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Kasper S, Bancher C, Eckert A, Förstl H, Frölich L, Hort J, Korczyn AD, Kressig RW, Levin O, Palomo MSM. Management of mild cognitive impairment (MCI): The need for national and international guidelines. World J Biol Psychiatry 2020; 21:579-594. [PMID: 32019392 DOI: 10.1080/15622975.2019.1696473] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: To review available evidence of pharmacological and non-pharmacological treatment for MCI and analyse information and limitations in national and international guidelines.Methods: Experts from several European countries conducted a qualitative review of the literature on MCI and treatments for MCI, as well as respective chapters in national and international guidelines on dementia/MCI. Psychotherapeutic/psychosocial treatments were excluded from the review.Results: Consensus diagnostic criteria for MCI are available, making early recognition and accurate classification of MCI subtypes possible. MCI can be identified in a primary care setting. Further corroboration and differential diagnosis should be done at specialist level. Mixed pathologies are the rule in MCI, thus a multi-target treatment approach is a rational strategy. Promising evidence has been generated for multi-domain interventions. Limited evidence is available for different pharmacological classes that have been investigated in MCI clinical trials (e.g. acetylcholinesterase inhibitors). EGb 761® improved symptoms in some clinical trials; it is the only pharmacological treatment recommended in existing guidelines for the symptomatic treatment of MCI.Conclusions: MCI is recognised as an important treatment target and some recent national guidelines have considered symptomatic treatment recommendations for MCI. However, more needs to be done, especially at an international level.
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Affiliation(s)
- Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Christian Bancher
- Department of Neurology/Neurological Rehabilitation, Landesklinikum Horn-Allentsteig, Horn, Austria
| | - Anne Eckert
- Neurobiology Lab for Brain Aging and Mental Health, Transfaculty Research Platform Molecular & Cognitive Neuroscience (MCN), University of Basel, Psychiatric University Clinics Basel, Basel, Switzerland
| | - Hans Förstl
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Lutz Frölich
- Department of Gerontopsychiatry, Central Institute of Mental Health Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Medical Faculty, and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Centre, Brno, Czechia
| | - Amos D Korczyn
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Oleg Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Ikeda Y, Han G, Maruta M, Hotta M, Ueno E, Tabira T. Association between Daily Activities and Behavioral and Psychological Symptoms of Dementia in Community-Dwelling Older Adults with Memory Complaints by Their Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6831. [PMID: 32962076 PMCID: PMC7558144 DOI: 10.3390/ijerph17186831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Abstract
It is important and useful to consider information provided by family members about individuals with memory complaints' instrumental activities of daily living (IADL). The purpose of this study was to clarify the characteristics and relevance of individuals with memory complaints' IADL and behavioral and psychological symptoms of dementia (BPSD) assessed from the perspective of the family members using the Process Analysis of Daily Activity for Dementia and short version Dementia Behavior Disturbance scale. A self-administered questionnaire was sent to 2000 randomly selected members of Consumer's Co-operative Kagoshima, and 621 responded. Of the returned responses, there were 159 participants who answered about individuals with memory complaints. The stepwise multiple regression analysis was used to examine the association between IADL and BPSD. The result showed that many IADL of the individuals with memory complaints were associated with BPSD of apathy, nocturnal wakefulness, and unwarranted accusations, adjusted for age, gender, and the observation list for early signs of dementia. In addition, each IADL was associated with BPSD of apathy, nocturnal wakefulness, and dresses inappropriately. Modifying lifestyle early on when families recognize these changes may help maintain and improve the long-term quality of life of the individuals with memory complaints and their family.
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Affiliation(s)
- Yuriko Ikeda
- Graduate School of Health Science, Kagoshima University, Kagoshima 890-8544, Japan
| | - Gwanghee Han
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan;
| | - Michio Maruta
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima 890-8544, Japan;
- Department of Rehabilitation, Medical Corporation, Sanshukai, Okatsu Hospital, Kagoshima 890-0067, Japan
| | - Maki Hotta
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka 565-0871, Japan;
| | - Eri Ueno
- Department of Rehabilitation, Medical Corporation, Nissyoukai, Minamikagoshimasakura Hospital, Kagoshima 890-0069, Japan;
| | - Takayuki Tabira
- Graduate School of Health Science, Kagoshima University, Kagoshima 890-8544, Japan
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53
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Di Nuovo S, De Beni R, Borella E, Marková H, Laczó J, Vyhnálek M. Cognitive Impairment in Old Age. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. A decline in cognitive functioning is part of physiological aging. Accelerated cognitive decline is frequently linked to pathological changes, mostly due to Alzheimer’s Disease (AD), but is present also in Mild Cognitive Impairment (MCI) which is a predictor of transition to dementia. This review aims to summarize possible preventive biological and psychological treatments in different stages of lifespan to avoid more rapid cognitive decline and prevent pathological aging. Psychophysiological approaches aim to prevent brain damage and inflammation, two factors playing probably a major role in middle and old age. Interventions on working memory and imagery, using “cognitive reserve,” are beneficial for tolerating neuropathological age-related changes. Some controversial results are outlined, suggesting explanations for the inconsistency of findings. Although clear evidence from interventional studies is lacking, it seems that multi-domain interventions should be recommended to avoid or delay cognitive decline.
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Affiliation(s)
| | | | - Erika Borella
- Department of Psychology, University of Padua, Italy
| | - Hana Marková
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Czech Republic
| | - Jan Laczó
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Czech Republic
| | - Martin Vyhnálek
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Czech Republic
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54
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Cavuoto MG, Kinsella GJ, Ong B, Pike KE, Nicholas CL. Naturalistic Measurement of Sleep in Older Adults with Amnestic Mild Cognitive Impairment: Anxiety Symptoms Do Not Explain Sleep Disturbance. Curr Alzheimer Res 2020; 16:233-242. [PMID: 30827241 DOI: 10.2174/1567205016666190301104645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/14/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep disturbance is prevalent in Alzheimer's disease (AD). In amnestic mild cognitive impairment (aMCI), the preclinical stage of AD, deterioration in sleep quality has also been reported. Consensus is lacking, however, regarding what aspects of sleep are characteristically affected, whether the setting of the sleep recordings impacts these findings, and whether anxiety may account for the differences. OBJECTIVE The current study aimed to address these knowledge gaps by obtaining comprehensive sleep measurement in aMCI within a naturalistic environment using in-home sleep recordings. METHODS 17 healthy older adults and twelve participants with aMCI wore an actiwatch for two weeks to objectively record habitual sleeping patterns and completed two nights of in-home polysomnography. RESULTS In aMCI, habitual sleep disturbances were evident on actigraphy including greater wake after sleep onset (p = .012, d = 0.99), fragmentation (p = .010, d = 1.03), and time in bed (p = .046, d = .76). Although not statistically significant, there was a large group effect on polysomnography with aMCI demonstrating less slow-wave-sleep than controls (p >.05, d = .0.83). Anxiety did not mediate the relationship between the group and sleep in this small study. CONCLUSIONS The results indicate that people with aMCI have poorer quality sleep than healthy controls, as indicated by greater sleep disruption and less slow-wave sleep, even in naturalistic settings. Additionally, anxiety symptoms do not mediate the relationship. Therefore, this research supports the view that sleep disturbance is likely to be indicative of neuropathological changes in aMCI rather than being attributed to psychological factors.
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Affiliation(s)
- Marina G Cavuoto
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia.,Department of Psychology, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Glynda J Kinsella
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia.,Department of Psychology, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Ben Ong
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kerryn E Pike
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing & Sleep, Heidelberg, Victoria, Australia
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55
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Fischer CE, Kortebi I, Karameh WK, Kumar S, Gallagher D, Golas A, Munoz D, Barfett J, Butters MA, Bowie CR, Flint A, Rajji T, Herrmann N, Pollock BG, Mulsant B, Schweizer TA, Mah L. Examining the Link Between Cardiovascular Risk Factors and Neuropsychiatric Symptoms in Mild Cognitive Impairment and Major Depressive Disorder in Remission. J Alzheimers Dis 2020; 67:1305-1311. [PMID: 30741676 DOI: 10.3233/jad-181099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular risk factors (CVRFs) have been linked to both depression and cognitive decline but their role in neuropsychiatric symptoms (NPS) has yet to be clarified. OBJECTIVE Understanding the role of CVRFs in the etiology of NPS for prospective treatments and preventive strategies to minimize these symptoms. METHODS We examined the distribution of NPS using the Neuropsychiatric Inventory (NPI) scores in three cohorts from the Prevention of Alzheimer's Dementia with Cognitive Remediation Plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression (PACt-MD) study: older patients with a lifetime history of major depressive disorder (MDD) in remission, patients with mild cognitive impairment (MCI), and patients with combined MCI and MDD. We also examined the link between individual NPS and CVRFs, Framingham risk score, and Hachinski ischemic score in a combined sample. RESULTS Analyses were based on a sample of 140 subjects, 70 with MCI, 38 with MCI plus MDD, and 32 with MDD. There was no effect of age, gender, education, cognition, or CVRFs on the presence (NPI >1) or absence (NPI = 0) of NPS. Depression was the most prevalent affective NPS domain followed by night-time behaviors and appetite changes across all three diagnostic groups. Agitation and aggression correlated negatively while anxiety, disinhibition, night-time behaviors, and irritability correlated positively with CVRFs (all p-values <0.05). Other NPS domains showed no significant association with CVRFs. CONCLUSION CVRFs are significantly associated with individual NPI sub-scores but not with total NPI scores, suggesting that different pathologies may contribute to different NPS domains.
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Affiliation(s)
- Corinne E Fischer
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Keenan Research Centre for Biomedical Research, St. Michael's Hospital, Toronto, Canada
| | | | - Wael K Karameh
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Damien Gallagher
- University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Angela Golas
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - David Munoz
- Keenan Research Centre for Biomedical Research, St. Michael's Hospital, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Joseph Barfett
- Keenan Research Centre for Biomedical Research, St. Michael's Hospital, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Christopher R Bowie
- Centre for Addiction and Mental Health, Toronto, Canada.,Queen's University, Kingston, Canada
| | - Alastair Flint
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Mental Health, University Health Network, Toronto, Canada
| | - Tarek Rajji
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Research, St. Michael's Hospital, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Linda Mah
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, Canada
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56
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Clement-Carbonell V, Cabañero-Martínez MJ, Fernández-Alcántara M, Ruiz-Robledillo N, Escribano S, Congost-Maestre N, Ferrer-Cascales R. Psychometric properties of the Spanish version of the mild cognitive impairment questionnaire. Res Nurs Health 2020; 43:284-293. [PMID: 32173878 DOI: 10.1002/nur.22017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/27/2020] [Indexed: 01/07/2023]
Abstract
The prevalence of mild cognitive impairment (MCI) has significantly increased in recent years. No specific instruments are available in Spanish for assessing health-related quality of life (HRQoL) in people with MCI. The aim of this study was to adapt transculturally and validate the mild cognitive impairment questionnaire (MCQ) in Spanish people with MCI. A standardized transcultural adaptation process was carried out, and the structural equivalence of the Spanish version of the scale was examined. In addition, we studied the reliability and construct validity of the instrument. The sample comprised 100 people with MCI, with a mean age of 79.5 years. In a confirmatory factor analysis, we found the instrument had a one-factor structure and adequate internal consistency. Related to the construct validity, we found meaningful relationships with measures of HRQoL and depression. Our results indicate that the Spanish version of the MCQ is a reliable and valid tool for measuring HRQoL in Spanish patients with MCI. The availability of specific tools, such as the MCQ allows nurses to evaluate new intervention strategies to improve the HRQoL of these patients. Furthermore, this scale can be used by researchers and clinicians to improve the standards of care provided to this population.
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Affiliation(s)
| | | | | | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Silvia Escribano
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
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57
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Fischer CE, Ismail Z, Youakim JM, Creese B, Kumar S, Nuñez N, Ryan Darby R, Di Vita A, D’Antonio F, de Lena C, McGeown WJ, Ramit R, Rasmussen J, Bell J, Wang H, Bruneau MA, Panegyres PK, Lanctôt KL, Agüera-Ortiz L, Lyketsos C, Cummings J, Jeste DV, Sano M, Devanand D, Sweet RA, Ballard C. Revisiting Criteria for Psychosis in Alzheimer’s Disease and Related Dementias: Toward Better Phenotypic Classification and Biomarker Research. J Alzheimers Dis 2020; 73:1143-1156. [DOI: 10.3233/jad-190828] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences; Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | | | - Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicolas Nuñez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - R. Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Antonella Di Vita
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabrizia D’Antonio
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carlo de Lena
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - William J. McGeown
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Ravona Ramit
- Memory and Geriatric Psychiatry Clinic, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, Beijing, China
| | - Marie-Andrée Bruneau
- Department of Psychiatry, University of Montreal, Centre de Recherche de l’Institut Universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - Peter K. Panegyres
- Director, Neurodegenerative Disorders Research Pty Ltd, West Perth, WA, Australia
| | - Krista L. Lanctôt
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Luis Agüera-Ortiz
- Department of Psychiatry Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, & Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jeffrey Cummings
- UNLV Department of Brain Health and the Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Dilip V. Jeste
- Departments of Psychiatry and Neurosciences, and Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - Mary Sano
- Mt Sinai School of Medicine, Manhattan, NY, USA
| | - D.P. Devanand
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Robert A. Sweet
- Departments of Psychiatry and Neurology, University of Pittsburgh, PA, USA
| | - Clive Ballard
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
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58
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Mao Y, Fisher DW, Yang S, Keszycki RM, Dong H. Protein-protein interactions underlying the behavioral and psychological symptoms of dementia (BPSD) and Alzheimer's disease. PLoS One 2020; 15:e0226021. [PMID: 31951614 PMCID: PMC6968845 DOI: 10.1371/journal.pone.0226021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 11/19/2019] [Indexed: 12/25/2022] Open
Abstract
Alzheimer’s Disease (AD) is a devastating neurodegenerative disorder currently affecting 45 million people worldwide, ranking as the 6th highest cause of death. Throughout the development and progression of AD, over 90% of patients display behavioral and psychological symptoms of dementia (BPSD), with some of these symptoms occurring before memory deficits and therefore serving as potential early predictors of AD-related cognitive decline. However, the biochemical links between AD and BPSD are not known. In this study, we explored the molecular interactions between AD and BPSD using protein-protein interaction (PPI) networks built from OMIM (Online Mendelian Inheritance in Man) genes that were related to AD and two distinct BPSD domains, the Affective Domain and the Hyperactivity, Impulsivity, Disinhibition, and Aggression (HIDA) Domain. Our results yielded 8 unique proteins for the Affective Domain (RHOA, GRB2, PIK3R1, HSPA4, HSP90AA1, GSK3beta, PRKCZ, and FYN), 5 unique proteins for the HIDA Domain (LRP1, EGFR, YWHAB, SUMO1, and EGR1), and 6 shared proteins between both BPSD domains (APP, UBC, ELAV1, YWHAZ, YWHAE, and SRC) and AD. These proteins might suggest specific targets and pathways that are involved in the pathogenesis of these BPSD domains in AD.
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Affiliation(s)
- Yimin Mao
- School of Information and Technology, Jiangxi University of Science and Technology, Jiangxi, China
- Applied Science Institute, Jiangxi University of Science and Technology, Jiangxi, China
| | - Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Shuxing Yang
- School of Information and Technology, Jiangxi University of Science and Technology, Jiangxi, China
| | - Rachel M. Keszycki
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
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59
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Ferreira AR, Simões MR, Moreira E, Guedes J, Fernandes L. Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs. Arch Gerontol Geriatr 2020; 86:103919. [DOI: 10.1016/j.archger.2019.103919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/01/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023]
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Sarraf S, Desouza DD, Anderson J, Saverino C. MCADNNet: Recognizing Stages of Cognitive Impairment through Efficient Convolutional fMRI and MRI Neural Network Topology Models. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2019; 7:155584-155600. [PMID: 32021737 PMCID: PMC6999050 DOI: 10.1109/access.2019.2949577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Mild cognitive impairment (MCI) represents the intermediate stage between normal cerebral aging and dementia associated with Alzheimer's disease (AD). Early diagnosis of MCI and AD through artificial intelligence has captured considerable scholarly interest; researchers hope to develop therapies capable of slowing or halting these processes. We developed a state-of-the-art deep learning algorithm based on an optimized convolutional neural network (CNN) topology called MCADNNet that simultaneously recognizes MCI, AD, and normally aging brains in adults over the age of 75 years, using structural and functional magnetic resonance imaging (fMRI) data. Following highly detailed preprocessing, four-dimensional (4D) fMRI and 3D MRI were decomposed to create 2D images using a lossless transformation, which enables maximum preservation of data details. The samples were shuffled and subject-level training and testing datasets were completely independent. The optimized MCADNNet was trained and extracted invariant and hierarchical features through convolutional layers followed by multi-classification in the last layer using a softmax layer. A decision-making algorithm was also designed to stabilize the outcome of the trained models. To measure the performance of classification, the accuracy rates for various pipelines were calculated before and after applying the decision-making algorithm. Accuracy rates of 99.77% 0.36% and 97.5% 1.16% were achieved for MRI and fMRI pipelines, respectively, after applying the decision-making algorithm. In conclusion, a cutting-edge and optimized topology called MCADNNet was designed and preceded a preprocessing pipeline; this was followed by a decision-making step that yielded the highest performance achieved for simultaneous classification of the three cohorts examined.
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Affiliation(s)
- Saman Sarraf
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | - John Anderson
- Kimel Family Translational Imaging Genetics Research Laboratory, The Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental 5 Health, University of Toronto, Toronto, Ontario, Canada
| | - Cristina Saverino
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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61
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Stanzani Maserati M, Mitolo M, Medici F, D'Onofrio R, Oppi F, Poda R, De Matteis M, Tonon C, Lodi R, Liguori R, Capellari S. Color Choice Preference in Cognitively Impaired Patients: A Look Inside Alzheimer's Disease Through the Use of Lüscher Color Diagnostic. Front Psychol 2019; 10:1951. [PMID: 31507498 PMCID: PMC6718708 DOI: 10.3389/fpsyg.2019.01951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/08/2019] [Indexed: 11/13/2022] Open
Abstract
Objective To study the emotional state of cognitively impaired patients through the color choice preference in a group of Alzheimer's disease (AD) patients and compare it with a group of Mild Cognitive Impairment (MCI) patients and a matched control group. Methods A total of 71 AD, 50 MCI and 68 controls were consecutively evaluated. All patients and controls underwent the Mini Mental State Evaluation (MMSE) and the Lüscher color test. Results Cognitively impaired patients mainly chose auxiliary colors, in particular violet and brown, and rejected black and gray. AD patients predominantly chose forms corresponding to auxiliary colors. The auxiliary color choice negatively correlated with the MMSE score. MCI patients and controls had a higher presence of anxiety on gray table and controls had higher frustration and ambivalence, i.e., psychic complexity, on basic color tables.Data globally suggest that AD patients live with a feeling of personal change due to instability and emotional insecurity, experiencing physical discomfort and a bodily need of being welcomed in a favorable environment. They aspire to a sensitive understanding by someone with whom they can be identified. Differently, MCI patients have less of these needs; however, they feel more anxious. Conclusion The comprehension of the inner emotional state of cognitively impaired patients allows us to better communicate with them and effectively approach their behavioral disorders. Like other projective techniques, such as the tree-drawing test and the human figure-drawing test, Lüscher color test is proposed as a simple and unconventional approach to understand the emotional life of AD patients. The awareness of clinicians about the existential fragility and insecurity of such type of patients allows us not only to better manage their behavioral disturbances but also to improve their quality of life and that of their caregivers.
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Affiliation(s)
| | - Micaela Mitolo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
| | - Federica Medici
- Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
| | - Renato D'Onofrio
- Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
| | - Federico Oppi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Roberto Poda
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Caterina Tonon
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
| | - Raffaele Lodi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
| | - Sabina Capellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Bologna, Italy
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62
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Simon KC, Yucus C, Castle J, Chesis R, Lai R, Hillman L, Tideman S, Garduno L, Meyers S, Frigerio R, Maraganore DM. Building of EMR Tools to Support Quality and Research in a Memory Disorders Clinic. Front Neurol 2019; 10:161. [PMID: 30899241 PMCID: PMC6416163 DOI: 10.3389/fneur.2019.00161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/07/2019] [Indexed: 12/14/2022] Open
Abstract
The electronic medical record (EMR) presents an opportunity to standardize patient data collection based on quality guidelines and conduct practice-based research. We describe the development of a customized EMR “toolkit” that standardizes patient data collection with hundreds of discrete fields that supports Best Practices for treating patients with memory disorders. The toolkit also supports practice-based research. We describe the design and successful implementation of a customized EMR toolkit to support Best Practices in the care of patients with memory disorders. We discuss applications, including quality improvement projects and current research initiatives, using the toolkit. This toolkit is being shared with other departments of Neurology as part of the Neurology Practice-Based Research Network. Data collection is ongoing, including longitudinal follow-up. This toolkit will generate data that will allow for descriptive and hypothesis driven research as well-quality improvement among patients seen in a memory clinic.
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Affiliation(s)
- Kelly Claire Simon
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Chad Yucus
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - James Castle
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Richard Chesis
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Rebekah Lai
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Laura Hillman
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Samuel Tideman
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Lisette Garduno
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven Meyers
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Roberta Frigerio
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Demetrius M Maraganore
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
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63
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Terada S, Nakashima M, Wakutani Y, Nakata K, Kutoku Y, Sunada Y, Kondo K, Ishizu H, Yokota O, Maki Y, Hattori H, Yamada N. Social problems in daily life of patients with dementia. Geriatr Gerontol Int 2018; 19:113-118. [PMID: 30515960 DOI: 10.1111/ggi.13554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/10/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Abstract
AIM Most patients with dementia frequently encounter various problems in their daily lives. Those troubles embarrass both the patients and their families, and cause problems for society. However, there have been few scientific reports on the difficulties in the daily life of patients with dementia. Therefore, we tried to clarify the frequency and characteristics of troubles experienced by patients with dementia. METHODS Seven medical centers treating dementia patients in Okayama Prefecture, Japan, participated in this survey. A total of 737 patients were placed in one of the three groups: a dementia group (n = 478), a mild cognitive impairment group (n = 199) and a control group (n = 60). The frequency of 13 difficulties was scored for each patient. RESULTS Among normal participants, no person caused these problems once a year or more frequently. "Massive, recurrent buying" and "acts that risk causing a fire" were reported once a year or more for >10% of mild cognitive impairment patients. "Troubles with wealth management" and "troubles with money management" were the most frequent problems of dementia patients. CONCLUSIONS Several problems are already sometimes encountered in patients with mild cognitive impairment. It would be useful to know which social difficulties are often seen in dementia patients in order to protect the safety of the patients. It is always difficult to balance respecting the autonomy of dementia patients and ensuring their safely. Geriatr Gerontol Int 2019; 19: 113-118.
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Affiliation(s)
- Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Makoto Nakashima
- Department of Psychiatry, Okayama Red Cross Hospital, Okayama, Japan
| | - Yosuke Wakutani
- Department of Neurology, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Nakata
- Department of Psychiatry, Taiyo Hills Hospital, Takahashi, Japan
| | - Yumiko Kutoku
- Department of Neurology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshihide Sunada
- Department of Neurology, Kawasaki Medical School, Kurashiki, Japan
| | - Keiko Kondo
- Department of Psychiatry, Sekizen Hospital, Tsuyama, Japan
| | - Hideki Ishizu
- Department of Psychiatry, Zikei Hospital, Okayama, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Yohko Maki
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hideyuki Hattori
- Department of Psychiatry, National Hospital for Geriatric Medicine, NCGG, Obu, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Okayama, Japan
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64
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De Vito A, Calamia M, Weitzner DS, Bernstein J. Examining differences in neuropsychiatric symptom factor trajectories in empirically derived mild cognitive impairment subtypes. Int J Geriatr Psychiatry 2018; 33:1627-1634. [PMID: 30276884 PMCID: PMC8785654 DOI: 10.1002/gps.4963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/22/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine neuropsychiatric symptom (NPS) factor severity progression over time in empirically derived (ED) mild cognitive impairment (MCI) subtypes. METHODS Participants in the Alzheimer's Disease Neuroimaging Initiative study diagnosed with MCI by Alzheimer's Disease Neuroimaging Initiative protocol using conventional clinical (CC) criteria (n = 788) were reclassified using cluster analysis as amnestic, dysnomic, dysexecutive MCI, or cluster-derived normal (CC-Normal) using empirical criteria. Cognitively normal (CN) participants (n = 207) were also identified. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was administered from baseline through 48-month follow-up. Exploratory factor analysis was completed to determine the NPI-Q factor structure at 6-month follow-up. Multilevel modeling was used to determine NPI-Q symptom severity factor and apathy symptom progression over time by cognitive subtype. RESULTS The exploratory factor analysis revealed that the NPI-Q consisted of 2 factors: hyperactivity/agitation and mood symptoms. Using clinical and empirical criteria, all MCI groups were identified as having more severe hyperactivity/agitation symptoms than CN participants. However, only the amnestic MCI group identified using empirical criteria showed an increase in symptom severity over time relative to CN participants. Mood factor and apathy symptoms were found to be more severe in dysexecutive and amnestic groups in both models. Similarly, both models identified a significant worsening of mood and apathy symptoms over time for dysexecutive and amnestic groups relative to CN participants. CONCLUSIONS This study provides further support that empirical criteria aid in examining the progression of clinical characteristics associated with MCI. Further, it helps to identify which MCI subtypes may be at higher risk for NPS progression.
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Affiliation(s)
- Alyssa De Vito
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
| | - Matthew Calamia
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
| | - Daniel S. Weitzner
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
| | - John Bernstein
- Louisiana State University, Department of Psychology, Baton Rouge, LA 70803
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65
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Kinsella GJ, Pike KE, Cavuoto MG, Lee SD. Mild cognitive impairment and prospective memory: translating the evidence into neuropsychological practice. Clin Neuropsychol 2018; 32:960-980. [PMID: 29708011 DOI: 10.1080/13854046.2018.1468926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE There has been a recent rapid development of research characterizing prospective memory performance in mild cognitive impairment (MCI) in older age. However, this body of literature remains largely separated from routine clinical practice in neuropsychology. Furthermore, there is emerging evidence of effective interventions to improve prospective memory performance. Therefore, our objective in this article was to offer a clinical neuropsychological perspective on the existing research in order to facilitate the translation of the evidence-base into clinical practice. METHOD By conducting a critical review of the existing research related to prospective memory and MCI, we highlight how this data can be introduced into clinical practice, either within diagnostic assessment or clinical management. CONCLUSIONS Prospective memory is impaired in older adults with MCI, with a pattern of performance that helps with differential diagnosis from healthy aging. Clinical neuropsychologists are encouraged to add prospective memory assessment to their toolbox for diagnostic evaluation of clients with MCI. Preliminary findings of prospective memory interventions in MCI are promising, but more work is required to determine how different approaches translate to increasing independence in everyday life.
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Affiliation(s)
- Glynda J Kinsella
- a School of Psychology & Public Health , La Trobe University , Melbourne , Australia.,b Caulfield Hospital , Melbourne , Australia
| | - Kerryn E Pike
- a School of Psychology & Public Health , La Trobe University , Melbourne , Australia
| | - Marina G Cavuoto
- a School of Psychology & Public Health , La Trobe University , Melbourne , Australia.,b Caulfield Hospital , Melbourne , Australia
| | - Stephen D Lee
- a School of Psychology & Public Health , La Trobe University , Melbourne , Australia
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66
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Clark US, Arce Rentería M, Hegde RR, Morgello S. Early Life Stress-Related Elevations in Reaction Time Variability Are Associated with Brain Volume Reductions in HIV+ Adults. Front Behav Neurosci 2018; 12:6. [PMID: 29441001 PMCID: PMC5797588 DOI: 10.3389/fnbeh.2018.00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
There is burgeoning evidence that, among HIV+ adults, exposure to high levels of early life stress (ELS) is associated with increased cognitive impairment as well as brain volume abnormalities and elevated neuropsychiatric symptoms. Currently, we have a limited understanding of the degree to which cognitive difficulties observed in HIV+ High-ELS samples reflect underlying neural abnormalities rather than increases in neuropsychiatric symptoms. Here, we utilized a behavioral marker of cognitive function, reaction time intra-individual variability (RT-IIV), which is sensitive to both brain volume reductions and neuropsychiatric symptoms, to elucidate the unique contributions of brain volume abnormalities and neuropsychiatric symptoms to cognitive difficulties in HIV+ High-ELS adults. We assessed the relation of RT-IIV to neuropsychiatric symptom levels and total gray and white matter volumes in 44 HIV+ adults (26 with high ELS). RT-IIV was examined during a working memory task. Self-report measures assessed current neuropsychiatric symptoms (depression, stress, post-traumatic stress disorder). Magnetic resonance imaging was used to quantify total gray and white matter volumes. Compared to Low-ELS participants, High-ELS participants exhibited elevated RT-IIV, elevated neuropsychiatric symptoms, and reduced gray and white matter volumes. Across the entire sample, RT-IIV was significantly associated with gray and white matter volumes, whereas significant associations with neuropsychiatric symptoms were not observed. In the High-ELS group, despite the presence of elevated neuropsychiatric symptom levels, brain volume reductions explained more than 13% of the variance in RT-IIV, whereas neuropsychiatric symptoms explained less than 1%. Collectively, these data provide evidence that, in HIV+ High-ELS adults, ELS-related cognitive difficulties (as indexed by RT-IIV) exhibit strong associations with global brain volumes, whereas ELS-related elevations in neuropsychiatric symptoms appear to contribute minimally to these cognitive difficulties. Such findings support a growing body of evidence indicating that high ELS exposure is a significant risk factor for neurocognitive dysfunction in HIV+ adults. Further, these data highlight the need to better understand how ELS-related pathophysiological mechanisms contribute to volumetric and other neural abnormalities in HIV+ individuals.
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Affiliation(s)
- Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Rachal R Hegde
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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67
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Mortby ME, Burns R, Eramudugolla R, Ismail Z, Anstey KJ. Neuropsychiatric Symptoms and Cognitive Impairment: Understanding the Importance of Co-Morbid Symptoms. J Alzheimers Dis 2017; 59:141-153. [DOI: 10.3233/jad-170050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Moyra E. Mortby
- Centre for Research on Ageing, Health andWellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
- NHMRC National Institute for Dementia Research, Australia
| | - Richard Burns
- Centre for Research on Ageing, Health andWellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Ranmalee Eramudugolla
- Centre for Research on Ageing, Health andWellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Zahinoor Ismail
- Departments of Psychiatry and Clinical Neurosciences, Mathison Centre for Mental Health Research &Education, Ron and Rene Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Kaarin J. Anstey
- Centre for Research on Ageing, Health andWellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
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68
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Iaboni A, Rapoport MJ. Detecting and Managing Neuropsychiatric Symptoms in Dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:158-160. [PMID: 28212493 PMCID: PMC5317019 DOI: 10.1177/0706743716672409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Andrea Iaboni
- 1 Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario.,2 University of Toronto, Toronto, Ontario
| | - Mark J Rapoport
- 2 University of Toronto, Toronto, Ontario.,3 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
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