRN disease. Finally, our study demonstrates that structural and metabolic changes could represent possible biomarkers to monitor the progression of disease in the presymptomatic stage toward clinical onset.
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Affiliation(s)
- Paola Caroppo
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,Neurological Institut Carlo Besta, Milan, Italy
| | - Marie-Odile Habert
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Département de Médecine Nucléaire, Paris, France
| | - Stanley Durrleman
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,INRIA, project-team Aramis, Centre Paris-Rocquencourt, France
| | - Aurélie Funkiewiez
- Inserm, U1127, ICM, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Institut de la Mémoire et de la maladie d'Alzheimer, Departement de Neurologie, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Centre de Référence des Démences Rares, Paris, France
| | - Vincent Perlbarg
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, Paris, France.,IHU-A-ICM, Bioinformatics/Biostatistis Platform, Paris, France
| | - Valérie Hahn
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Centre de Référence des Démences Rares, Paris, France
| | - Hugo Bertin
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, Paris, France.,Centre pour l'Acquisition et le Traitement des Images (http://www.cati-neuroimaging.com), Paris and Saclay, France
| | - Malo Gaubert
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, Paris, France.,Centre pour l'Acquisition et le Traitement des Images (http://www.cati-neuroimaging.com), Paris and Saclay, France
| | - Alexandre Routier
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,INRIA, project-team Aramis, Centre Paris-Rocquencourt, France.,Centre pour l'Acquisition et le Traitement des Images (http://www.cati-neuroimaging.com), Paris and Saclay, France
| | - Didier Hannequin
- Service de Neurologie et CMRR, Inserm U1079, Centre Hospitalier Universitaire, Rouen, France
| | | | | | - Sophie Rivaud-Pechoux
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - Geoffrey Edouart
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Clinical Investigation Center (CIC-1422), Paris, France
| | - Romain Valabregue
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - Mira Didic
- Service de Neurologie et Neuropsychologie, APHM, CHU Timone et Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - Jean-Christophe Corvol
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Clinical Investigation Center (CIC-1422), Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Département de Neurologie, Paris, France
| | - Habib Benali
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Stephane Lehericy
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France
| | - Bruno Dubois
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Institut de la Mémoire et de la maladie d'Alzheimer, Departement de Neurologie, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Centre de Référence des Démences Rares, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Département de Neurologie, Paris, France
| | - Olivier Colliot
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,INRIA, project-team Aramis, Centre Paris-Rocquencourt, France
| | - Alexis Brice
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Département de Neurologie, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Département de Génétique et Cytogénétique, Unité Fonctionnelle de Génétique Clinique, Paris, France
| | - Isabelle Le Ber
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, ICM, Paris, France.,Inserm, U1127, ICM, Paris, France.,CNRS, UMR 7225, ICM, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié Salpêtrière, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Centre de Référence des Démences Rares, Paris, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Département de Neurologie, Paris, France
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67
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Munro CE, Donovan NJ, Guercio BJ, Wigman SE, Schultz AP, Amariglio RE, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Neuropsychiatric Symptoms and Functional Connectivity in Mild Cognitive Impairment. J Alzheimers Dis 2016; 46:727-35. [PMID: 25854929 DOI: 10.3233/jad-150017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS), such as apathy and depression, commonly accompany cognitive and functional decline in early Alzheimer's disease (AD). Prior studies have shown associations between affective NPS and neurodegeneration of medial frontal and inferior temporal regions in mild cognitive impairment (MCI) and AD dementia. OBJECTIVE To investigate the association between functional connectivity in four brain networks and NPS in elderly with MCI. METHODS NPS were assessed using the Neuropsychiatric Inventory in 42 subjects with MCI. Resting-state functional connectivity in four networks (default mode network, fronto-parietal control network (FPCN), dorsal attention network, and ventral attention network) was assessed using seed-based magnetic resonance imaging. Factor analysis was used to identify two factors of NPS: Affective and Hyperactivity. Linear regression models were utilized with the neuropsychiatric factors as the dependent variable and the four networks as the predictors of interest. Covariates included age, gender, premorbid intelligence, processing speed, memory, head movement, and signal-to-noise ratio. These analyses were repeated with the individual items of the affective factor, using the same predictors. RESULTS There was a significant association between greater Affective factor symptoms and reduced FPCN connectivity (p = 0.03). There was no association between the Hyperactivity factor and any of the networks. Secondary analyses revealed an association between greater apathy and reduced FPCN connectivity (p = 0.005), but none in other networks. CONCLUSIONS Decreased connectivity in the FPCN may be associated with greater affective symptoms, particularly apathy, early in AD. These findings extend prior studies, using different functional imaging modalities in individuals with greater disease severity.
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Affiliation(s)
- Catherine E Munro
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy J Donovan
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sarah E Wigman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca E Amariglio
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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68
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Apathy associated with neurocognitive disorders: Recent progress and future directions. Alzheimers Dement 2016; 13:84-100. [PMID: 27362291 DOI: 10.1016/j.jalz.2016.05.008] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Apathy is common in neurocognitive disorders (NCDs) such as Alzheimer's disease and mild cognitive impairment. Although the definition of apathy is inconsistent in the literature, apathy is primarily defined as a loss of motivation and decreased interest in daily activities. METHODS The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Neuropsychiatric Syndromes Professional Interest Area (NPS-PIA) Apathy workgroup reviewed the latest research regarding apathy in NCDs. RESULTS Progress has recently been made in three areas relevant to apathy: (1) phenomenology, including the use of diagnostic criteria and novel instruments for measurement, (2) neurobiology, including neuroimaging, neuropathological and biomarker correlates, and (3) interventions, including pharmacologic, nonpharmacologic, and noninvasive neuromodulatory approaches. DISCUSSION Recent progress confirms that apathy has a significant impact on those with major NCD and those with mild NCDs. As such, it is an important target for research and intervention.
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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] [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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Rosenberg PB, Nowrangi MA, Lyketsos CG. Neuropsychiatric symptoms in Alzheimer's disease: What might be associated brain circuits? Mol Aspects Med 2015; 43-44:25-37. [PMID: 26049034 DOI: 10.1016/j.mam.2015.05.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 12/15/2022]
Abstract
Neuropsychiatric symptoms (NPS) are very common in Alzheimer's disease (AD), particularly agitation, apathy, depression, and delusions. Brain networks or circuits underlying these symptoms are just starting to be understood, and there is a growing imaging and neurochemical evidence base for understanding potential mechanisms for NPS. We offer a synthetic review of the recent literature and offer hypotheses for potential networks/circuits underlying these NPS, particularly agitation, apathy, and delusions. Agitation in AD appears to be associated with deficits in structure and function of frontal cortex, anterior cingulate cortex, posterior cingulate cortex, amygdala, and hippocampus, and may be associated with mechanisms underlying misinterpretation of threats and affective regulation. Apathy in AD is associated with frontal cortex, anterior cingulate cortex, posterior cingulate cortex, as well as orbitofrontal cortex, and inferior temporal cortex, and may be associated with mechanisms underlying avoidance behaviors.
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Affiliation(s)
- Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA.
| | - Milap A Nowrangi
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA
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71
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On visual hallucinations and cortical networks: a trans-diagnostic review. J Neurol 2015; 262:1780-90. [PMID: 25761375 PMCID: PMC4503861 DOI: 10.1007/s00415-015-7687-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
Our current clinical approach to visual hallucinations is largely derived from work carried out by Georges de Morsier in the 1930s. Now, almost a century after his influential papers, we have the research tools to further explore the ideas he put forward. In this review, we address de Morsier's proposal that visual hallucinations in all clinical conditions have a similar neurological mechanism by comparing structural imaging studies of susceptibility to visual hallucinations in Parkinson's disease, Alzheimer's disease, Dementia with Lewy bodies and schizophrenia. Systematic review of the literature was undertaken using PubMed searches. A total of 18 studies across conditions were identified reporting grey matter differences between patients with and without visual hallucinations. Grey matter changes were categorised into brain regions relevant to current theories of visual hallucinations. The distribution of cortical atrophy supports de Morsier's premise that visual hallucinations are invariably linked to aberrant activity within visual thalamo-cortical networks. Further work is required to determine by what mechanism these networks become predisposed to spontaneous activation, and whether the frontal lobe and hippocampal changes identified are present in all conditions. The findings have implications for the development of effective treatments for visual hallucinations.
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72
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Liemburg EJ, Dlabac-De Lange JJLAS, Bais L, Knegtering H, van Osch MJP, Renken RJ, Aleman A. Neural correlates of planning performance in patients with schizophrenia--relationship with apathy. Schizophr Res 2015; 161:367-75. [PMID: 25497221 DOI: 10.1016/j.schres.2014.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/06/2014] [Accepted: 11/22/2014] [Indexed: 11/15/2022]
Abstract
Patients with schizophrenia often suffer from apathy: a quantitative reduction of voluntary, goal-directed behaviors that impairs daily functioning. We hypothesized that schizophrenia patients with high levels of apathy would show decreased activation in brain regions involved in planning and goal-directed behavior. Patients with schizophrenia or psychotic spectrum disorder (n=47) and healthy controls (n=20) performed the Tower of London (ToL) task during fMRI scanning using arterial spin labeling. To investigate the relationship between apathy and planning in patients, a proxy measure of apathy based on the Positive and Negative syndrome Scale was regressed against the task-related brain activation. Brain activation was also compared between patients and healthy controls. Higher levels of apathy were associated with less task-related activation within the inferior parietal lobule precuneus and thalamus. Compared to controls, patients showed lower activation in lateral prefrontal regions, parietal and motor areas, and a higher activation of medial frontal areas. Apathy was related to abnormal activation in thalamus and parietal regions during the ToL task. This supports the hypothesis that impaired function of brain regions involved in planning and goal-directed behavior may underlie apathy in schizophrenia. Moreover, impaired lateral prefrontal activation in schizophrenia patients compared to controls is consistent with the hypofrontality model of schizophrenia. In contrast, stronger medial frontal activation in patients may be related to increased effort to perform a task with conflicting task solutions.
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Affiliation(s)
- Edith J Liemburg
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Rob Giel Research Centrum, University of Groningen, University Medical Center Groningen, CC72, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Jozarni J L A S Dlabac-De Lange
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands.
| | - Leonie Bais
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Lentis Research, Center for Mental Health, Hereweg 80, 9725 AG Groningen, The Netherlands.
| | - Henderikus Knegtering
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Rob Giel Research Centrum, University of Groningen, University Medical Center Groningen, CC72, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Matthias J P van Osch
- Department of Radiology, Leiden University Medical Center, Postzone C2S, Postbox 9600, 2300 RC, Leiden, The Netherlands.
| | - Remco J Renken
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands.
| | - André Aleman
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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73
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Hirao K, Pontone GM, Smith GS. Molecular imaging of neuropsychiatric symptoms in Alzheimer's and Parkinson's disease. Neurosci Biobehav Rev 2015; 49:157-70. [PMID: 25446948 PMCID: PMC4806385 DOI: 10.1016/j.neubiorev.2014.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 01/14/2023]
Abstract
Neuropsychiatric symptoms (NPS) are very common in neurodegenerative diseases and are a major contributor to disability and caregiver burden. There is accumulating evidence that NPS may be a prodrome and/or a "risk factor" of neurodegenerative diseases. The medications used to treat these symptoms in younger patients are not very effective in patients with neurodegenerative disease and may have serious side effects. An understanding of the neurobiology of NPS is critical for the development of more effective intervention strategies. Targeting these symptoms may also have implications for prevention of cognitive or motor decline. Molecular brain imaging represents a bridge between basic and clinical observations and provides many opportunities for translation from animal models and human post-mortem studies to in vivo human studies. Molecular brain imaging studies in Alzheimer's disease (AD) and Parkinson's disease (PD) are reviewed with a primary focus on positron emission tomography studies of NPS. Future directions for the field of molecular imaging in AD and PD to understand the neurobiology of NPS will be discussed.
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Affiliation(s)
- Kentaro Hirao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
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74
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Guekht AB, Avedisova AS, Zaharova KV, Luzin RV, Gaskin VV, Rozovskaya RI. [Neuroanatomical age-related changes in apathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:117-123. [PMID: 27030831 DOI: 10.17116/jnevro2015115111117-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The introduction of new instrumental methods, in particular neuroimaging techniques, in academic studies and clinical practice allowed to identify neuroanatomical and functional correlates of different clinical syndromes. Authors summarized the results of magnetic-resonance tomography (MRI) and one-photon emission computed tomography (OPECT) studies of apathy of old-age developed in the structure of different neurological and mental diseases. The literature over that last two decades was reviewed
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Affiliation(s)
- A B Guekht
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - A S Avedisova
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - K V Zaharova
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - R V Luzin
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - V V Gaskin
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - R I Rozovskaya
- Research-Practical Psychoneurological Center, Moscow, Russia
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75
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Guercio B, Donovan NJ, Ward A, Schultz A, Lorius N, Amariglio RE, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Apathy is associated with lower inferior temporal cortical thickness in mild cognitive impairment and normal elderly individuals. J Neuropsychiatry Clin Neurosci 2015; 27:e22-7. [PMID: 25716491 PMCID: PMC4342844 DOI: 10.1176/appi.neuropsych.13060141] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Apathy is a common neuropsychiatric symptom in Alzheimer's disease dementia and amnestic mild cognitive impairment and is associated with cortical atrophy in Alzheimer's disease dementia. This study investigated possible correlations between apathy and cortical atrophy in 47 individuals with mild cognitive impairment and 19 clinically normal elderly. Backward elimination multivariate linear regression was used to evaluate the cross-sectional relationship between scores on the Apathy Evaluation Scale and thickness of several cortical regions and covariates. Lower inferior temporal cortical thickness was predictive of greater apathy. Greater anterior cingulate cortical thickness was also predictive of greater apathy, suggesting an underlying reactive process.
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Affiliation(s)
- Brendan Guercio
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Nancy J. Donovan
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrew Ward
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aaron Schultz
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Natacha Lorius
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Rebecca E. Amariglio
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dorene M. Rentz
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Keith A. Johnson
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Reisa A. Sperling
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gad A. Marshall
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA,Correspondence to: Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, 221 Longwood Avenue, BL-104H, Boston, MA 02115, P: 617-732-8085, F: 617-264-5212,
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76
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Clinical workout for the early detection of cognitive decline and dementia. Eur J Clin Nutr 2014; 68:1186-91. [PMID: 25271010 DOI: 10.1038/ejcn.2014.189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/18/2014] [Indexed: 02/02/2023]
Abstract
Aging is the major risk factor for the development of human neurodegenerative maladies such as Alzheimer's, Huntington's and Parkinson's diseases (PDs) and prion disorders, all of which stem from toxic protein aggregation. All of these diseases are correlated with cognitive decline. Cognitive Decline is a dynamic state from normal cognition of aging to dementia. According to the original criteria for Alzheimer's Disease (AD) (1984), a clinical diagnosis was possible only when someone was already demented. The prevalence rates of Cognitive Decline (mild cognitive impairment plus dementia) are very high now and will be higher in future because of the increasing survival time of people. Many neurological and psychiatric diseases are correlated with cognitive decline. Diagnosis of cognitive decline is mostly clinical (clinical criteria), but there are multiple biomarkers that could help us mostly in research programs such as short or long, paper and pencil or computerized neuropsychological batteries for cognition, activities of daily living and behavior, electroencephalograph, event-related potentials, and imaging-structural magnetic resonance imaging (MRI) and functional (fMRI, Pittsburgh bound positron emission tomography, FDG-PET, single photon emission computerized tomography and imaging of tau pathology)-cerebrospinal fluid proteins (Abeta, tau and phospho-tau in AD and α-synuclein (αSyn) for PD). Blood biomarkers need more studies to confirm their usefulness. Genetic markers are also studied but until now are not used in clinical praxis. Finally, in everyday clinical praxis and in research workout for early detection of cognitive decline, the combination of biomarkers is useful.
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77
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Li XL, Hu N, Tan MS, Yu JT, Tan L. Behavioral and psychological symptoms in Alzheimer's disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:927804. [PMID: 25133184 PMCID: PMC4123596 DOI: 10.1155/2014/927804] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 01/11/2023]
Abstract
Neuropsychiatric symptoms (NPS) such as depression, apathy, aggression, and psychosis are now recognized as core features of Alzheimer's disease (AD), and there is a general consensus that greater symptom severity is predictive of faster cognitive decline, loss of independence, and even shorter survival. Whether these symptoms result from the same pathogenic processes responsible for cognitive decline or have unique etiologies independent of AD-associated neurodegeneration is unclear. Many structural and metabolic features of the AD brain are associated with individual neuropsychiatric symptoms or symptom clusters. In addition, many genes have been identified and confirmed that are associated with symptom risk in a few cases. However, there are no single genes strongly predictive of individual neuropsychiatric syndromes, while functional and structural brain changes unique to specific symptoms may reflect variability in progression of the same pathological processes. Unfortunately, treatment success for these psychiatric symptoms may be lower when comorbid with AD, underscoring the importance of future research on their pathobiology and treatment. This review summarizes some of the most salient aspects of NPS pathogenesis.
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Affiliation(s)
- Xiao-Ling Li
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao 266071, China
| | - Nan Hu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao 266071, China
| | - Meng-Shan Tan
- Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao 266003, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao 266071, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao 266071, China
- Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao 266003, China
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