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Elefante C, Brancati GE, Pistolesi G, Amadori S, Torrigiani S, Baldacci F, Ceravolo R, Ismail Z, Lattanzi L, Perugi G. The impact of mild behavioral impairment on the prognosis of geriatric depression: preliminary results. Int Clin Psychopharmacol 2024; 39:305-312. [PMID: 37966156 DOI: 10.1097/yic.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Our study aimed to examine how the presence of Mild Behavioral Impairment (MBI) symptoms influenced the outcome of late-life depression (LLD). Twenty-nine elderly (≥ 60 years) depressive patients, including eleven (37.9%) with MBI, were recruited and followed-up on average for 33.41 ± 8.24 weeks. Psychiatric symptoms severity and global functioning were assessed, respectively, using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) scale. BPRS total score significantly decreased from baseline to follow-up ( P < 0.001, d = 1.33). The presence of MBI had no significant effect on mood and cognitive symptoms improvement. On the contrary, while a significant increase in GAF score was observed in patients without MBI ( P = 0.001, d = 1.01), no significant improvement of global functioning was detected in those with MBI ( P = 0.154, d = 0.34) after 6-month follow-up. The presence of MBI in patients with LLD may negatively affect long-term outcome, slowing or preventing functional improvement.
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Affiliation(s)
- Camilla Elefante
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | | | - Gabriele Pistolesi
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | - Salvatore Amadori
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | - Samuele Torrigiani
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | - Filippo Baldacci
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology and Laboratory Medicine, Hotchkiss Brain Institute & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- College of Health and Medicine, University of Exeter, Exeter, UK
| | | | - Giulio Perugi
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
- G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
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Angelopoulou E, Bougea A, Hatzimanolis A, Scarmeas N, Papageorgiou SG. Unraveling the Potential Underlying Mechanisms of Mild Behavioral Impairment: Focusing on Amyloid and Tau Pathology. Cells 2024; 13:1164. [PMID: 38995015 PMCID: PMC11240615 DOI: 10.3390/cells13131164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
The emergence of sustained neuropsychiatric symptoms (NPS) among non-demented individuals in later life, defined as mild behavioral impairment (MBI), is linked to a higher risk of cognitive decline. However, the underlying pathophysiological mechanisms remain largely unexplored. A growing body of evidence has shown that MBI is associated with alterations in structural and functional neuroimaging studies, higher genetic predisposition to clinical diagnosis of Alzheimer's disease (AD), as well as amyloid and tau pathology assessed in the blood, cerebrospinal fluid, positron-emission tomography (PET) imaging and neuropathological examination. These findings shed more light on the MBI-related potential neurobiological mechanisms, paving the way for the development of targeted pharmacological approaches. In this review, we aim to discuss the available clinical evidence on the role of amyloid and tau pathology in MBI and the potential underlying pathophysiological mechanisms. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, disruption of neurotrophic factors, such as the brain-derived neurotrophic factor (BDNF), abnormal neuroinflammatory responses including the kynurenine pathway, dysregulation of transforming growth factor beta (TGF-β1), epigenetic alterations including micro-RNA (miR)-451a and miR-455-3p, synaptic dysfunction, imbalance in neurotransmitters including acetylcholine, dopamine, serotonin, gamma-aminobutyric acid (GABA) and norepinephrine, as well as altered locus coeruleus (LC) integrity are some of the potential mechanisms connecting MBI with amyloid and tau pathology. The elucidation of the underlying neurobiology of MBI would facilitate the design and efficacy of relative clinical trials, especially towards amyloid- or tau-related pathways. In addition, we provide insights for future research into our deeper understanding of its underlying pathophysiology of MBI, and discuss relative therapeutic implications.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Street 72-74, 11528 Athens, Greece
| | - Anastasia Bougea
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Street 72-74, 11528 Athens, Greece
| | - Alexandros Hatzimanolis
- 1st Department of Psychiatry, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Street 72-74, 11528 Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Street 72-74, 11528 Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Street 72-74, 11528 Athens, Greece
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Gonzalez‐Bautista E, Momméja M, de Mauléon A, Ismail Z, Vellas B, Delrieu J, Soto Martin ME. Mild behavioral impairment domains are longitudinally associated with pTAU and metabolic biomarkers in dementia-free older adults. Alzheimers Dement 2024; 20:4692-4701. [PMID: 38877658 PMCID: PMC11247706 DOI: 10.1002/alz.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The mechanisms linking mild behavioral impairment (MBI) and Alzheimer's disease (AD) have been insufficiently explored, with conflicting results regarding tau protein and few data on other metabolic markers. We aimed to evaluate the longitudinal association of the MBI domains and a spectrum of plasma biomarkers. METHODS Our study is a secondary analysis of data from NOLAN. The longitudinal association of the MBI domains with plasma biomarkers, including pTau181, was tested using adjusted linear mixed-effects models. RESULTS The sample comprised 359 participants (60% female, mean age: 78.3, standard deviation: 0.3 years). After 1 year, the MBI domain of abnormal perception was associated with steeper increases in plasma pTau181. Abnormal perception, decreased motivation, and impulse dyscontrol were associated with homocysteine or insulin dysregulation. DISCUSSION Apart from the association with plasma pTau181, our results suggest that MBI might also represent metabolic dysregulation, probably contributing to dementia transition among older adults with subjective cognitive decline or mild cognitive impairment. HIGHLIGHTS Mild behavioral impairment (MBI) psychosis was associated with steeper increases in plasma p. pTau could be a pharmacological target to treat agitation and psychosis symptoms. MBI domains were linked to metabolic dysregulation involving insulin and homocysteine.
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Affiliation(s)
- Emmanuel Gonzalez‐Bautista
- Research and Clinical Alzheimer's Disease CenterCMRRCHU ToulouseIHU HealthAgeToulouseFrance
- Maintain Aging Research teamCERPOPUniversité de ToulouseInserm, Université Paul SabatierToulouseFrance
| | - Marie Momméja
- Research and Clinical Alzheimer's Disease CenterCMRRCHU ToulouseIHU HealthAgeToulouseFrance
| | - Adelaïde de Mauléon
- Research and Clinical Alzheimer's Disease CenterCMRRCHU ToulouseIHU HealthAgeToulouseFrance
- Maintain Aging Research teamCERPOPUniversité de ToulouseInserm, Université Paul SabatierToulouseFrance
| | - Zahinoor Ismail
- Departments of PsychiatryClinical NeurosciencesCommunity Health Sciences, and PathologyHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
- Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Bruno Vellas
- Research and Clinical Alzheimer's Disease CenterCMRRCHU ToulouseIHU HealthAgeToulouseFrance
- Maintain Aging Research teamCERPOPUniversité de ToulouseInserm, Université Paul SabatierToulouseFrance
| | - Julien Delrieu
- Research and Clinical Alzheimer's Disease CenterCMRRCHU ToulouseIHU HealthAgeToulouseFrance
- Maintain Aging Research teamCERPOPUniversité de ToulouseInserm, Université Paul SabatierToulouseFrance
| | - Maria E. Soto Martin
- Research and Clinical Alzheimer's Disease CenterCMRRCHU ToulouseIHU HealthAgeToulouseFrance
- Maintain Aging Research teamCERPOPUniversité de ToulouseInserm, Université Paul SabatierToulouseFrance
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Cushing SD, Moseley SC, Stimmell AC, Schatschneider C, Wilber AA. Rescuing impaired hippocampal-cortical interactions and spatial reorientation learning and memory during sleep in a mouse model of Alzheimer's disease using hippocampal 40 Hz stimulation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.20.599921. [PMID: 38979221 PMCID: PMC11230253 DOI: 10.1101/2024.06.20.599921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
In preclinical Alzheimer's disease (AD), spatial learning and memory is impaired. We reported similar impairments in 3xTg-AD mice on a virtual maze (VM) spatial-reorientation-task that requires using landmarks to navigate. Hippocampal (HPC)-cortical dysfunction during sleep (important for memory consolidation) is a potential mechanism for memory impairments in AD. We previously found deficits in HPC-cortical coordination during sleep coinciding with VM impairments the next day. Some forms of 40 Hz stimulation seem to clear AD pathology in mice, and improve functional connectivity in AD patients. Thus, we implanted a recording array targeting parietal cortex (PC) and HPC to assess HPC-PC coordination, and an optical fiber targeting HPC for 40 Hz or sham optogenetic stimulation in 3xTg/PV cre mice. We assessed PC delta waves (DW) and HPC sharp wave ripples (SWRs). In sham mice, SWR-DW cross-correlations were reduced, similar to 3xTg-AD mice. In 40 Hz mice, this phase-locking was rescued, as was performance on the VM. However, rescued HPC-PC coupling no longer predicted performance as in NonTg animals. Instead, DWs and SWRs independently predicted performance in 40 Hz mice. Thus, 40 Hz stimulation of HPC rescued functional interactions in the HPC-PC network, and rescued impairments in spatial navigation, but did not rescue the correlation between HPC-PC coordination during sleep and learning and memory. Together this pattern of results could inform AD treatment timing by suggesting that despite applying 40 Hz stimulation before significant tau and amyloid aggregation, pathophysiological processes led to brain changes that were not fully reversed even though cognition was recovered. Significance Statement One of the earliest symptoms of Alzheimer's disease (AD) is getting lost in space or experiencing deficits in spatial navigation, which involve navigation computations as well as learning and memory. We investigated cross brain region interactions supporting memory formation as a potential causative factor of impaired spatial learning and memory in AD. To assess this relationship between AD pathophysiology, brain changes, and behavioral alterations, we used a targeted approach for clearing amyloid beta and tau to rescue functional interactions in the brain. This research strongly connects brain activity patterns during sleep to tau and amyloid accumulation, and will aid in understanding the mechanisms underlying cognitive dysfunction in AD. Furthermore, the results offer insight for improving early identification and treatment strategies.
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Naude J, Wang M, Leon R, Smith E, Ismail Z. Tau-PET in early cortical Alzheimer brain regions in relation to mild behavioral impairment in older adults with either normal cognition or mild cognitive impairment. Neurobiol Aging 2024; 138:19-27. [PMID: 38490074 DOI: 10.1016/j.neurobiolaging.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
Mild Behavioral Impairment (MBI) leverages later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high-risk group for incident dementia. Phosphorylated tau (p-tau) is a hallmark biological manifestation of Alzheimer disease (AD). We investigated associations between MBI and tau accumulation in early-stage AD cortical regions. In 442 Alzheimer's Disease Neuroimaging Initiative participants with normal cognition or mild cognitive impairment, MBI status was determined alongside corresponding p-tau and Aβ. Two meta-regions of interest were generated to represent Braak I and III neuropathological stages. Multivariable linear regression modelled the association between MBI as independent variable and tau tracer uptake as dependent variable. Among Aβ positive individuals, MBI was associated with tau uptake in Braak I (β=0.45(0.15), p<.01) and Braak III (β=0.24(0.07), p<.01) regions. In Aβ negative individuals, MBI was not associated with tau in the Braak I region (p=0.11) with a negative association in Braak III (p=.01). These findings suggest MBI may be a sequela of neurodegeneration, and can be implemented as a cost-effective framework to help improve screening efficiency for AD.
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Affiliation(s)
- James Naude
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rebeca Leon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Monchi O, Pinilla-Monsalve GD, Almgren H, Ghahremani M, Kibreab M, Maarouf N, Kathol I, Boré A, Rheault F, Descoteaux M, Ismail Z. White Matter Microstructural Underpinnings of Mild Behavioral Impairment in Parkinson's Disease. Mov Disord 2024; 39:1026-1036. [PMID: 38661496 DOI: 10.1002/mds.29804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/13/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) experience changes in behavior, personality, and cognition that can manifest even in the initial stages of the disease. Previous studies have suggested that mild behavioral impairment (MBI) should be considered an early marker of cognitive decline. However, the precise neurostructural underpinnings of MBI in early- to mid-stage PD remain poorly understood. OBJECTIVE The aim was to explore the changes in white matter microstructure linked to MBI and mild cognitive impairment (MCI) in early- to mid-stage PD using diffusion magnetic resonance imaging (dMRI). METHODS A total of 91 PD patients and 36 healthy participants were recruited and underwent anatomical MRI and dMRI, a comprehensive neuropsychological battery, and the completion of the Mild Behavioral Impairment-Checklist. Metrics of white matter integrity included tissue fractional anisotropy (FAt) and radial diffusivity (RDt), free water (FW), and fixel-based apparent fiber density (AFD). RESULTS The connection between the left amygdala and the putamen was disrupted when comparing PD patients with MBI (PD-MBI) to PD-non-MBI, as evidenced by increased RDt (η2 = 0.09, P = 0.004) and both decreased AFD (η2 = 0.05, P = 0.048) and FAt (η2 = 0.12, P = 0.014). Compared to controls, PD patients with both MBI and MCI demonstrated increased FW for the connection between the left orbitofrontal gyrus (OrG) and the hippocampus (η2 = 0.22, P = 0.008), augmented RDt between the right OrG and the amygdala (η2 = 0.14, P = 0.008), and increased RDt (η2 = 0.25, P = 0.028) with decreased AFD (η2 = 0.10, P = 0.046) between the right OrG and the caudate nucleus. CONCLUSION MBI is associated with abnormal microstructure of connections involving the orbitofrontal cortex, putamen, and amygdala. To our knowledge, this is the first assessment of the white matter microstructure in PD-MBI using dMRI. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Oury Monchi
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
- Département de radiologie, radio-oncologie et médicine nucléaire, Université de Montréal, Montreal, Quebec, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Gabriel D Pinilla-Monsalve
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
- Département de radiologie, radio-oncologie et médicine nucléaire, Université de Montréal, Montreal, Quebec, Canada
| | - Hannes Almgren
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Maryam Ghahremani
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mekale Kibreab
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nadia Maarouf
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Iris Kathol
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Arnaud Boré
- Département d'informatique, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Rheault
- Département d'informatique, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maxime Descoteaux
- Département d'informatique, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Iordan AD, Ploutz-Snyder R, Ghosh B, Rahman-Filipiak A, Koeppe R, Peltier S, Giordani B, Albin RL, Hampstead BM. Salience Network Segregation Mediates the Effect of Tau Pathology on Mild Behavioral Impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.26.24307943. [PMID: 38854100 PMCID: PMC11160832 DOI: 10.1101/2024.05.26.24307943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
INTRODUCTION A recently developed mild behavioral impairment (MBI) diagnostic framework standardizes the early characterization of neuropsychiatric symptoms in older adults. However, the links between MBI, brain function, and Alzheimer's disease (AD) biomarkers are unclear. METHODS Using data from 128 participants with diagnosis of amnestic mild cognitive impairment and mild dementia - Alzheimer's type, we test a novel model assessing direct relationships between AD biomarker status and MBI symptoms, as well as mediated effects through segregation of the salience and default-mode networks. RESULTS We identified a mediated effect of tau positivity on MBI through functional segregation of the salience network from the other high-level, association networks. There were no direct effects of AD biomarkers status on MBI. DISCUSSION Our findings suggest an indirect role of tau pathology in MBI through brain network dysfunction and emphasize the role of the salience network in mediating relationships between neuropathological changes and behavioral manifestations.
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Affiliation(s)
- Alexandru D. Iordan
- Research Program on Cognition and Neuromodulation Based Interventions (RP-CNBI), Department of Psychiatry, University of Michigan, 4251 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Robert Ploutz-Snyder
- Applied Biostatistics Laboratory, School of Nursing, University of Michigan, 426 N Ingalls St, Ann Arbor, MI 48109, USA
| | - Bidisha Ghosh
- Applied Biostatistics Laboratory, School of Nursing, University of Michigan, 426 N Ingalls St, Ann Arbor, MI 48109, USA
| | - Annalise Rahman-Filipiak
- Research Program on Cognition and Neuromodulation Based Interventions (RP-CNBI), Department of Psychiatry, University of Michigan, 4251 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Robert Koeppe
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Scott Peltier
- Functional MRI Laboratory, University of Michigan, 2360 Bonisteel Blvd, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, MI 48109, USA
| | - Bruno Giordani
- Research Program on Cognition and Neuromodulation Based Interventions (RP-CNBI), Department of Psychiatry, University of Michigan, 4251 Plymouth Rd., Ann Arbor, MI, 48105, USA
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Roger L. Albin
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
- Neurology Service & GRECC, VAAAHS, 2215 Fuller Rd, Ann Arbor, MI 48105, USA
| | - Benjamin M. Hampstead
- Research Program on Cognition and Neuromodulation Based Interventions (RP-CNBI), Department of Psychiatry, University of Michigan, 4251 Plymouth Rd., Ann Arbor, MI, 48105, USA
- VA Ann Arbor Healthcare System, Neuropsychology Section, Mental Health Service, 2215 Fuller Rd, Ann Arbor, MI 48105, USA
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Sanchez-Rodriguez LM, Bezgin G, Carbonell F, Therriault J, Fernandez-Arias J, Servaes S, Rahmouni N, Tissot C, Stevenson J, Karikari TK, Ashton NJ, Benedet AL, Zetterberg H, Blennow K, Triana-Baltzer G, Kolb HC, Rosa-Neto P, Iturria-Medina Y. Personalized whole-brain neural mass models reveal combined Aβ and tau hyperexcitable influences in Alzheimer's disease. Commun Biol 2024; 7:528. [PMID: 38704445 PMCID: PMC11069569 DOI: 10.1038/s42003-024-06217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
Neuronal dysfunction and cognitive deterioration in Alzheimer's disease (AD) are likely caused by multiple pathophysiological factors. However, mechanistic evidence in humans remains scarce, requiring improved non-invasive techniques and integrative models. We introduce personalized AD computational models built on whole-brain Wilson-Cowan oscillators and incorporating resting-state functional MRI, amyloid-β (Aβ) and tau-PET from 132 individuals in the AD spectrum to evaluate the direct impact of toxic protein deposition on neuronal activity. This subject-specific approach uncovers key patho-mechanistic interactions, including synergistic Aβ and tau effects on cognitive impairment and neuronal excitability increases with disease progression. The data-derived neuronal excitability values strongly predict clinically relevant AD plasma biomarker concentrations (p-tau217, p-tau231, p-tau181, GFAP) and grey matter atrophy obtained through voxel-based morphometry. Furthermore, reconstructed EEG proxy quantities show the hallmark AD electrophysiological alterations (theta band activity enhancement and alpha reductions) which occur with Aβ-positivity and after limbic tau involvement. Microglial activation influences on neuronal activity are less definitive, potentially due to neuroimaging limitations in mapping neuroprotective vs detrimental activation phenotypes. Mechanistic brain activity models can further clarify intricate neurodegenerative processes and accelerate preventive/treatment interventions.
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Affiliation(s)
- Lazaro M Sanchez-Rodriguez
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics & Mental Health, Montreal, QC, Canada
| | - Gleb Bezgin
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics & Mental Health, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | | | - Joseph Therriault
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Jaime Fernandez-Arias
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Stijn Servaes
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Nesrine Rahmouni
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Cécile Tissot
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
- Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Jenna Stevenson
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- King's College London, Institute of Psychiatry, Psychology and Neuroscience Maurice Wohl Institute Clinical Neuroscience Institute, London, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Andréa L Benedet
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | | | - Hartmuth C Kolb
- Neuroscience Biomarkers, Janssen Research & Development, La Jolla, CA, USA
| | - Pedro Rosa-Neto
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Yasser Iturria-Medina
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada.
- Ludmer Centre for Neuroinformatics & Mental Health, Montreal, QC, Canada.
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Dibbern P, Horsch J, Fiegl J, Eckl L, Finger T, Diermeier L, Deppe M, Schiekofer S, Langguth B, Ismail Z, Barinka F. [Mild behavioral impairment checklist : English-German translation and feasibility study assessing its use in clinical practice]. Z Gerontol Geriatr 2024; 57:207-213. [PMID: 37358788 PMCID: PMC11078794 DOI: 10.1007/s00391-023-02200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/19/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The mild behavioral impairment (MBI) syndrome is defined by the emergence in later life of persistent neuropsychiatric symptoms. The MBI checklist (MBI-C) can be used for systematic detection and documentation of such symptoms. OBJECTIVE Development of a German version of the MBI‑C and assessment of its application in a clinical setting. MATERIAL AND METHODS The MBI‑C was translated from English into German in collaboration with the main author of the original version, and its practical application was then tested on a study population (n = 21) in a gerontopsychiatric inpatient clinic. Patient compliance, understanding of questions, time effort, evaluation procedure and possible discrepancy between patient and family member evaluations were assessed. RESULTS The German translation of the original MBI‑C obtained certification as an official version and can be downloaded at https://mbitest.org . All 34 questions were fully completed by the study population, the level of understanding of questions was good, with the mean time effort being 16 min. In some cases, significant differences between patients' and family members' responses were found. DISCUSSION The presence of MBI may indicate the development of an otherwise presymptomatic neurodegenerative dementia syndrome. Hence, the MBI‑C could aid in the early detection of neurodegenerative dementia. By means of the translated version of the MBI‑C presented in this study, this hypothesis can now be tested in German-speaking countries.
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Affiliation(s)
- Pauline Dibbern
- Zentrum für Altersmedizin der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland
| | - Jennifer Horsch
- Klinik für Innere Medizin, Krankenhaus Barmherzige Brüder St. Barbara, Schwandorf, Deutschland
| | - Julia Fiegl
- Zentrum für Altersmedizin der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland
| | - Linda Eckl
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
| | - Tamara Finger
- Zentrum für Psychiatrie Cham der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Cham, Deutschland
| | - Lisa Diermeier
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Mainkofen, Deggendorf, Germany
| | - Markus Deppe
- Zentrum für Altersmedizin der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland
| | - Stephan Schiekofer
- Zentrum für Altersmedizin der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland
- Fakultät für Medizin, Lehrstuhl für Geriatrie, Sigmund Freud PrivatUniversität, Wien, Österreich
| | - Berthold Langguth
- Zentrale Aufnahme und Psychiatrische Institutsambulanz der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland
- Zentrum für Allgemeinpsychiatrie (Zentrum II) der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Kanada
| | - Filip Barinka
- Zentrum für Altersmedizin der Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg, Regensburg, Deutschland.
- Klinik und Poliklinik für Neurologie, Universität Regensburg, Regensburg, Deutschland.
- Dr. Filip Barinka, Altersneurologie und Gedächtnis-Sprechstunde, Bürglistrasse 29, 8002, Zürich, Switzerland.
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Ronat L, Hanganu A, Chylinski D, Van Egroo M, Narbutas J, Besson G, Muto V, Schmidt C, Bahri MA, Phillips C, Salmon E, Maquet P, Vandewalle G, Collette F, Bastin C. Prediction of cognitive decline in healthy aging based on neuropsychiatric symptoms and PET-biomarkers of Alzheimer's disease. J Neurol 2024; 271:2067-2077. [PMID: 38114820 DOI: 10.1007/s00415-023-12131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
Neuropsychiatric symptoms (NPS) have been associated with a risk of accelerated cognitive decline or conversion to dementia of the Alzheimer's Disease (AD) type. Moreover, the NPS were also associated with higher AD biomarkers (brain tau and amyloid burden) even in non-demented patients. But the effect of the relationship between NPS and biomarkers on cognitive decline has not yet been studied. This work aims to assess the relationship between longitudinal cognitive changes and NPS, specifically depression and anxiety, in association with AD biomarkers in healthy middle-aged to older participants. The cohort consisted of 101 healthy participants aged 50-70 years, 66 of whom had neuropsychological assessments of memory, executive functions, and global cognition at a 2-year follow-up. At baseline, NPS were assessed using the Beck Depression and Anxiety Inventories while brain tau and amyloid loads were measured using positron emission topography. For tau burden, THK5351 uptake is used as a proxy of tau and neuroinflammation. Participants, declining or remaining stable at follow-up, were categorized into groups for each cognitive domain. Group classification was investigated using binary logistic regressions based on combined AD biomarkers and the two NPS. The results showed that an association between anxiety and prefrontal amyloid burden significantly classified episodic memory decline, while the classification of global cognitive decline involved temporal and occipital amyloid burden but not NPS. Moreover, depression together with prefrontal and hippocampal tau burden were associated with a decline in memory. The classification of participants based on executive decline was related to depression and mainly prefrontal tau burden. These findings suggest that the combination of NPS and brain biomarkers of AD predicts the occurrence of cognitive decline in aging.
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Affiliation(s)
- Lucas Ronat
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, QC, Canada
- Research Centre, University Institute of Geriatrics of Montreal, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Alexandru Hanganu
- Research Centre, University Institute of Geriatrics of Montreal, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Faculty of Arts and Sciences, Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Daphné Chylinski
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Maxime Van Egroo
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Justinas Narbutas
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
| | - Gabriel Besson
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Vincenzo Muto
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Christina Schmidt
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Christophe Phillips
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Eric Salmon
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
- Department of Neurology, CHU Liege, 4000, Liege, Belgium
| | - Pierre Maquet
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Department of Neurology, CHU Liege, 4000, Liege, Belgium
| | - Gilles Vandewalle
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Fabienne Collette
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Christine Bastin
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium.
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium.
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium.
- Bât. B30 GIGA CRC In Vivo Imaging - Aging and Memory, Quartier Agora, Allée du 6 Août 8, 4000, Liege, Belgium.
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11
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Chen AP, Ismail Z, Mann FD, Bromet EJ, Clouston SAP, Luft BJ. Behavioral Impairments and Increased Risk of Cortical Atrophy Risk Scores Among World Trade Center Responders. J Geriatr Psychiatry Neurol 2024; 37:114-124. [PMID: 37542409 PMCID: PMC10839111 DOI: 10.1177/08919887231195234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Objective: World Trade Center (WTC) responders are susceptible to both cognitive and neuropsychiatric impairments, particularly chronic posttraumatic stress disorder. The present study examined self-reported behavioral impairments in a sample of 732 WTC responders, 199 of whom were determined to have high risk of WTC-related cortical atrophy by an artificial neural network. Results: We found that responders at increased risk of cortical atrophy showed behavioral impairment across five domains: motivation, mood, disinhibition, empathy, and psychosis (14.6% vs 3.9% in the low-risk group; P = 3.90 × 10-7). Factor analysis models revealed that responders at high risk of cortical atrophy tended to have deficits generalized across all aspects of behavioral impairment with focal dysfunction in sensory psychosis. We additionally describe how relationships are modulated by exposure severity and pharmacological treatments. Discussion: Our findings suggest a potential link between sensory deficits and the development of cortical atrophy in WTC responders and may indicate symptoms consistent with a clinical portrait of parietal dominant Alzheimer's disease or a related dementia (ADRD). Results underscore the importance of investigating neuropsychiatric symptomatology in clinical evaluations of possible ADRD.
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Affiliation(s)
- Allen P.F. Chen
- Department of Neurobiology and Behavior, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary
| | - Frank D. Mann
- Program in Public Health, Renaissance School of Medicine, Stony Brook, NY, USA
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sean A. P. Clouston
- Program in Public Health, Renaissance School of Medicine, Stony Brook, NY, USA
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Benjamin J. Luft
- Department of Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
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12
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Angelopoulou E, Koros C, Hatzimanolis A, Stefanis L, Scarmeas N, Papageorgiou SG. Exploring the Genetic Landscape of Mild Behavioral Impairment as an Early Marker of Cognitive Decline: An Updated Review Focusing on Alzheimer's Disease. Int J Mol Sci 2024; 25:2645. [PMID: 38473892 DOI: 10.3390/ijms25052645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
The clinical features and pathophysiology of neuropsychiatric symptoms (NPSs) in dementia have been extensively studied. However, the genetic architecture and underlying neurobiological mechanisms of NPSs at preclinical stages of cognitive decline and Alzheimer's disease (AD) remain largely unknown. Mild behavioral impairment (MBI) represents an at-risk state for incident cognitive impairment and is defined by the emergence of persistent NPSs among non-demented individuals in later life. These NPSs include affective dysregulation, decreased motivation, impulse dyscontrol, abnormal perception and thought content, and social inappropriateness. Accumulating evidence has recently begun to shed more light on the genetic background of MBI, focusing on its potential association with genetic factors related to AD. The Apolipoprotein E (APOE) genotype and the MS4A locus have been associated with affective dysregulation, ZCWPW1 with social inappropriateness and psychosis, BIN1 and EPHA1 with psychosis, and NME8 with apathy. The association between MBI and polygenic risk scores (PRSs) in terms of AD dementia has been also explored. Potential implicated mechanisms include neuroinflammation, synaptic dysfunction, epigenetic modifications, oxidative stress responses, proteosomal impairment, and abnormal immune responses. In this review, we summarize and critically discuss the available evidence on the genetic background of MBI with an emphasis on AD, aiming to gain insights into the potential underlying neurobiological mechanisms, which till now remain largely unexplored. In addition, we propose future areas of research in this emerging field, with the aim to better understand the molecular pathophysiology of MBI and its genetic links with cognitive decline.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Christos Koros
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Alexandros Hatzimanolis
- 1st Department of Psychiatry, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Naude J, Wang M, Leon R, Smith E, Ismail Z. Tau-PET in early cortical Alzheimer brain regions in relation to mild behavioral impairment in older adults with either normal cognition or mild cognitive impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.11.24302665. [PMID: 38405711 PMCID: PMC10888987 DOI: 10.1101/2024.02.11.24302665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Mild Behavioral Impairment (MBI) leverages later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high-risk group for incident dementia. Phosphorylated tau (p-tau) is a hallmark biological manifestation of Alzheimer disease (AD). We investigated associations between MBI and tau accumulation in early-stage AD cortical regions. In 442 Alzheimer's Disease Neuroimaging Initiative participants with normal cognition or mild cognitive impairment, MBI status was determined alongside corresponding p-tau and Aβ. Two meta-regions of interest were generated to represent Braak I and III neuropathological stages. Multivariable linear regression modelled the association between MBI as independent variable and tau tracer uptake as dependent variable. Among Aβ positive individuals, MBI was associated with tau uptake in Braak I (β =0.45(0.15), p<.01) and Braak III (β =0.24(0.07), p<.01) regions. In Aβ negative individuals, MBI was not associated with tau in the Braak I region (p=.11) with a negative association in Braak III (p=.01). These findings suggest MBI may be a sequela of neurodegeneration, and can be implemented as a cost-effective framework to help improve screening efficiency for AD.
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Affiliation(s)
- James Naude
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rebeca Leon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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14
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Matuskova V, Veverova K, Jester DJ, Matoska V, Ismail Z, Sheardova K, Horakova H, Cerman J, Laczó J, Andel R, Hort J, Vyhnalek M. Mild behavioral impairment in early Alzheimer's disease and its association with APOE and BDNF risk genetic polymorphisms. Alzheimers Res Ther 2024; 16:21. [PMID: 38279143 PMCID: PMC10811933 DOI: 10.1186/s13195-024-01386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Mild behavioral impairment (MBI) has been commonly reported in early Alzheimer's disease (AD) but rarely using biomarker-defined samples. It is also unclear whether genetic polymorphisms influence MBI in such individuals. We thus aimed to examine the association between the cognitive status of participants (amnestic mild cognitive impairment (aMCI-AD) vs cognitively normal (CN) older adults) and MBI severity. Within aMCI-AD, we further examined the association between APOE and BDNF risk genetic polymorphisms and MBI severity. METHODS We included 62 aMCI-AD participants and 50 CN older adults from the Czech Brain Aging Study. The participants underwent neurological, comprehensive neuropsychological examination, APOE and BDNF genotyping, and magnetic resonance imaging. MBI was diagnosed with the Mild Behavioral Impairment Checklist (MBI-C), and the diagnosis was based on the MBI-C total score ≥ 7. Additionally, self-report instruments for anxiety (the Beck Anxiety Inventory) and depressive symptoms (the Geriatric Depression Scale-15) were administered. The participants were stratified based on the presence of at least one risk allele in genes for APOE (i.e., e4 carriers and non-carriers) and BDNF (i.e., Met carriers and non-carriers). We used linear regressions to examine the associations. RESULTS MBI was present in 48.4% of the aMCI-AD individuals. Compared to the CN, aMCI-AD was associated with more affective, apathy, and impulse dyscontrol but not social inappropriateness or psychotic symptoms. Furthermore, aMCI-AD was related to more depressive but not anxiety symptoms on self-report measures. Within the aMCI-AD, there were no associations between APOE e4 and BDNF Met and MBI-C severity. However, a positive association between Met carriership and self-reported anxiety appeared. CONCLUSIONS MBI is frequent in aMCI-AD and related to more severe affective, apathy, and impulse dyscontrol symptoms. APOE and BDNF polymorphisms were not associated with MBI severity separately; however, their combined effect warrants further investigation.
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Affiliation(s)
- Veronika Matuskova
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Katerina Veverova
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Dylan J Jester
- Women's Operational Military Exposure Network (WOMEN), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Vaclav Matoska
- Department of Clinical Biochemistry, Hematology and Immunology, Homolka Hospital, Prague, Czech Republic
| | - Zahinoor Ismail
- Departments of Psychiatry and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Katerina Sheardova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Hana Horakova
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
- Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic
| | - Jiri Cerman
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Jan Laczó
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Ross Andel
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Jakub Hort
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine and Motol University Hospital, V Uvalu 84, 150 06, Prague, Czech Republic.
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15
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Singh AK, Malviya R, Prakash A, Verma S. Neuropsychiatric Manifestations in Alzheimer's Disease Patients: Genetics and Treatment Options. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:39-54. [PMID: 36856177 DOI: 10.2174/1871527322666230301111216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/03/2022] [Accepted: 12/27/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by neuropsychiatric symptoms (NPS), which cause great misery to those with dementia and those who care for them and may lead to early institutionalization. OBJECTIVE The present systematic review aims to discuss the various aspects of Alzheimer's, including treatment options. METHODS The databases Embase, PubMed, and Web of Science were searched to collect data. RESULTS Incipient cognitive deterioration is commonly accompanied by these early warning signals of neurocognitive diseases. The neurobiology of NPSs in Alzheimer's disease, as well as particular symptoms, including psychosis, agitation, apathy, sadness, and sleep disorders, will be examined in this review. For NPSs in Alzheimer's disease, clinical trial designs, as well as regulatory issues, were also addressed. A fresh wave of research, however, is helping to push the discipline ahead. For medication development and repurposing, we highlight the most recent results in genetics, neuroimaging, and neurobiology. Even though identifying and treating psychosis in adults with dementia is still a challenging endeavor, new options are coming up that give the field fresh focus and hope. Conclsuion: It can be concluded from the complete literature survey that Alzheimer's-related psychosis as well as other symptoms that are not psychotic, have made significant progress in the last decade. These milestones in the development of safer, more effective treatments have been achieved as a consequence of great focus on non-pharmacological interventions like DICE or WHELD; the investigation into ways to improve existing drugs like aripiprazole, risperidone, amisulpride, and Escitalopram for safer precision-based treatment; and the development of a clinical trial program for pimavanserin.
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Affiliation(s)
- Arun Kumar Singh
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Anuj Prakash
- Reference Standard Division, Indian Pharmacopoeia Commission, Sec-23, Raj Nagar, Ghaziabad, Uttar Pradesh, India
| | - Swati Verma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
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16
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Mudalige D, Guan DX, Ghahremani M, Ismail Z. Longitudinal Associations Between Mild Behavioral Impairment, Sleep Disturbance, and Progression to Dementia. J Alzheimers Dis Rep 2023; 7:1323-1334. [PMID: 38143778 PMCID: PMC10741901 DOI: 10.3233/adr-230086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Clinical guidelines recommend incorporating non-cognitive markers like mild behavioral impairment (MBI) and sleep disturbance (SD) into dementia screening to improve detection. Objective We investigated the longitudinal associations between MBI, SD, and incident dementia. Methods Participant data were from the National Alzheimer's Coordinating Center in the United States. MBI was derived from the Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. SD was determined using the NPI-Q nighttime behaviors item. Cox proportional hazard regressions with time-dependant variables for MBI, SD, and cognitive diagnosis were used to model associations between baseline 1) MBI and incident SD (n = 11,277); 2) SD and incident MBI (n = 10,535); 3) MBI with concurrent SD and incident dementia (n = 13,544); and 4) MBI without concurrent SD and incident dementia (n = 11,921). Models were adjusted for first-visit age, sex, education, cognitive diagnosis, race, and for multiple comparisons using the Benjamini-Hochberg method. Results The rate of developing SD was 3.1-fold higher in older adults with MBI at baseline compared to those without MBI (95% CI: 2.8-3.3). The rate of developing MBI was 1.5-fold higher in older adults with baseline SD than those without SD (95% CI: 1.3-1.8). The rate of developing dementia was 2.2-fold greater in older adults with both MBI and SD, as opposed to SD alone (95% CI:1.9-2.6). Conclusions There is a bidirectional relationship between MBI and SD. Older adults with SD develop dementia at higher rates when co-occurring with MBI. Future studies should explore the mechanisms underlying these relationships, and dementia screening may be improved by assessing for both MBI and SD.
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Affiliation(s)
| | | | - Maryam Ghahremani
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Department of Community Health Sciences, Department of Clinical Neurosciences, Hotchkiss Brain Institute, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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17
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Babulal GM, Chen L, Murphy SA, Doherty JM, Johnson AM, Morris JC. Neuropsychiatric Symptoms and Alzheimer Disease Biomarkers Independently Predict Progression to Incident Cognitive Impairment. Am J Geriatr Psychiatry 2023; 31:1190-1199. [PMID: 37544835 PMCID: PMC10861300 DOI: 10.1016/j.jagp.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To investigate the effect of neuropsychiatric symptoms and depression symptoms, respectively, and Alzheimer disease (AD) biomarkers (cerebrospinal fluid [CSF] or Positron Emission Tomography [PET] imaging) on the progression to incident cognitive impairment among cognitively normal older adults. DESIGN Prospective, observation, longitudinal study. SETTING Knight Alzheimer Disease Research Center (ADRC) at Washington University School of Medicine. PARTICIPANTS Older adults aged 65 and above who participated in AD longitudinal studies (n = 286). MEASUREMENTS CSF and PET biomarkers, Clinical Dementia Rating (CDR), Geriatric Depression Scale (GDS), and Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS Participants had an average follow-up of eight years, and 31 progressed from CDR 0 to CDR >0. After adjusting for sex, age, and education in the Cox proportional hazards survival models, neuropsychiatric symptoms as a time-dependent covariate was statistically significant in the three CSF (Aβ42/Aβ40, t-Tau/Aβ42, p-Tau/Aβ42) PET imaging models (HR = 1.33-1.50). The biomarkers were also significant as main effects (HR = 2.00-4.04). Change in depression symptoms was not significant in any models. The interactions between biomarkers and neuropsychiatric symptoms and depression were not statistically significant. CONCLUSIONS Changes in neuropsychiatric symptoms increase the risk of progression to cognitive impairment among healthy, cognitively normal adults, independent of AD biomarkers. Routine assessment of neuropsychiatric symptoms could provide valuable clinical information about cognitive functioning and preclinical disease state.
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Affiliation(s)
- Ganesh M Babulal
- Department of Neurology (GMB, SAM, JCM), Washington University in St. Louis, St. Louis, MO; Institute of Public Health (GMB), Washington University in St. Louis, St. Louis, MO; Department of Psychology, Faculty of Humanities (GMB), University of Johannesburg, Johannesburg, South Africa; Department of Clinical Research and Leadership (GMB), The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Ling Chen
- Division of Biostatistics (LC), Washington University in St. Louis, St. Louis, MO
| | - Samantha A Murphy
- Department of Neurology (GMB, SAM, JCM), Washington University in St. Louis, St. Louis, MO
| | - Jason M Doherty
- Department of Neurology (GMB, SAM, JCM), Washington University in St. Louis, St. Louis, MO
| | - Ann M Johnson
- Center for Clinical Studies (AMJ), Washington University in St. Louis, St. Louis, MO
| | - John C Morris
- Department of Neurology (GMB, SAM, JCM), Washington University in St. Louis, St. Louis, MO; Hope Center for Neurological Disorders (JCM), Washington University in St. Louis, St. Louis, MO
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Kassam F, Chen H, Nosheny R, McGirr A, Williams T, Ng N, Camacho M, Mackin R, Weiner M, Ismail Z. Cognitive profile of people with mild behavioral impairment in Brain Health Registry participants. Int Psychogeriatr 2023; 35:643-652. [PMID: 35130991 PMCID: PMC10063171 DOI: 10.1017/s1041610221002878] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR). DESIGN Observational cohort study. SETTING Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal. PARTICIPANTS The final sample included 499 participant-informant dyads. MEASUREMENTS Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/- individuals, as was the association between cognitive scores and MBI symptom severity. RESULTS Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity. CONCLUSION These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.
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Affiliation(s)
- F. Kassam
- University of Calgary, Hotchkiss Brain Institute
| | - H. Chen
- University of Calgary, Hotchkiss Brain Institute
| | - R.L. Nosheny
- University of California, San Francisco, Department of Psychiatry
| | - A. McGirr
- University of Calgary, Department of Psychiatry
| | - T. Williams
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | | | - Monica Camacho
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - R.S. Mackin
- University of California, San Francisco, Department of Psychiatry
| | - M.W. Weiner
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - Z. Ismail
- University of Calgary, Hotchkiss Brain Institute
- University of Calgary, Department of Psychiatry
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De Lucia N, Carbone G, Muzii B, Ferrara N, Rengo G, Maldonato NM, Femminella GD. Neuropsychiatric symptoms and their neural correlates in individuals with mild cognitive impairment. Int Psychogeriatr 2023; 35:623-632. [PMID: 36714990 DOI: 10.1017/s104161022200117x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Neuropsychiatric symptoms are common in subjects with MCI and associated with higher risk of progression to AD. The cognitive and neuroanatomical correlates of neuropsychiatric symptoms in MCI have not been fully elucidated. In this study, we sought to evaluate the association between neuropsychiatric symptoms, cognitive function, regional tau deposition, and brain volumes in MCI subjects. METHODS A total of 233 MCI and 305 healthy comparisons were selected from the ADNI-3 cohort. All the subjects underwent a comprehensive neuropsychological assessment, volumetric MR brain scan, and Flortaucipir PET for in vivo assessment of regional tau deposition. Prevalence of neuropsychiatric symptoms was evaluated by means of the NPI questionnaire. Multivariate analyses of variance were used to detect differences in cognitive and imaging markers in MCI subjects with and without neuropsychiatric symptoms. RESULTS 61.4% MCI subjects showed at least one neuropsychiatric symptom, with the most prevalent ones being depression (26.1%), irritability (23.6%), and sleep disturbances (23.6%). There was a significant effect of neuropsychiatric symptoms on cognitive tests of frontal and executive functions. MCI subjects with neuropsychiatric symptoms showed reduced brain volumes in the orbitofrontal and posterior cingulate cortices, while no effects were detected on regional tau deposition. Posterior cingulate cortex volume was the only predictor of global neuropsychiatric burden in this MCI population. CONCLUSIONS Neuropsychiatric symptoms occur early in the AD trajectory and are mainly related to defects of control executive abilities and to the reduction of gray matter volume in the orbitofrontal and posterior cingulate cortices. A better understanding of the cognitive and neuroanatomical mechanisms of neuropsychiatric symptoms in MCI could help develop more targeted and efficacious treatment alternatives.
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Affiliation(s)
- Natascia De Lucia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Giovanni Carbone
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Benedetta Muzii
- Department of Humanistic Studies, "Federico II" University, Naples, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
- Instituti Clinici Scientifici Maugeri IRCCS - Scientific Institute of Telese Terme (BN), Telese BN, Italy
| | - Nelson Mauro Maldonato
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
- Department of Brain Sciences, Imperial College London, London, UK
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Ozaki T, Hashimoto N, Udo N, Narita H, Nakagawa S, Kusumi I. Neurobiological correlation between phosphorylated tau and mood symptoms in memory clinic patients. Psychogeriatrics 2023; 23:954-962. [PMID: 37806671 DOI: 10.1111/psyg.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) dementia and mild cognitive impairment are characterised by impaired cognition accompanied by neuropsychiatric symptoms (NPS) relating to mood, including depression, anxiety, and apathy. However, the utility of AD biomarkers for predicting mood symptoms of NPS remains controversial. Herein, we analyzed the relationship between phosphorylated tau (p-tau) and depression, anxiety, and apathy of NPS. We also examined the influence of genetic factors such as apolipoprotein E (APOE) ε4 on these relationships. METHODS We conducted a cross-sectional survey in older patients (n = 122) with normal cognition (n = 12), mild cognitive impairment (n = 46), and AD (n = 64) strictly diagnosed by the board of psychiatrists and neurologists of Hokkaido University. NPS of the patients were assessed using the Neuropsychiatric Inventory Questionnaire (NPI). All patients also received a lumbar puncture to obtain cerebral spinal fluid for assessment of p-tau. The inverse probability weighting method was used to adjust for demographic differences between the p-tau present group and the p-tau absent group. RESULTS There was an association between p-tau accumulation and decreased incidence of depression and apathy. APOE ε4 non-carriers also showed a trend toward a negative association between p-tau and depression, which was not evident in APOE ε4 carriers. CONCLUSIONS We provide new evidence for a negative correlation between p-tau and depression and apathy of NPS, which may be influenced by APOE ε4. Future longitudinal studies are required to confirm the utility of p-tau for predicting the course of mood symptoms in patients with cognitive decline.
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Affiliation(s)
- Takashi Ozaki
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Niki Udo
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hisashi Narita
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Abbatantuono C, Alfeo F, Clemente L, Lancioni G, De Caro MF, Livrea P, Taurisano P. Current Challenges in the Diagnosis of Progressive Neurocognitive Disorders: A Critical Review of the Literature and Recommendations for Primary and Secondary Care. Brain Sci 2023; 13:1443. [PMID: 37891810 PMCID: PMC10605551 DOI: 10.3390/brainsci13101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Screening for early symptoms of cognitive impairment enables timely interventions for patients and their families. Despite the advances in dementia diagnosis, the current nosography of neurocognitive disorders (NCDs) seems to overlook some clinical manifestations and predictors that could contribute to understanding the conversion from an asymptomatic stage to a very mild one, eventually leading to obvious disease. The present review examines different diagnostic approaches in view of neurophysiological and neuropsychological evidence of NCD progression, which may be subdivided into: (1) preclinical stage; (2) transitional stage; (3) prodromal or mild stage; (4) major NCD. The absence of univocal criteria and the adoption of ambiguous or narrow labels might complicate the diagnostic process. In particular, it should be noted that: (1) only neuropathological hallmarks characterize preclinical NCD; (2) transitional NCD must be assessed through proactive neuropsychological protocols; (3) prodromal/mild NCDs are based on cognitive functional indicators; (4) major NCD requires well-established tools to evaluate its severity stage; (5) insight should be accounted for by both patient and informants. Therefore, the examination of evolving epidemiological and clinical features occurring at each NCD stage may orient primary and secondary care, allowing for more targeted prevention, diagnosis, and/or treatment of both cognitive and functional impairment.
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Affiliation(s)
- Chiara Abbatantuono
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
| | - Federica Alfeo
- Department of Education, Communication and Psychology (For.Psi.Com), University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Livio Clemente
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
| | - Giulio Lancioni
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
- Lega F D’Oro Research Center, 60027 Osimo, Italy
| | - Maria Fara De Caro
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
| | | | - Paolo Taurisano
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
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Krell-Roesch J, Rakusa M, Syrjanen JA, van Harten AC, Lowe VJ, Jack CR, Kremers WK, Knopman DS, Stokin GB, Petersen RC, Vassilaki M, Geda YE. Association between CSF biomarkers of Alzheimer's disease and neuropsychiatric symptoms: Mayo Clinic Study of Aging. Alzheimers Dement 2023; 19:4498-4506. [PMID: 35142047 PMCID: PMC10433790 DOI: 10.1002/alz.12557] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/17/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We examined the association between cerebrospinal fluid (CSF)-derived biomarkers of Alzheimer's disease and neuropsychiatric symptoms (NPS) in older non-demented adults. METHODS We included 784 persons (699 cognitively unimpaired, 85 with mild cognitive impairment) aged ≥ 50 years who underwent CSF amyloid beta (Aβ42), hyperphosphorylated tau 181 (p-tau), and total tau (t-tau) as well as NPS assessment using Beck Depression and Anxiety Inventories (BDI-II, BAI), and Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS Lower CSF Aβ42, and higher t-tau/Aβ42 and p-tau/Aβ42 ratios were associated with BDI-II and BAI total scores, clinical depression (BDI-II ≥ 13), and clinical anxiety (BAI ≥ 10), as well as NPI-Q-assessed anxiety, apathy, and nighttime behavior. DISCUSSION CSF Aβ42, t-tau/Aβ42, and p-tau/Aβ42 ratios were associated with NPS in community-dwelling individuals free of dementia. If confirmed by a longitudinal cohort study, the findings have clinical relevance of taking into account the NPS status of individuals with abnormal CSF biomarkers.
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Affiliation(s)
- Janina Krell-Roesch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Martin Rakusa
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Argonde C. van Harten
- Alzheimer Center, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Gorazd B. Stokin
- International Clinical Research Center, St. Anne’s Hospital, Brno, Czech Republic
| | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Yonas E. Geda
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
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Guan DX, Smith EE, Pike GB, Ismail Z. Persistence of neuropsychiatric symptoms and dementia prognostication: A comparison of three operational case definitions of mild behavioral impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12483. [PMID: 37786862 PMCID: PMC10541800 DOI: 10.1002/dad2.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION We compared three operational case definitions of mild behavioral impairment (MBI) in the context of MBI prevalence estimates and dementia risk modeling. METHODS Participants were dementia-free older adults (n = 13701) from the National Alzheimer's Coordinating Center. Operational case definitions of MBI were generated based on neuropsychiatric symptoms at one (OV), two-consecutive (TCV), or more than two-thirds (TTV) of dementia-free study visits. Definitions were compared in prevalence and in Cox regressions using MBI to predict incident dementia. RESULTS OV MBI was the most prevalent (54.4%), followed by TCV (32.3%) and TTV (26.7%) MBI. However, OV MBI had the lowest rate of incident dementia (hazard ratio [HR] = 2.54, 95% confidence interval [CI]: 2.33-2.78) and generated poorer model metrics than TCV MBI (HR = 4.06, 95% CI: 3.74-4.40) and TTV MBI (HR = 5.77, 95% CI: 5.32-6.26). DISCUSSION Case ascertainment with longer timeframe MBI operational case definitions may more accurately define groups at risk of dementia in datasets lacking tools designed to detect MBI.Highlights: Mild behavioral impairment (MBI) can identify older adults at risk of dementia.Neuropsychiatric symptom (NPS) assessment tools can be proxy measures for MBI.Hazard for dementia was highest for MBI defined by NPS presence at more than two-thirds of visits.
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Affiliation(s)
| | - Eric E. Smith
- Departments of Clinical Neurosciences and Community Health SciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - G. Bruce Pike
- Departments of Radiology and Clinical NeurosciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of CalgaryCalgaryAlbertaCanada
- Clinical and Biomedical SciencesFaculty of Health and Life Sciences, University of ExeterExeterUK
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Petersen RC, Graf A, Brady C, De Santi S, Florian H, Landen J, Pontecorvo M, Randolph C, Sink KM, Carrillo MC, Weber CJ. Operationalizing selection criteria for clinical trials in Alzheimer's disease: Biomarker and clinical considerations. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12434. [PMID: 38023620 PMCID: PMC10655199 DOI: 10.1002/trc2.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Alzheimer's disease (AD) staging criteria lack standardized, empirical description. Well-defined AD staging criteria are an important consideration in protocol design, influencing a more standardized inclusion/exclusion criteria and defining what constitutes meaningful differentiation among the stages. However, many trials are being designed on the basis of biomarker features and the two need to be coordinated. The Alzheimer's Association Research Roundtable (AARR) Spring 2021 meeting discussed the implementation of preclinical AD staging criteria, and provided recommendations for how they may best be incorporated into clinical trials research. Discussion also included what currently available tools for global clinical trials may best define populations in preclinical AD trials, and if are we able to differentiate preclinical from clinical stages of the disease. Well-defined AD staging criteria are key to improving early detection, diagnostics, clinical trial enrollment, and identifying statistically significant clinical changes, and researchers discussed how emerging blood biomarkers may help with more efficient screening in preclinical stages.
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Affiliation(s)
| | - Ana Graf
- Novartis Pharma AGBaselSwitzerland
| | - Chris Brady
- WCG Clinical Endpoint Solutions, PrincetonNew JerseyUSA
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Gosselin P, Guan DX, Smith EE, Ismail Z. Temporal associations between treated and untreated hearing loss and mild behavioral impairment in older adults without dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12424. [PMID: 37818228 PMCID: PMC10560825 DOI: 10.1002/trc2.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 08/18/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Hearing loss (HL) and mild behavioral impairment (MBI) are non-cognitive markers of dementia. This study investigated the relationship between hearing and MBI and explored the influence of hearing aid use on the treatment of hearing loss, both cross-sectionally and longitudinally. METHODS Data were analyzed from National Alzheimer's Coordinating Center participants, age ≥50, dementia-free at baseline, collected between 2005 and 2022. Three self-report questions were used to generate a three-level categorical hearing variable: No-HL, Untreated-HL, and Treated-HL. MBI status was derived from the informant-rated Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. At baseline (n = 7080), logistic regression was used to examine the association between hearing status (predictor) and the presence of global and domain-specific MBI (outcome), adjusting for age, sex, cognitive diagnosis, and apolipoprotein E4 (APOE4). Cox proportional hazard models with time-dependent covariates were used to examine the effect of (1) hearing status as exposure on the rate of incident MBI (n = 5889); and (2) MBI as exposure on the rate of incident HL in those with no HL at baseline (n = 6252). RESULTS Cross-sectionally, participants with Untreated-HL were more likely to exhibit global MBI (adjusted odds ratio (aOR) = 1.66, 95% CI: 1.24-2.21) and individual MBI domains of social inappropriateness (aOR = 1.95, 95% CI: 1.06-3.39), affective dysregulation (aOR = 1.71, 95% CI: 1.21-2.38), and impulse dyscontrol (aOR = 1.71, 95% CI: 1.21-2.38), compared to those with No-HL. Participants with Treated-HL (i.e., hearing aid use) did not differ from No-HL for odds of global or most MBI domains, except for impulse dyscontrol (aOR = 1.38, 95% CI: 1.05-1.81). Longitudinally, we found relationships between Treated-HL and incident MBI (adjusted hazard ratio (aHR) = 1.29, 95% CI: 1.01-1.63) and between MBI and incident Untreated-HL (aHR = 1.51, 95% CI: 1.19-1.94). DISCUSSION Our cross-sectional results support that hearing aid use is associated with lower odds of concurrent global MBI in dementia-free participants. Longitudinally, relationships were found between MBI and HL. The severity of HL was not assessed, however, and may require further exploration. Highlights Hearing Loss (HL) and mild behavioral impairment (MBI) are markers of dementiaCross-sectionally: Untreated-HL was associated with global MBI burden, butHL treated with hearing aids was notWe found associations between MBI and incident Untreated-HL.
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Affiliation(s)
- Penny Gosselin
- Audiology & Children's Allied Health ServicesAlberta Health ServicesLethbridgeAlbertaCanada
| | - Dylan X. Guan
- Medical Science Graduate ProgramUniversity of CalgaryCalgaryAlbertaCanada
| | - Eric E. Smith
- Department of Clinical NeurosciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesO'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Department of Clinical NeurosciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesO'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of PsychiatryUniversity of CalgaryCalgaryAlbertaCanada
- Department of Pathology and Laboratory MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
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Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
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Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
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Matsuoka T, Narumoto J, Morii-Kitani F, Niwa F, Mizuno T, Abe M, Takano H, Wakasugi N, Shima A, Sawamoto N, Ito H, Toda W, Hanakawa T. Contribution of amyloid and putative Lewy body pathologies in neuropsychiatric symptoms. Int J Geriatr Psychiatry 2023; 38:e5993. [PMID: 37655505 DOI: 10.1002/gps.5993] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Neuropsychiatric symptom could be useful for detecting patients with prodromal dementia. Similarities and differences in the NPSs between preclinical/prodromal Alzheimer's disease (AD) and prodromal Parkinson's disease dementia (PDD)/Dementia with Lewy bodies (DLB) may exist. This study aimed to compare the NPSs between preclinical/prodromal AD and prodromal PDD/DLB. METHODS One hundred and three participants without dementia aged ≥50 years were included in this study. The mild behavioral impairment (MBI) total score and the MBI scores for each domain were calculated using the neuropsychiatric inventory questionnaire score. Participants were divided into five groups based on the clinical diagnosis by neurologists or psychiatrists in each institution based on the results of the amyloid positron emission tomography and dopamine transporter single photon emission computed tomography (DAT-SPECT): Group 1: amyloid-positive and abnormal DAT-SPECT, Group 2: amyloid-negative and abnormal DAT-SPECT, Group 3: amyloid-positive and normal DAT-SPECT, Group 4: mild cognitive impairment unlikely due to AD with normal DAT-SPECT, and Group 5: cognitively normal with amyloid-negative and normal DAT-SPECT. RESULTS The MBI abnormal perception or thought content scores were significantly higher in Group 1 than Group 5 (Bonferroni-corrected p = 0.012). The MBI total score (Bonferroni-corrected p = 0.011) and MBI impulse dyscontrol score (Bonferroni-corrected p = 0.033) in Group 4 were significantly higher than those in Group 5. CONCLUSION The presence of both amyloid and putative Lewy body pathologies may be associated with psychotic symptoms.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Psychiatry, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fukiko Morii-Kitani
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumitoshi Niwa
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsunari Abe
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Harumasa Takano
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noritaka Wakasugi
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsushi Shima
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobukatsu Sawamoto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Wataru Toda
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Takashi Hanakawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Cozza M, Boccardi V. A narrative review on mild behavioural impairment: an exploration into its scientific perspectives. Aging Clin Exp Res 2023; 35:1807-1821. [PMID: 37392350 DOI: 10.1007/s40520-023-02472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
In clinical practice, the admission of patients with late-onset psychological and behavioural symptoms is frequent, regardless of the presence or absence of cognitive decline. These symptoms commonly occur in the prodromal stage of dementia and can precede the onset of dementia. While the concept of Mild Cognitive Impairment (MCI) -which is defined as a level of cognitive impairment insufficient to impact daily functioning- is well established, the notion of Mild Behavioural Impairment (MBI) is not yet widely recognized. However, studies have demonstrated that the presence of MBI in both cognitively normal patients and individuals with MCI is associated with an increased risk of dementia progression. Thus, MBI may serve as a neurobehavioral indicator of pre-dementia risk states. This narrative review aims to discuss the evolution of the term, the relevant clinical aspects, and potential biomarkers that may contribute to the clinical definition of MBI. The objective is to assist clinicians in recognizing the diagnosis and differentiating it from psychiatric syndromes, as well as identifying possible etiologies of neurodegeneration.
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Affiliation(s)
- Mariagiovanna Cozza
- Department of Integration, Intermediate Care Programme, AUSL Bologna, Bologna, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Piazzale Gambuli 1, 06132, Perugia, Italy.
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Tsai CF, Huang MH, Lin YS, Chen CY, Fuh JL. Health-related quality of life and mild behavioral impairment in older adults without dementia. Int J Geriatr Psychiatry 2023; 38:e6003. [PMID: 37732590 DOI: 10.1002/gps.6003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The Mild Behavioral Impairment Checklist (MBI-C) was developed to assess neuropsychiatric symptoms (NPS) and to identify mild behavioral impairment (MBI). This study validated the Taiwanese version of the MBI-C and examined its association of health-related quality of life (HR-QoL). METHODS We recruited 242 older individuals without dementia (129 amnestic mild cognitive impairment, 113 cognitively normal). Their family completed the MBI-C, the Neuropsychiatric Inventory Questionnaire (NPI-Q), and instrumental activities of daily living scale. Participants completed the Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination, the 12-item word recall test, the category verbal fluency test and the EuroQol 5 dimensions questionnaire (EQ-5D). Cronbach's α was used to evaluate the internal consistency of the MBI-C. Linear regression models were used to examined the association between MBI-C score and HR-QoL assessed using ED-5D. RESULTS The prevalence of MBI was 12% of all participants. Cronbach's α of the MBI-C was 0.893. The optimal cut-off point of MBI-C was 7.5 for identifying MBI, with a sensitivity of 100% and specificity of 85%. The MBI-C total score (β = -0.01, 95% confidence interval [CI] = -0.02 to -0.01, p < 0.001), MBI-C subdomain of decreased motivation (β = -0.04, 95% CI = -0.05 to -0.02, p < 0.001) and emotional dysregulation (β = -0.02, 95% CI = -0.04 to -0.004, p = 0.01) were factors related to EQ-5D index scores. CONCLUSION Among older adults without dementia, the Taiwanese version of the MBI-C has good reliability and validity for detecting MBI. The total and subdomains of MBI-C were associated with decreased HR-QoL among individuals without dementia.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mao-Hsuan Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Shuan Lin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Jong-Ling Fuh
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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Arenare G, Manca R, Caffarra P, Venneri A. Associations between Neuropsychiatric Symptoms and Alzheimer's Disease Biomarkers in People with Mild Cognitive Impairment. Brain Sci 2023; 13:1195. [PMID: 37626552 PMCID: PMC10452057 DOI: 10.3390/brainsci13081195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are associated with faster decline in mild cognitive impairment (MCI). This study aimed to investigate the association between NPS severity and Alzheimer's disease (AD) biomarkers, i.e., amyloid-β (Aβ), phosphorylated tau protein (p-tau) and hippocampal volume ratio (HR), to characterise in more detail MCI patients with a poor prognosis. METHODS A total of 506 individuals with MCI and 99 cognitively unimpaired older adults were selected from the ADNI dataset. The patients were divided into three different groups based on their NPI-Q total scores: no NPS (n = 198), mild NPS (n = 160) and severe NPS (n = 148). Regression models were used to assess the association between the severity of NPS and each biomarker level and positivity status. RESULTS Cerebrospinal fluid Aβ levels were positively associated with older age and lower MMSE scores, while higher p-tau levels were associated with female sex and lower MMSE scores. Only patients with severe NPS had a lower HR (β = -0.18, p = 0.050), i.e., more pronounced medio-temporal atrophy, than those without NPS. DISCUSSION Only HR was associated with the presence of NPS, partially in line with previous evidence showing that severe NPS may be explained primarily by greater grey matter loss. Future longitudinal studies will be needed to ascertain the relevance of this finding.
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Affiliation(s)
- Giulia Arenare
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
| | - Riccardo Manca
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
- Department of Life Sciences, Brunel University London, Uxbridge UB8 3BH, UK
| | - Paolo Caffarra
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
| | - Annalena Venneri
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
- Department of Life Sciences, Brunel University London, Uxbridge UB8 3BH, UK
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Ismail Z, Leon R, Creese B, Ballard C, Robert P, Smith EE. Optimizing detection of Alzheimer's disease in mild cognitive impairment: a 4-year biomarker study of mild behavioral impairment in ADNI and MEMENTO. Mol Neurodegener 2023; 18:50. [PMID: 37516848 PMCID: PMC10386685 DOI: 10.1186/s13024-023-00631-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/05/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Disease-modifying drug use necessitates better Alzheimer disease (AD) detection. Mild cognitive impairment (MCI) leverages cognitive decline to identify the risk group; similarly, mild behavioral impairment (MBI) leverages behavioral change. Adding MBI to MCI improves dementia prognostication over conventional approaches of incorporating neuropsychiatric symptoms (NPS). Here, to determine if adding MBI would better identify AD, we interrogated associations between MBI in MCI, and cerebrospinal fluid biomarkers [β-amyloid (Aβ), phosphorylated-tau (p-tau), and total-tau (tau)-ATN], cross-sectionally and longitudinally. METHODS Data were from two independent referral-based cohorts, ADNI (mean[SD] follow-up 3.14[1.07] years) and MEMENTO (4.25[1.40] years), collected 2003-2021. Exposure was based on three-group stratification: 1) NPS meeting MBI criteria; 2) conventionally measured NPS (NPSnotMBI); and 3) noNPS. Cohorts were analyzed separately for: 1) cross-sectional associations between NPS status and ATN biomarkers (linear regressions); 2) 4-year longitudinal repeated-measures associations of MBI and NPSnotMBI with ATN biomarkers (hierarchical linear mixed-effects models-LMEs); and 3) rates of incident dementia (Cox proportional hazards regressions). RESULTS Of 510 MCI participants, 352 were from ADNI (43.5% females; mean [SD] age, 71.68 [7.40] years), and 158 from MEMENTO (46.2% females; 68.98 [8.18] years). In ADNI, MBI was associated with lower Aβ42 (standardized β [95%CI], -5.52% [-10.48-(-0.29)%]; p = 0.039), and Aβ42/40 (p = 0.01); higher p-tau (9.67% [3.96-15.70%]; p = 0.001), t-tau (7.71% [2.70-12.97%]; p = 0.002), p-tau/Aβ42 (p < 0.001), and t-tau/Aβ42 (p = 0.001). NPSnotMBI was associated only with lower Aβ42/40 (p = 0.045). LMEs revealed a similar 4-year AD-specific biomarker profile for MBI, with NPSnotMBI associated only with higher t-tau. MBI had a greater rate of incident dementia (HR [95%CI], 3.50 [1.99-6.17; p < 0.001). NPSnotMBI did not differ from noNPS (HR 0.96 [0.49-1.89]; p = 0.916). In MEMENTO, MBI demonstrated a similar magnitude and direction of effect for all biomarkers, but with a greater reduction in Aβ40. HR for incident dementia was 3.93 (p = 0.004) in MBI, and 1.83 (p = 0.266) in NPSnotMBI. Of MBI progressors to dementia, 81% developed AD dementia. CONCLUSIONS These findings support a biological basis for NPS that meet MBI criteria, the continued inclusion of MBI in NIA-AA ATN clinical staging, and the utility of MBI criteria to improve identification of patients for enrollment in disease-modifying drug trials or for clinical care.
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Affiliation(s)
- Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK.
| | - Rebeca Leon
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK
| | - Clive Ballard
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK
| | | | - Eric E Smith
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Ebrahim IM, Ghahremani M, Camicioli R, Smith EE, Ismail Z. Effects of race, baseline cognition, and APOE on the association of affective dysregulation with incident dementia: A longitudinal study of dementia-free older adults. J Affect Disord 2023; 332:9-18. [PMID: 36997127 DOI: 10.1016/j.jad.2023.03.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Affective symptoms are dementia risk factors. Mild behavioral impairment (MBI) is a neurobehavioral syndrome that refines incorporation of psychiatric symptomatology into dementia prognostication by stipulating symptoms must emerge de novo in later life and persist for ≥6 months. Here, we investigated the longitudinal association of MBI-affective dysregulation with incident dementia. METHODS National Alzheimer Coordinating Centre participants with normal cognition (NC) or mild cognitive impairment (MCI) were included. MBI-affective dysregulation was operationalized as Neuropsychiatric Inventory Questionnaire-measured depression, anxiety, and elation at two consecutive visits. Comparators had no neuropsychiatric symptoms (no NPS) in advance of dementia. Cox proportional hazard models were implemented to assess the risk of dementia, adjusted for age, sex, years of education, race, cognitive diagnosis, and APOE-ε4 status, with interaction terms as appropriate. RESULTS The final sample included 3698 no-NPS (age:72.8; 62.7 % female), and 1286 MBI-affective dysregulation participants (age:75; 54.5 % female). MBI-affective dysregulation had lower dementia-free survival (p < 0.0001) and greater incidence of dementia (HR = 1.76, CI:1.48-2.08, p < 0.001) versus no NPS. Interaction analyses revealed that MBI-affective dysregulation was associated with higher dementia incidence in Black participants than White (HR = 1.70, CI:1.00-2.87, p = 0.046), NC than MCI (HR = 1.73, CI:1.21-2.48, p = 0.0028), and APOE-ε4 noncarriers than carriers (HR = 1.47, CI:1.06-2.02, p = 0.0195). Of MBI-affective dysregulation converters to dementia, 85.5 % developed Alzheimer's disease, which increased to 91.4 % in those with amnestic MCI. LIMITATIONS MBI-affective dysregulation was not stratified by symptom to further examine dementia risk. CONCLUSIONS Emergent and persistent affective dysregulation in dementia-free older adults is associated with substantial risk for dementia and should be considered in clinical assessments.
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Affiliation(s)
- Inaara M Ebrahim
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Maryam Ghahremani
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada; Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; School of Medicine and Health, University of Exeter, Exeter, UK.
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Sibahi A, Gandhi R, Al-Haddad R, Therriault J, Pascoal T, Chamoun M, Boutin-Miller K, Tardif C, Rosa-Neto P, Cassidy CM. Characterization of an automated method to segment the human locus coeruleus. Hum Brain Mapp 2023; 44:3913-3925. [PMID: 37126580 DOI: 10.1002/hbm.26324] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/17/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
Following the development of magnetic resonance imaging (MRI) methods to assay the integrity of catecholamine nuclei, including the locus coeruleus (LC), there has been an effort to develop automated methods that can accurately segment this small structure in an automated manner to promote its widespread use and overcome limitations of manual segmentation. Here we characterize an automated LC segmentation approach (referred to as the funnel-tip [FT] method) in healthy individuals and individuals with LC degeneration in the context of Alzheimer's disease (AD, confirmed with tau-PET imaging using [18F]MK6240). The first sample included n = 190 individuals across the AD spectrum from cognitively normal to moderate AD. LC signal assayed with FT segmentation showed excellent agreement with manual segmentation (intraclass correlation coefficient [ICC] = 0.91). Compared to other methods, the FT method showed numerically higher correlation to AD status (defined by presence of tau: Cohen's d = 0.64) and AD severity (Braak stage: Pearson R = -.35, cognitive function: R = .25). In a separate sample of n = 12 control participants, the FT method showed excellent scan-rescan reliability (ICC = 0.82). In another sample of n = 30 control participants, we found that the structure of the LC defined by FT segmentation approximated its expected shape as a contiguous line: <5% of LC voxels strayed >1 voxel (0.69 mm) from this line. The FT LC segmentation shows high agreement with manual segmentation and captures LC degeneration in AD. This practical method may facilitate larger research studies of the human LC-norepinephrine system and has potential to support future use of neuromelanin-sensitive MRI as a clinical biomarker.
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Affiliation(s)
- Ahmad Sibahi
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
| | - Rushali Gandhi
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
| | - Rami Al-Haddad
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Therriault
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
- Douglas Research Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Tharick Pascoal
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
- Douglas Research Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry and Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mira Chamoun
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
- Douglas Research Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Krysta Boutin-Miller
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Tardif
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
- Douglas Research Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Clifford M Cassidy
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
- Douglas Research Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, McGill University, Montreal, Quebec, Canada
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Jin P, Xu J, Liao Z, Zhang Y, Wang Y, Sun W, Yu E. A review of current evidence for mild behavioral impairment as an early potential novel marker of Alzheimer's disease. Front Psychiatry 2023; 14:1099333. [PMID: 37293396 PMCID: PMC10246741 DOI: 10.3389/fpsyt.2023.1099333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/31/2023] [Indexed: 06/10/2023] Open
Abstract
Mild behavioral impairment (MBI) is a neurobehavioral syndrome that occurs in the absence of cognitive impairment later in life (≥50 years of age). MBI is widespread in the pre-dementia stage and is closely associated with the progression of cognitive impairment, reflecting the neurobehavioral axis of pre-dementia risk states and complementing the traditional neurocognitive axis. Despite being the most common type of dementia, Alzheimer's disease (AD) does not yet have an effective treatment; therefore, early recognition and intervention are crucial. The Mild Behavioral Impairment Checklist is an effective tool for identifying MBI cases and helps identify people at risk of developing dementia. However, because the concept of MBI is still quite new, the overall understanding of it is relatively insufficient, especially in AD. Therefore, this review examines the current evidence from cognitive function, neuroimaging, and neuropathology that suggests the potential use of MBI as a risk indicator in preclinical AD.
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Affiliation(s)
- Piaopiao Jin
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaxi Xu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhengluan Liao
- Department of Geriatric VIP No. 3 (Department of Clinical Psychology), Rehabilitation Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yuhan Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wangdi Sun
- Department of Psychiatry, Zhejiang Hospital, Hangzhou, China
| | - Enyan Yu
- Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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Imai A, Matsuoka T, Narumoto J. Emotional Dysregulation in Mild Behavioral Impairment Is Associated with Reduced Cortical Thickness in the Right Supramarginal Gyrus. J Alzheimers Dis 2023; 93:521-532. [PMID: 37038811 DOI: 10.3233/jad-220948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Mild behavioral impairment (MBI) has attracted attention as a possible precursor symptom of dementia, but its neural basis has not been fully investigated. OBJECTIVE We aimed to investigate the relationship between MBI and surface area, cortical thickness, and volume in the temporal and parietal lobes, which are strongly associated with dementia and emotional disorders. METHODS This retrospective study evaluated 123 participants: 90 with mild cognitive impairment (MCI), 13 with subjective cognitive decline (SCD), and 20 cognitively healthy (CH). Using analysis of covariance (ANCOVA) with sex, age, and MMSE score as covariates, cortical thickness, surface area, and volume in 10 regions were compared between groups with and without MBI. Groups with MBI emotional dysregulation were also compared with groups without MBI. RESULTS ANCOVA revealed significantly smaller cortical thickness in the MBI group's right parahippocampal (p = 0.01) and supramarginal gyri (p = 0.002). After multiple comparison correction, only the right supramarginal gyrus was significantly smaller (p = 0.02). When considering only MBI emotional dysregulation, the right parahippocampal and supramarginal gyrus' cortical thicknesses were significantly smaller in this MBI group (p = 0.03, 0.01). However, multiple comparison correction identified no significant differences (p = 0.14, 0.11). CONCLUSION Overall MBI and the emotional dysregulation domains were associated with reduced cortical thickness in the right parahippocampal and supramarginal gyri. Since neurodegeneration in the medial temporal and parietal lobe precedes early Alzheimer's disease (AD), MBI, particularly emotion dysregulation, may predict early AD below the diagnostic threshold.
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Affiliation(s)
- Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Creese B, Arathimos R, Aarsland D, Ballard C, Brooker H, Hampshire A, Corbett A, Ismail Z. Late-life onset psychotic symptoms and incident cognitive impairment in people without dementia: Modification by genetic risk for Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12386. [PMID: 37139261 PMCID: PMC10150165 DOI: 10.1002/trc2.12386] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/01/2023] [Indexed: 05/05/2023]
Abstract
Introduction Late-life onset psychosis is associated with faster progression to dementia in cognitively normal people, but little is known about its relationship with cognitive impairment in advance of dementia. Methods Clinical and genetic data from 2750 people ≥50 years of age without dementia were analyzed. Incident cognitive impairment was operationalized using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and psychosis was rated using the Mild Behavioral Impairment Checklist (henceforth MBI-psychosis). The whole sample was analyzed before stratification on apolipoprotein E (APOE) ε4 status. Results In Cox proportional hazards models, MBI-psychosis had a higher hazard for cognitive impairment relative to the No Psychosis group (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.2-6, p < 0.0001). The hazard for MBI-psychosis was higher in APOE ε4 carriers and there was an interaction between the two (HR for interaction: 3.4, 95% CI: 1.2-9.8, p = 0.02). Discussion Psychosis assessment in the MBI framework is associated with incident cognitive impairment in advance of dementia. These symptoms may be particularly important in the context of APOE genotype.
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Affiliation(s)
- Byron Creese
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Ryan Arathimos
- Social Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Dag Aarsland
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
| | - Clive Ballard
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Helen Brooker
- Department of Health and Community SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Adam Hampshire
- Department of Brain SciencesFaculty of MedicineImperial College LondonLondonUK
| | - Anne Corbett
- Department of Health and Community SciencesFaculty of Health and Life SciencesUniversity of ExeterUK
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health SciencesHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Health and Community Sciences, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
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Hu S, Patten S, Charlton A, Fischer K, Fick G, Smith EE, Ismail Z. Validating the Mild Behavioral Impairment Checklist in a Cognitive Clinic: Comparisons With the Neuropsychiatric Inventory Questionnaire. J Geriatr Psychiatry Neurol 2023; 36:107-120. [PMID: 35430902 PMCID: PMC9941652 DOI: 10.1177/08919887221093353] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the utility of the Mild Behavioral Impairment-Checklist (MBI-C) and Neuropsychiatric Inventory Questionnaire (NPI-Q) to capture NPS in subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. METHODS In this cross-sectional memory clinic study, linear regression models compared MBI-C (n = 474) and NPI-Q (n = 1040) scores in relation to Montreal Cognitive Assessment (MoCA) score. RESULTS MBI prevalence was 37% in subjective cognitive decline, 54% in mild cognitive impairment, and 62% in dementia. Worse diagnostic status was associated with higher MBI-C and NPI-Q score (P < .001), lower MoCA (P < .001), and greater age (P < .001). Higher MBI-C (β -.09; 95% CI -.13, -.05) and NPI-Q (β -.17; 95% CI -.23, -.10) scores were associated with lower MoCA scores, with psychosis most strongly associated (β -1.11; 95% CI -1.56, -.65 vs β -1.14; 95% CI -1.55, -.73). CONCLUSIONS The MBI-C captures global and domain-specific NPS across cognitive stages. Both the MBI-C and NPI-Q have utility in characterizing NPS.
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Affiliation(s)
- Sophie Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Anna Charlton
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Karyn Fischer
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Gordon Fick
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Eric E. Smith
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Zahinoor Ismail, MD, Hotchkiss Brain Institute, University of Calgary, 3280 Hospital Drive NW, TRW Building 1st Floor Calgary, AB T2N 4Z6, Canada.
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Matsuoka T, Imai A, Narumoto J. Neuroimaging of mild behavioral impairment: A systematic review. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e81. [PMID: 38868411 PMCID: PMC11114318 DOI: 10.1002/pcn5.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/30/2023] [Indexed: 06/14/2024]
Abstract
There are many neuroimaging studies of mild behavioral impairment (MBI), but the results have been somewhat inconsistent. Moreover, it remains unclear whether MBI is a risk factor or prodromal symptom of dementia. Therefore, a systematic review was conducted to summarize the results of neuroimaging studies of MBI and consider whether MBI is a prodromal symptom of dementia in terms of its neural correlates. A systematic review supported by a JSPS Grant-in-Aid for Scientific Research (C) was conducted using MBI neuroimaging studies identified using PubMed, PsycINFO, CINAHL, and Google Scholar on November 1, 2022. The inclusion criteria were (i) neuroimaging study; (ii) research on human subjects; (iii) papers written in English; and (iv) not a case study, review, book, comments, or abstract only. Joanna Briggs Institute critical appraisal checklists were used to assess the quality of selected studies, and 23 structural and functional imaging studies were ultimately included in the systematic review. The structural studies suggested an association of MBI with atrophy in the hippocampus, parahippocampal gyrus, entorhinal cortex, and temporal lobe, whereas the functional studies indicated involvement of an altered default mode network, frontoparietal control network, and salience network in MBI. A limitation in many studies was the use of region-of-interest analysis. The brain areas detected as neural correlates of MBI are considered to be alterations in the early stage of each dementia. Therefore, MBI may emerge against a background of pathological changes in dementia.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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Pépin É, Tanguay N, Roy MP, Macoir J, Bruneau MA, Ismail Z, Hudon C. Preliminary Validation Study of the French-Quebec Version of the Mild Behavioral Impairment Checklist. Cogn Behav Neurol 2023; 36:9-18. [PMID: 36201620 DOI: 10.1097/wnn.0000000000000321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alzheimer disease dementia may be preceded by cognitive stages during which behavioral and psychological changes can occur. More precisely, behavioral symptoms may be observed during the subjective cognitive decline (SCD) or the mild cognitive impairment (MCI) stages; these symptoms can be measured using the Mild Behavioral Impairment Checklist (MBI-C). OBJECTIVE To validate the French-Quebec version of the MBI-C in individuals ages 60-85 years. METHOD The sample included 60 participants (20 MCI, 20 SCD, 20 cognitively healthy) and their informants. To assess the discriminant validity of the MBI-C, a Kruskal-Wallis analysis with a multiple comparisons test was performed on the MBI-C Total score. To determine convergent validity, Spearman correlations were calculated between the MBI-C subscales and a set of validation tools. Finally, test-retest reliability was assessed with Spearman correlations of MBI-C scores between two test sessions. RESULTS All of the analyses indicated satisfactory psychometric properties for the French-Quebec version of the MBI-C. CONCLUSION This validation study reveals that the MBI-C can be used successfully in dementia risk assessments. From now on, the use of a validated MBI-C will be possible in the French-Quebec population.
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Affiliation(s)
- Émilie Pépin
- Universite du Quebec à Trois-Rivières, Trois-Rivières, Québec, Canada
- CERVO Brain Research Center, Québec, Québec, Canada
| | - Noémie Tanguay
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
| | - Marie-Pier Roy
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
| | - Joël Macoir
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
| | - Marie-Andrée Bruneau
- Research Center of the University Institute of Geriatrics of Montreal, Montréal, Québec, Canada
- Department of Psychiatry and Addictology, University of Montreal, Montréal, Québec, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- College of Health and Medicine, University of Exeter, Exeter, UK
| | - Carol Hudon
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
- VITAM Research Center, Québec, Québec, Canada
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Ghahremani M, Wang M, Chen HY, Zetterberg H, Smith E, Ismail Z. Plasma Phosphorylated Tau at Threonine 181 and Neuropsychiatric Symptoms in Preclinical and Prodromal Alzheimer Disease. Neurology 2023; 100:e683-e693. [PMID: 36323521 PMCID: PMC9969916 DOI: 10.1212/wnl.0000000000201517] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Plasma phosphorylated tau at threonine 181 (p-tau181), a well-validated marker of Alzheimer disease (AD) pathologic change, could be a more efficient way to diagnose AD than invasive or expensive biomarkers requiring CSF or PET. In some individuals, neuropsychiatric symptoms (NPS) are the earliest manifestation of AD, observed in advance of clear cognitive decline. However, the few studies assessing AD biomarkers in association with NPS have often had imprecision in capturing behavioral symptoms that represent sequelae of neurodegenerative disease. Thus, the mild behavioral impairment (MBI) construct was developed, framing NPS in a way to improve the precision of risk estimates for disease. MBI core criteria stipulate that NPS emerge de novo in later life and persist for at least 6 months. Here, cross-sectionally and longitudinally, we investigated associations of MBI with p-tau181, neuropsychological test performance, and incident AD. METHODS Cognitively unimpaired and mild cognitive impairment (MCI) Alzheimer's Disease Neuroimaging Initiative participants were selected. MBI status was derived from the Neuropsychiatric Inventory (NPI) using a published algorithm. NPI total scores at baseline and year 1 visits were used to operationalize MBI (score >0 at both visits), NPS not meeting the MBI criteria (NPS-not-MBI, score >0 at only 1 visit), and no NPS (score = 0 at both visits). Linear regressions were fitted for cross-sectional analyses; multilevel linear mixed-effects and Cox proportional hazards models were implemented to examine the longitudinal associations of MBI with changes in p-tau181 and cognition and incident dementia. RESULTS The sample included 571 participants (age 72.2 years, 46.8% female, 64.8% MCI). Cross-sectionally (β = 8.1%, 95% CI 1.4%-15.2%, p = 0.02), MBI was associated with higher plasma p-tau181 levels compared with no NPS; NPS-not-MBI was not. Longitudinally, MBI was associated with higher p-tau181 (β = 0.014%, 95% CI 0.003-0.026, p = 0.02), in addition to a decline in memory and executive function. Survival analyses demonstrated a 3.92-fold greater dementia incidence in MBI, with no significant differences between NPS-not-MBI and no NPS. DISCUSSION These findings extend the evidence base that MBI is associated with elevated risk of cognitive decline and dementia and a sequela of emerging Alzheimer-related proteinopathies. MBI offers a substantial improvement over current approaches that explore behavior as a proxy marker for Alzheimer-related proteinopathies, with both clinical and AD trial enrichment implications.
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Affiliation(s)
| | | | | | | | | | - Zahinoor Ismail
- From the Department of Psychiatry (M.G., H.-Y.C., Z.I.), Hotchkiss Brain Institute (M.G., M.W., H.-Y.C., E.S., Z.I.), Department of Clinical Neurosciences (M.W., E.S., Z.I.), Cumming School of Medicine, and Department of Community Health Sciences (M.W., E.S., Z.I.), University of Calgary, Alberta, Canada; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology, Queen Square; UK Dementia Research Institute at UCL (H.Z.); Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Mathison Centre for Mental Health Research & Education (Z.I.), University of Calgary, Alberta, Canada; and College of Medicine and Health (Z.I.), University of Exeter, United Kingdom.
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Liu JY, Ma LZ, Wang J, Cui XJ, Sheng ZH, Fu Y, Li M, Ou YN, Yu JT, Tan L, Lian Y. Age-Related Association Between APOE ɛ4 and Cognitive Progression in de novo Parkinson's Disease. J Alzheimers Dis 2023; 91:1121-1132. [PMID: 36565124 DOI: 10.3233/jad-220976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND APOE ɛ4 genotype was correlated with exacerbation of pathology and higher risk of dementia in Parkinson's disease (PD). Meanwhile, the differential influence of APOE ɛ4 on cognition in young and old individuals interpreted as antagonistic pleiotropy. OBJECTIVE To examine whether the effect of APOE ɛ4 on cognitive progression in de novo PD is age dependent. METHODS In this study, 613 de novo PD patients were recruited from Parkinson's Progression Markers Initiative (PPMI). To examine the age-dependent relationship between APOE ɛ4 and cognitive changes, we added 3-way interaction of APOE ɛ4*baseline age*time to the linear mixed-effect (LME) models and evaluated the specific roles of APOE ɛ4 in the middle age group and elderly group separately. Cox regression was utilized to examine the progression of cognition in age-stratified PD participants. RESULTS Age significantly modified relationship between APOE ɛ4 and cognitive changes in most cognitive domains (pinteraction <0.05). In the elderly group, APOE ɛ4 carriers showed steeper decline in global cognition (p = 0.001) as well as in most cognitive domains, and they had a greater risk of cognitive progression (adjusted HR 1.625, 95% CI 1.143-2.310, p = 0.007), compared with non-carriers. However, in the middle age group, no significant relationships between APOE ɛ4 and cognitive decline can be detected. CONCLUSION Our results indicated that the APOE ɛ4 allele has an age-dependent effect on cognitive decline in PD patients. The underlying mechanisms need to be investigated in the future.
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Affiliation(s)
- Jia-Yao Liu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ling-Zhi Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jun Wang
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China.,Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xin-Jing Cui
- Department of Outpatient, Qingdao Municipal Hospital, Qingdao, China
| | - Ze-Hu Sheng
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Meng Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yan Lian
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China.,Department of Prevention and Health Care, Daping Hospital, Third Military Medical University, Chongqing, China
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The Fuzzy Border between the Functional and Dysfunctional Effects of Beta-Amyloid: A Synaptocentric View of Neuron-Glia Entanglement. Biomedicines 2023; 11:biomedicines11020484. [PMID: 36831020 PMCID: PMC9953143 DOI: 10.3390/biomedicines11020484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Recent observations from clinical trials using monoclonal antibodies against Aβ seem to suggest that Aβ-targeting is modestly effective and not sufficiently based on an effective challenge of the role of Aβ from physiological to pathological. After an accelerated approval procedure for aducanumab, and more recently lecanemab, their efficacy and safety remain to be fully defined despite previous attempts with various monoclonal antibodies, and both academic institutions and pharmaceutical companies are actively searching for novel treatments. Aβ needs to be clarified further in a more complicated context, taking into account both its accumulation and its biological functions during the course of the disease. In this review, we discuss the border between activities affecting early, potentially reversible dysfunctions of the synapse and events trespassing the threshold of inflammatory, self-sustaining glial activation, leading to irreversible damage. We detail a clear understanding of the biological mechanisms underlying the derangement from function to dysfunction and the switch of the of Aβ role from physiological to pathological. A picture is emerging where the optimal therapeutic strategy against AD should involve a number of allied molecular processes, displaying efficacy not only in reducing the well-known AD pathogenesis players, such as Aβ or neuroinflammation, but also in preventing their adverse effects.
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Ghahremani M, Nathan S, Smith EE, McGirr A, Goodyear B, Ismail Z. Functional connectivity and mild behavioral impairment in dementia-free elderly. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12371. [PMID: 36698771 PMCID: PMC9847513 DOI: 10.1002/trc2.12371] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 01/19/2023]
Abstract
Background Mild behavioral impairment (MBI) is a syndrome that uses later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a group at high risk for incident dementia. MBI is associated with neurodegenerative disease markers in advance of syndromic dementia. Functional connectivity (FC) correlates of MBI are understudied and could provide further insights into mechanisms early in the disease course. We used resting-state functional magnetic resonance imaging (rs-fMRI) to test the hypothesis that FC within the default mode network (DMN) and salience network (SN) of persons with MBI (MBI+) is reduced, relative to those without (MBI-). Methods From two harmonized dementia-free cohort studies, using a score of ≥6 on the MBI Checklist to define MBI status, 32 MBI+ and 63 MBI- individuals were identified (mean age: 71.7 years; 54.7% female). Seed-based connectivity analysis was implemented in each MBI group using the CONN fMRI toolbox (v20.b), with the posterior cingulate cortex (PCC) as the seed region within the DMN and anterior cingulate cortex (ACC) as the seed within the SN. The average time series from the PCC and ACC were used to determine FC with other regions within the DMN (medial prefrontal cortex, lateral inferior parietal cortex) and SN (anterior insula, supramarginal gyrus, rostral prefrontal cortex), respectively. Age, sex, years of education, and Montreal Cognitive Assessment scores were included as model covariates. The false discovery rate approach was used to correct for multiple comparisons, with a p-value of .05 considered significant. Results For the DMN, MBI+ individuals exhibited reduced FC between the PCC and the medial prefrontal cortex, compared to MBI-. For the SN, MBI+ individuals exhibited reduced FC between the ACC and left anterior insula. Conclusion MBI in dementia-free older adults is associated with reduced FC in networks known to be disrupted in dementia. Our results complement the evidence linking MBI with Alzheimer's disease biomarkers. Highlights Resting-state functional magnetic resonance imaging was completed in 95 dementia-free persons from FAVR and COMPASS-ND studies.Participants were stratified by informant-rated Mild Behavioral Impairment Checklist (MBI-C) score, ≥6 for MBI+.MBI+ participants showed reduced functional connectivity (FC) within the default mode network and salience network.These FC changes are consistent with those seen in early-stage Alzheimer's disease.MBI may help identify persons with early-stage neurodegenerative disease.
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Affiliation(s)
- Maryam Ghahremani
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of PsychiatryCumming School of MedicineCalgaryAlbertaCanada
| | - Santhosh Nathan
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Eric E. Smith
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Clinical NeurosciencesCumming School of MedicineCalgaryAlbertaCanada
| | - Alexander McGirr
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of PsychiatryCumming School of MedicineCalgaryAlbertaCanada
| | - Bradley Goodyear
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of PsychiatryCumming School of MedicineCalgaryAlbertaCanada
- Department of Clinical NeurosciencesCumming School of MedicineCalgaryAlbertaCanada
- Department of RadiologyCumming School of MedicineCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of PsychiatryCumming School of MedicineCalgaryAlbertaCanada
- Department of Clinical NeurosciencesCumming School of MedicineCalgaryAlbertaCanada
- College of Medicine and HealthUniversity of ExeterExeterUK
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Yoon EJ, Lee JY, Kwak S, Kim YK. Mild behavioral impairment linked to progression to Alzheimer's disease and cortical thinning in amnestic mild cognitive impairment. Front Aging Neurosci 2023; 14:1051621. [PMID: 36688162 PMCID: PMC9846631 DOI: 10.3389/fnagi.2022.1051621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Background Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later life emergence of sustained neuropsychiatric symptoms, as an at-risk state for dementia. However, the associations between MBI and a risk of progression to Alzheimer's disease (AD) and its neuroanatomical correlates in mild cognitive impairment (MCI) are still unclear. Method A total 1,184 older adults with amnestic MCI was followed for a mean of 3.1 ± 2.0 years. MBI was approximated using a transformation algorithm for the Neuropsychiatric Inventory at baseline. A two-step cluster analysis was used to identify subgroups of individuals with amnestic MCI based on profiles of 5 MBI domain symptoms (decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, abnormal perception/thought content). A Cox regression analysis was applied to investigate differences in the risk of progression to AD between subgroups. A subset of participants (n = 202) underwent 3D T1-weighted MRI scans at baseline and cortical thickness was compared between the subgroups of amnestic MCI patients. Result The cluster analysis classified the patients into 3 groups: (1) patients without any MBI domain symptoms (47.4%, asymptomatic group); (2) those with only affective dysregulation (29.4%, affective dysregulation group); (3) those with multiple MBI domain symptoms, particularly affective dysregulation, decreased motivation and impulse dyscontrol (23.2%, complex group). Compared to the asymptomatic group, the complex group was associated with a higher risk of progression to AD (hazard ratio = 2.541 [1.904-3.392], p < 0.001), but the affective dysregulation group was not (1.214 [0.883-1.670], p = 0.232). In cortical thickness analysis, the complex group revealed cortical thinning bilaterally in the inferior parietal, lateral occipital, lateral superior temporal, and frontopolar regions compared with the affective dysregulation group. Conclusion The multiple co-occuring MBI domains in individuals with amnestic MCI are associated with a higher risk of progression to AD and cortical thinning in temporal, parietal and frontal areas. These results suggest that evaluation of MBI could be useful for risk stratification for AD and appropriate intervention in MCI individuals.
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Affiliation(s)
- Eun Jin Yoon
- Memory Network Medical Research Center, Seoul National University, Seoul, South Korea,Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, South Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea,Department of Medical Device Development, Seoul National University College of Medicine, Seoul, South Korea
| | - Seyul Kwak
- Department of Psychology, Pusan National University, Busan, South Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea,*Correspondence: Yu Kyeong Kim,
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Bergamini G, Massinet H, Hart A, Durkin S, Pierlot G, Steiner MA. Probing the relevance of the accelerated aging mouse line SAMP8 as a model for certain types of neuropsychiatric symptoms in dementia. Front Psychiatry 2023; 14:1054163. [PMID: 36896346 PMCID: PMC9989166 DOI: 10.3389/fpsyt.2023.1054163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/06/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION People with dementia (PwD) often present with neuropsychiatric symptoms (NPS). NPS are of substantial burden to the patients, and current treatment options are unsatisfactory. Investigators searching for novel medications need animal models that present disease-relevant phenotypes and can be used for drug screening. The Senescence Accelerated Mouse-Prone 8 (SAMP8) strain shows an accelerated aging phenotype associated with neurodegeneration and cognitive decline. Its behavioural phenotype in relation to NPS has not yet been thoroughly investigated. Physical and verbal aggression in reaction to the external environment (e.g., interaction with the caregiver) is one of the most prevalent and debilitating NPS occurring in PwD. Reactive aggression can be studied in male mice using the Resident-Intruder (R-I) test. SAMP8 mice are known to be more aggressive than the Senescence Accelerated Mouse-Resistant 1 (SAMR1) control strain at specific ages, but the development of the aggressive phenotype over time, is still unknown. METHODS In our study, we performed a longitudinal, within-subject, assessment of aggressive behaviour of male SAMP8 and SAMR1 mice at 4, 5, 6 and 7 months of age. Aggressive behaviour from video recordings of the R-I sessions was analysed using an in-house developed behaviour recognition software. RESULTS SAMP8 mice were more aggressive relative to SAMR1 mice starting at 5 months of age, and the phenotype was still present at 7 months of age. Treatment with risperidone (an antipsychotic frequently used to treat agitation in clinical practice) reduced aggression in both strains. In a three-chamber social interaction test, SAMP8 mice also interacted more fervently with male mice than SAMR1, possibly because of their aggression-seeking phenotype. They did not show any social withdrawal. DISCUSSION Our data support the notion that SAMP8 mice might be a useful preclinical tool to identify novel treatment options for CNS disorders associated with raised levels of reactive aggression such as dementia.
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Affiliation(s)
- Giorgio Bergamini
- CNS Pharmacology and Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Helene Massinet
- CNS Pharmacology and Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Aaron Hart
- Scientific Computing Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Sean Durkin
- CNS Pharmacology and Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Gabin Pierlot
- Scientific Computing Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
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Vellone D, Ghahremani M, Goodarzi Z, Forkert ND, Smith EE, Ismail Z. Apathy and APOE in mild behavioral impairment, and risk for incident dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12370. [PMID: 36544988 PMCID: PMC9763783 DOI: 10.1002/trc2.12370] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Introduction Mild behavioral impairment (MBI) is a high-risk state for incident dementia and comprises five core domains including affective dysregulation, impulse dyscontrol, social inappropriateness, psychotic symptoms, and apathy. Apathy is among the most common neuropsychiatric symptoms (NPS) in dementia but can also develop in persons with normal cognition (NC) or mild cognitive impairment (MCI). The later-life emergence and persistence of apathy as part of the MBI syndrome may be a driving factor for dementia risk. Therefore, we investigated MBI-apathy-associated progression to dementia, and effect modification by sex, race, cognitive diagnosis, and apolipoprotein E (APOE) genotype. Methods Dementia-free National Alzheimer's Coordinating Center participants were stratified by persistent apathy status, based on Neuropsychiatric Inventory (NPI)-Questionnaire scores at two consecutive visits. Hazard ratios (HRs) for incident dementia for MBI-apathy and NPI-apathy relative to no NPS, and MBI-apathy relative to no apathy, were determined using Cox proportional hazards regressions, adjusted for baseline age, sex, years of education, race, cognitive diagnosis, and APOE genotype. Interactions with relevant model covariates were explored. Results Of the 3932 participants (3247 with NC), 354 had MBI-apathy. Of all analytic groups, MBI-apathy had the greatest dementia incidence (HR = 2.69, 95% confidence interval [CI]: 2.15-3.36, P < 0.001). Interaction effects were observed between cognitive diagnosis and APOE genotype with the NPS group. The contribution of apathy to dementia risk was greater in NC (HR = 5.91, 95% CI: 3.91-8.93) than in MCI (HR = 2.16, 95% CI: 1.69-2.77, interaction P < 0.001) and in all APOE genotypes, was greatest in APOE ɛ3 (HR = 4.25, 95% CI: 3.1-5.82, interaction P < 0.001). Discussion Individuals with MBI-apathy have a markedly elevated risk for future dementia, especially when symptoms emerge in those with NC. Both cognitive status and APOE genotype are important moderators in the relationship between MBI-apathy and incident dementia. MBI-apathy may represent a group in whom apathy is a preclinical or prodromal manifestation of dementia and identify a precision medicine target for preventative interventions.
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Affiliation(s)
- Daniella Vellone
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Maryam Ghahremani
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahra Goodarzi
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Mathison Centre for Mental Health Research and EducationCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,O'Brien Institute for Public HealthCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Nils D. Forkert
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of RadiologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Eric E. Smith
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Mathison Centre for Mental Health Research and EducationCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,O'Brien Institute for Public HealthCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,College of Medicine and HealthUniversity of ExeterExeterUK
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Ruthirakuhan M, Ismail Z, Herrmann N, Gallagher D, Lanctot KL. Mild behavioral impairment is associated with progression to Alzheimer's disease: A clinicopathological study. Alzheimers Dement 2022; 18:2199-2208. [PMID: 35103400 PMCID: PMC9339594 DOI: 10.1002/alz.12519] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Mild behavioral impairment (MBI) is characterized by later-life emergence of neuropsychiatric symptoms. Investigating its relationship with progression to Alzheimer's disease (AD) would provide insight on its importance as a predictor of AD. METHODS Cognitively normal participants (N = 11,372) from the National Alzheimer's Coordinating Center were stratified by MBI status, using the Neuropsychiatric Inventory-Questionnaire. We investigated whether MBI and its domains were predictors of progression to clinically-diagnosed AD. MBI as a predictor of progression to neuropathology-confirmed AD was also investigated in those with neuropathological data. RESULTS Six percent (N = 671) of participants progressed to AD. MBI (N = 2765) was a significant predictor of progression to clinically-diagnosed (hazard ratio [HR] = 1.75) and neuropathology-confirmed AD (HR = 1.59). MBI domains were also associated with clinically-diagnosed AD, with psychosis having the greatest effect (HR = 6.49). DISCUSSION These findings support the biological underpinnings of MBI, emphasizing the importance of later life behavioral changes in dementia detection and prognostication.
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Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute and O’Brien Institute for Public Health University of Calgary, Calgary, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Damien Gallagher
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Krista L. Lanctot
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Chen TH, Yeh YC, Huang MF, Chen HM, Lee JI, Chen CS. Validation and Comparison of the Informant-Rated and Self-Rated Versions of the Mild Behavioral Impairment Checklist. J Alzheimers Dis 2022; 90:1203-1213. [DOI: 10.3233/jad-220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The Mild Behavioral Impairment Checklist (MBI-C) has been developed to assess mild behavioral impairment (MBI). However, no study has validated the use of MBI-C using a promising translation method in Taiwan. Thus, consistency and discrepancy between informant-rated and self-rated scores have not been extensively researched. Objective: This study validated and compared the informant- and self-rated versions of the MBI-C among community-dwelling people in Taiwan. Method: We recruited 202 pairs of individuals without dementia aged ≥50 years and their cohabitating informants. The participants completed the MBI-C (MBI-C-self), and the informants completed the MBI-C (MBI-C-informant) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) independently. Internal consistency, inter-rater reliability, and convergent validity were examined. Results: Both MBI-C-self and MBI-C-informant exhibited satisfactory Cronbach’s α values (0.92 and 0.88, respectively). The MBI-C-informant total scorewas correlated with the NPI-Q total score (r = 0.83, p < 0.001). Inter-rater reliability between the two versions, as represented by the inter-rater correlation coefficient, was 0.57 (p < 0.001). The prevalence of MBI based on the MBI-C-informant scores was 1.5% higher than that based on the MBI-C-self scores according to the suggested cut-off score of 8.5. The affective dysregulation domain score of MBI-C-informant was significantly lower than that of MBI-C-self. Conclusion: MBI-C-informant exhibited both high reliability and validity. Discrepancies between MBI-C-informant and MBI-C-self related to the detection rates and affective dysregulation domain scores were noted. The level of consistency and discrepancy between these two versions provide implications for the use of MBI-C in clinical practice and future research.
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Affiliation(s)
- Ting-Hsiang Chen
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduated Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Mei Chen
- Department of Occupational Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-In Lee
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduated Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Johansson M, Stomrud E, Johansson PM, Svenningsson A, Palmqvist S, Janelidze S, van Westen D, Mattsson-Carlgren N, Hansson O. Development of Apathy, Anxiety, and Depression in Cognitively Unimpaired Older Adults: Effects of Alzheimer's Disease Pathology and Cognitive Decline. Biol Psychiatry 2022; 92:34-43. [PMID: 35346458 DOI: 10.1016/j.biopsych.2022.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of Alzheimer's disease (AD) pathology and cognitive deficits on longitudinal neuropsychiatric symptoms is unclear, especially in early disease stages. METHODS Cognitively unimpaired older adults (N = 356) enrolled in the prospective Swedish BioFINDER study were examined. Neuropsychiatric assessments encompassed the Apathy Evaluation Scale and the Hospital Anxiety and Depression Scale, performed biennially (together with tests of global cognition) for up to 8 years. Biomarkers were measured in cerebrospinal fluid or plasma at baseline. Magnetic resonance imaging quantified white matter lesions. We used linear mixed-effect models to test associations between baseline AD biomarkers (for amyloid-β [Aβ], tau, and neurodegeneration) and white matter lesions with longitudinal neuropsychiatric symptoms (apathy, anxiety, and depressive symptoms). We also tested associations between changes in cognition and changes in neuropsychiatric symptoms. Finally, we tested if change in cognition mediated the effects of different brain pathologies on neuropsychiatric symptoms. RESULTS Aβ pathology at baseline was associated with increasing levels of apathy (β = -0.284, p = .005) and anxiety (β = -0.060, p = .011) longitudinally. More rapid decline of cognition over time was related to increasing levels of apathy. The effects of baseline Aβ pathology on longitudinal apathy were partly mediated by changes in cognitive performance (proportion mediated 23%). CONCLUSIONS Aβ pathology may drive the development of both apathy and anxiety in very early stages of AD, largely independent of cognitive change. The effect of Aβ on apathy is only partially conveyed by worse cognition. Together, these findings highlight certain neuropsychiatric symptoms as early manifestations of AD.
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Affiliation(s)
- Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Helsingborg, Sweden; Clinical Department of Psychiatry, Helsingborg Hospital, Helsingborg, Sweden.
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Per Mårten Johansson
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Helsingborg, Sweden; Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anna Svenningsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Image and Function, Skåne University Hospital Lund, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital Lund, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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Ceïde ME, Eguchi D, Ayers EI, Lounsbury DW, Verghese J. Mediation Analyses of the Role of Apathy on Motoric Cognitive Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127376. [PMID: 35742625 PMCID: PMC9224534 DOI: 10.3390/ijerph19127376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
Recent literature indicates that apathy is associated with poor cognitive and functional outcomes in older adults, including motoric cognitive risk syndrome (MCR), a predementia syndrome. However, the underlying biological pathway is unknown. The objectives of this study were to (1) examine the cross-sectional associations between inflammatory cytokines (Interleukin 6 (IL-6) and C-Reactive Protein (CRP)) and apathy and (2) explore the direct and indirect relationships of apathy and motoric cognitive outcomes as it relates to important cognitive risk factors. N = 347 older adults (≥65 years old) enrolled in the Central Control of Mobility in Aging Study (CCMA). Linear and logic regression models showed that IL-6, but not CRP was significantly associated with apathy adjusted for age, gender, and years of education (β = 0.037, 95% CI: 0.002-0.072, p = 0.04). Apathy was associated with a slower gait velocity (β = -14.45, 95% CI: -24.89-4.01, p = 0.01). Mediation analyses demonstrated that IL-6 modestly mediates the relationship between apathy and gait velocity, while apathy mediated the relationships between dysphoria and multimorbidity and gait velocity. Overall, our findings indicate that apathy may be an early predictor of motoric cognitive decline. Inflammation plays a modest role, but the underlying biology of apathy warrants further investigation.
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Affiliation(s)
- Mirnova E. Ceïde
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (E.I.A.); (J.V.)
- Department of Psychiatry and Behavioral Sciences and Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Correspondence: ; Tel.: +1-347-920-0112; Fax: +1-718-430-3829
| | - Daniel Eguchi
- Medical Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Emmeline I. Ayers
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (E.I.A.); (J.V.)
| | - David W. Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Joe Verghese
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (E.I.A.); (J.V.)
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