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Parrotta I, Cacciatore S, D'Andrea F, D'Anna M, Giancaterino G, Lazzaro G, Arcara G, Manzo N. Prevalence, treatment, and neural correlates of apathy in different forms of dementia: a narrative review. Neurol Sci 2024; 45:1343-1376. [PMID: 38015288 PMCID: PMC10942903 DOI: 10.1007/s10072-023-07197-7] [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: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings obtained from studies in patients with apathy in different forms of dementia, including Alzheimer's disease (AD), vascular (VaD) and mixed dementia, frontotemporal dementia (FTD), and Parkinson's disease dementia (PDD). METHODS Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series from four databases (WebOfScience, Scopus, Pubmed, and PsycINFO) addressing apathy in adults or older people aged over 65 years of age affected by dementia were included. RESULTS The prevalence of apathy was 26-82% for AD, 28.6-91.7 for VaD, 29-97.5% in PDD, and 54.8-88.0 in FTD. The assessment of apathy was not consistent in the reviewed studies. Methylphenidate was the most successful pharmacological treatment for apathy. Neurobiological studies highlighted the relationship between both structural and functional brain areas and the presence or severity of apathy. CONCLUSION Apathy is a very common disorder in all types of dementia, although it is often underdiagnosed and undertreated. Further studies are needed to investigate its diagnosis and management. A consensus on the different evaluation scales should be achieved.
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Affiliation(s)
- Ilaria Parrotta
- Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Louvain, Belgium
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy
| | - Stefano Cacciatore
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy.
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy.
| | - Flavio D'Andrea
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marianna D'Anna
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giulia Giancaterino
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giovanni Lazzaro
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Nicoletta Manzo
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
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Thompson JL, Woods SP, Medina LD, Garcia JM, Teixeira AL. Apathy in persons living with HIV disease: A systematic narrative review. J Affect Disord 2024; 350:133-147. [PMID: 38224740 DOI: 10.1016/j.jad.2024.01.016] [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: 07/21/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Apathy was identified as a feature of HIV early in the epidemic; however, there are no systematic reviews of the diverse literature on the sociodemographic and clinical correlates of apathy in HIV disease. METHODS The current study adopted a hybrid systematic-narrative review methodology in which we used PRISMA guidelines to identify, summarize, and critique peer-reviewed, empirical studies of apathy in HIV disease in the era of combination antiretroviral therapy. RESULTS A total of 34 studies of apathy in persons living with HIV (PLWH) were identified. Findings across these studies showed that apathy was reliably related to the structure of grey and white matter pathways commonly implicated in apathy, poorer everyday functioning, education, and other neuropsychiatric symptoms (e.g., depression). Apathy was not reliably associated with age, sex, race/ethnicity, cognition, and clinical markers of HIV disease. LIMITATIONS The current review does not provide rigorous quantitative estimates of clinical correlates of apathy, and the exclusion criteria of non-English and non-peer reviewed publications introduces risk of bias and Type I error. CONCLUSIONS Apathy occurs at higher rates in PLWH and is linked to neuroanatomical differences, as well as negative outcomes for everyday functions, aspects of neurocognition, and neuropsychiatric symptoms. As such, apathy is an important component to consider in the clinical assessment, diagnosis, and management of neurocognitive disorders in PLWH. Future work is needed to replicate existing findings with larger sample sizes and longitudinal designs, examine apathy as a multi-dimensional construct, and develop evidence-based treatments for apathy in PLWH.
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Affiliation(s)
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX 77004, USA.
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Antonio L Teixeira
- Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX 77054, USA
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Fidder H, Veenhuizen RB, Gerridzen IJ, van Wieringen WN, Smalbrugge M, Hertogh CMPM, van Loon AM. Impaired Awareness in People with Severe Alcohol-Related Cognitive Deficits Including Korskoff's Syndrome: A Network Analysis. J Clin Med 2023; 12:jcm12093139. [PMID: 37176580 PMCID: PMC10178999 DOI: 10.3390/jcm12093139] [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: 03/13/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Impaired awareness of one's own functioning is highly common in people with Korsakoff's syndrome (KS). However, it is currently unclear how awareness relates to impairments in daily functioning and quality of life (QoL). METHODS We assessed how impaired awareness relates to cognitive, behavioral, physical, and social functioning and QoL by applying a network analysis. We used cross-sectional data from 215 patients with KS or other severe alcohol-related cognitive deficits living in Dutch long-term care facilities (LTCFs). RESULTS Apathy has the most central position in the network. Higher apathy scores relate positively to reduced cognition and to a greater decline in activities of daily living and negatively to social participation and the use of antipsychotic drugs. Impaired awareness is also a central node. It is positively related to a higher perceived QoL, reduced cognition and apathy, and negatively to social participation and length of stay in the LTCF. Mediated through apathy and social participation, impaired awareness is indirectly related to other neuropsychiatric symptoms. CONCLUSIONS Impaired awareness is closely related to other domains of daily functioning and QoL of people with KS or other severe alcohol-related cognitive deficits living in LTCFs. Apathy plays a central role. Network analysis offers interesting insights to evaluate the interconnection of different symptoms and impairments in brain disorders such as KS.
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Affiliation(s)
- Hester Fidder
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
| | - Ruth B Veenhuizen
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
- Atlant, Nursing Home Markenhof, Korsakoff Centre of Expertise, Kuiltjesweg 1, 7361 TC Beekbergen, The Netherlands
| | - Ineke J Gerridzen
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
- Atlant, Nursing Home Markenhof, Korsakoff Centre of Expertise, Kuiltjesweg 1, 7361 TC Beekbergen, The Netherlands
| | - Wessel N van Wieringen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1081a, 1081 HV Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
| | - Anouk M van Loon
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
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Weitzner DS, Miller BI, Webber TA. Embedded cognitive and emotional/affective self-reported symptom validity indices on the patient competency rating scale. J Clin Exp Neuropsychol 2022; 44:533-549. [PMID: 36369702 DOI: 10.1080/13803395.2022.2138270] [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: 11/15/2022]
Abstract
OBJECTIVE Although there is an abundance of research on stand-alone and embedded performance validity tests and stand-alone symptom validity tests (SVTs), less emphasis has been placed on embedded SVTs. The goal of the current study was to examine the ability of embedded indicators within the Patient Competency Rating Scale (PCRS) to separately detect invalid cognitive and/or emotional/affective symptom responding. METHOD Participants included 299 veterans assessed in a VA medical center epilepsy monitoring unit from 2013-2017 (mean age = 48.8 years, SD = 13.5 years). Two SVT composites were created; self-reported cognitive symptom validity (SVT-C) and self-reported emotional/affective symptom validity (SVT-E). Groups were compared on PCRS total and index scores (i.e., cognitive, activities of daily living, emotional, and interpersonal competencies) using ANOVAs. Receiver operating characteristic (ROC) curve analyses assessed the classification accuracy of the PCRS total and index scores for SVT-C and SVT-E. RESULTS In ANOVAs, SVT-C was significantly associated with all PCRS indices, while SVT-E was only significantly associated with the PCRS total, emotional, and interpersonal competency indices. Although the PCRS-T ≤ 90 had the strongest classification of SVT-C and SVT-E (specificities: .90, sensitivities: .44 to .50), PCRS index scores showed suggestive evidence of domain specificity, with PCRS-ADL ≤22, PCRS-C ≤ 20, and PCRS-CADL ≤45 best classifying SVT-C (specificities: .92, sensitivities: .33) and the PCRS-E ≤ 18 best classifying the SVT-E group (specificity: .93, sensitivity: .40). CONCLUSION Results suggest the PCRS may be used to obtain clinically useful information while including embedded indicators that can assess cognitive and/or emotional/affective symptom invalidity.
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Affiliation(s)
- Daniel S Weitzner
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Brian I Miller
- Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Boada M, López OL, Olazarán J, Núñez L, Pfeffer M, Puente O, Piñol‐Ripoll G, Gámez JE, Anaya F, Kiprov D, Alegret M, Grifols C, Barceló M, Bozzo J, Szczepiorkowski ZM, Páez A. Neuropsychological, neuropsychiatric, and quality-of-life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study. Alzheimers Dement 2022; 18:1314-1324. [PMID: 34726348 PMCID: PMC9540900 DOI: 10.1002/alz.12477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD. No worsening of their psychoaffective status was observed.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades‐Universitat Internacional de CatalunyaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Oscar L. López
- Departments of Neurology and PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Javier Olazarán
- Neurology ServiceHospital General Universitario Gregorio MarañónMadridSpain
- Memory Disorders ClinicHM HospitalesMadridSpain
| | - Laura Núñez
- Alzheimer's Research GroupGrifolsBarcelonaSpain
| | - Michael Pfeffer
- Medical ServicesAllied Biomedical Research Institute, Inc.MiamiFloridaUSA
| | - Orlando Puente
- Center for Prevention of Alzheimer's DiseaseMiami Dade Medical Research InstituteMiamiFloridaUSA
| | - Gerard Piñol‐Ripoll
- Cognitive Disorders UnitClinical Neuroscience ResearchIRB Lleida‐Hospital Universitari Santa MariaLleidaSpain
| | - José E. Gámez
- Psychiatry DepartmentGaliz ResearchHialeahFloridaUSA
| | - Fernando Anaya
- Nephrology ServiceHospital General Universitario Gregorio MarañónMadridSpain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical CareSan FranciscoCaliforniaUSA
| | - Montserrat Alegret
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades‐Universitat Internacional de CatalunyaBarcelonaSpain
| | | | | | - Jordi Bozzo
- Alzheimer's Research GroupGrifolsBarcelonaSpain
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory MedicineDartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Institute of Hematology and Transfusion MedicineWarsawPoland
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Cacciamani F, Houot M, Gagliardi G, Dubois B, Sikkes S, Sánchez-Benavides G, Denicolò E, Molinuevo JL, Vannini P, Epelbaum S. Awareness of Cognitive Decline in Patients With Alzheimer's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:697234. [PMID: 34413767 PMCID: PMC8370471 DOI: 10.3389/fnagi.2021.697234] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Identifying a poor degree of awareness of cognitive decline (ACD) could represent an early indicator of Alzheimer's disease (AD). Objectives: (1) to understand whether there is evidence of poor ACD in the pre-dementia stages of AD; (2) to summarize the main findings obtained investigating ACD in AD; (3) to propose a conceptual framework. Data Sources: We searched Scopus, Pubmed, and the reference lists for studies published up to August 2020. Original research articles must report a measure of ACD and included individuals with AD dementia, or prodromal AD (or MCI), or being at risk for AD. Data Synthesis: All studies covering preclinical, prodromal, and AD dementia were systematically reviewed. We intended to perform a meta-analysis of empirical studies on preclinical AD or prodromal AD (or MCI), to compare ACD between clinical groups. Due to the paucity of literature on preclinical AD, meta-analysis was only possible for prodromal AD (or MCI) studies. Results: We systematically reviewed 283 articles, and conducted a meta-analysis of 18 articles on prodromal AD (or MCI), showing that ACD was not significantly different between patients with amnestic and non-amnestic MCI (SMD = 0.09, p = 0.574); ACD was significantly poorer in amnestic MCI (SMD = -0.56, p = 0.001) and mild AD (SMD = -1.39, p < 0.001) than in controls; ACD was also significantly poorer in mild AD than in amnestic MCI (SMD = -0.75, p < 0.001), as well as poorer than in non-amnestic MCI (SMD = -1.00, p < 0.001). We also discuss key findings on ACD in AD, such as its neural and cognitive correlates. Conclusions and Implications: We propose that patients may be complaining of their initial subtle cognitive changes, but ACD would soon start to decrease. The individual would show mild anosognosia in the MCI stage, and severe anosognosia in dementia. The evaluation of ACD (comparing self-report to cognitive scores or to informant-report) could be useful to guide the clinician toward a timely diagnosis, and in trials targeting early-stage AD.
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Affiliation(s)
- Federica Cacciamani
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Inria, ARAMIS-Project Team, Paris, France
| | - Marion Houot
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Geoffroy Gagliardi
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Bruno Dubois
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Sietske Sikkes
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gonzalo Sánchez-Benavides
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Elena Denicolò
- Department of Biomedical Science and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - José Luis Molinuevo
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Patrizia Vannini
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Stéphane Epelbaum
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Inria, ARAMIS-Project Team, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
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Maruta M, Makizako H, Ikeda Y, Miyata H, Nakamura A, Han G, Shimokihara S, Tokuda K, Kubozono T, Ohishi M, Tabira T. Association between apathy and satisfaction with meaningful activities in older adults with mild cognitive impairment: A population-based cross-sectional study. Int J Geriatr Psychiatry 2021; 36:1065-1074. [PMID: 33786884 DOI: 10.1002/gps.5544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This cross-sectional study aimed to clarify the relationship between apathy, meaningful activities, and satisfaction with such activities of older adults with mild cognitive impairment (MCI). METHODS We analyzed 235 older adults with MCI (≥65 years, mean age: 76.9 ± 6.4 years, women: 63.4%) who participated in a community-based health check survey (Tarumizu Study 2018). MCI was defined as at least 1.5 SD below the reference threshold (age- and education-adjusted score) on one or more of the computerized cognitive test including memory, attention, executive functions, and processing speed. Apathy symptoms were assessed using three of the 15 items of Geriatric Depression Scale. Participants selected meaningful activities from the 95 activities of the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. RESULTS Apathy in MCI was prevalent by 23.8%. The categories of meaningful activities revealed no difference, with, or without apathy. Logistic regression analysis showed that activity satisfaction was significantly associated with apathy after adjusting for age, sex, education, instrumental activities of daily living, depressive symptoms, and MCI subtype (OR, 0.62; 95% CI, 0.44-0.88, p = 0.008). CONCLUSIONS Satisfaction with the activities that are deemed meaningful is associated with apathy among community-dwelling older adults with MCI.
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Affiliation(s)
- Michio Maruta
- Department of Rehabilitation, Medical Corporation, Sanshukai, Okatsu Hospital, Kagoshima, Japan.,Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuriko Ikeda
- Department of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
| | - Hironori Miyata
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
| | - Atsushi Nakamura
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
| | - Gwanghee Han
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Suguru Shimokihara
- Department of Rehabilitation, Minamikagoshima SAKURA Hospital, Kagoshima, Japan
| | - Keiichiro Tokuda
- Department of Rehabilitation, Medical Corporation, Gyokusyokai, Kirameki Terrace Healthcare Hospital, Kagoshima, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
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Azocar I, Livingston G, Huntley J. The Association Between Impaired Awareness and Depression, Anxiety, and Apathy in Mild to Moderate Alzheimer's Disease: A Systematic Review. Front Psychiatry 2021; 12:633081. [PMID: 33613344 PMCID: PMC7889585 DOI: 10.3389/fpsyt.2021.633081] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Impaired awareness of cognitive and functional deficits is a common feature of Alzheimer's disease (AD). Although a lack of awareness has been suggested to be a protective factor against experiencing affective symptoms, such as depression, anxiety, and apathy which are common in AD, there is conflicting evidence about the links between them. This systematic review examines the evidence for an association between impaired awareness and depressive, anxiety, and apathy symptoms in mild to moderate AD. Method: We searched four databases (OvidMedline, Embase, PsycInfo, and PsycArticles) using terms encompassing awareness, apathy, depression, anxiety, and mild-moderate AD. We included studies that assessed the relationship between awareness and depressive symptoms, anxiety symptoms, or apathy. We assessed included papers for quality and report results using a narrative approach, prioritizing high quality studies. Results: We identified 1,544 articles, and twenty-seven studies fulfilled inclusion criteria (high-quality = 15; moderate-quality = 12). Most high-quality studies reported that impaired awareness in early-stage AD is cross-sectionally linked with fewer depressive symptoms and anxiety symptoms (correlation ranged from -0.3 to -0.7), but with more apathy. Conclusions: High-quality studies suggested that in people with early AD, impaired awareness is related to fewer depressive and anxiety symptoms and to more apathy. Future research should focus on elucidating causality among impaired awareness and these symptoms in AD.
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Affiliation(s)
- Ignacia Azocar
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, United Kingdom
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9
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Belli E, Nicoletti V, Radicchi C, Bonaccorsi J, Cintoli S, Ceravolo R, Tognoni G. Confabulations in Cases of Dementia: Atypical Early Sign of Alzheimer’s Disease or Misleading Feature in Dementia Diagnosis? Front Psychol 2020; 11:553886. [PMID: 33117224 PMCID: PMC7550794 DOI: 10.3389/fpsyg.2020.553886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022] Open
Abstract
Confabulations, also known as false memories, have been associated with various diseases involving mainly the frontal areas, such as Wernicke–Korsakoff syndrome or frontal epilepsy. The neuropsychological dysfunctions underlying mechanisms of confabulation are not well known. We describe two patients with memory impairment and confabulations at the onset speculating about neuropsychological correlates of confabulations and self-awareness. Both patients, a 77-year-old woman and a 57-years-old man, exhibited confabulations as first symptom of cognitive decline. She later developed memory impairment without awareness of her memory deficits and her cognitive and imaging profile suggested an amnesic mild cognitive impairment due to Alzheimer’s disease (AD). Unlike her, he developed a prevalent involvement of frontal functions despite a clear consciousness of his cognitive deficits. However, the clinical diagnostic hypothesis of behavioral variant of frontotemporal dementia was not supported by imaging findings, which suggested AD. Both patients underwent neuropsychological evaluation including the Confabulation Battery. Despite that the exact anatomical correlation of confabulations is still not defined, imaging data shown by our patients is consistent with recent theories according to which at the origin of confabulatory tendency in AD there is an impairment of the connections between crucial hubs in frontal and mediotemporal areas, mainly involving the right hemisphere. Besides, it would be reasonable to hypothesize that self-awareness and confabulations should not be considered as necessarily associated dimensions.
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Eckert T, Bongartz M, Ullrich P, Abel B, Christian W, Kiss R, Hauer K. Promoting physical activity in geriatric patients with cognitive impairment after discharge from ward-rehabilitation: a feasibility study. Eur J Ageing 2020; 17:309-320. [PMID: 32904844 PMCID: PMC7458987 DOI: 10.1007/s10433-020-00555-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The aim of the present study was to examine adherence and acceptance of a home-based program to promote physical activity (PA) in older persons with cognitive impairment (CI) following inpatient rehabilitation. Sixty-three older persons (≥ 65 years) with mild to moderate CI (Mini-Mental State Examination score 17-26), allocated to the intervention group of a randomized, controlled intervention trial underwent a 12-week home-based PA intervention including (1) physical training and outdoor walking to improve functional fitness and (2) motivational strategies (goal-setting, pedometer-based self-monitoring, social support delivered by home visits, phone calls) to promote PA. Training logs were used to assess adherence to physical training, outdoor walking and to motivational strategies (goal-setting, pedometer-based self-monitoring). Acceptance (subjective feasibility and effectiveness) of the program components was assessed by a standardized questionnaire. Mean adherence rates over the intervention period were 63.6% for physical training, 57.9% for outdoor walking, and between 40.1% (achievement of walking goals), and 60.1% (pedometer-based self-monitoring) for motivational strategies. Adherence rates significantly declined from baseline to the end of intervention (T1: 43.4-76.8%, T2: 36.1-51.5%, p values<.019). Most participants rated physical training, outdoor walking, goal-setting, and pedometer self-monitoring as feasible (68.2-83.0%) and effective (63.5-78.3%). Highest ratings of self-perceived effectiveness were found for home visits (90.6%) and phone calls (79.2%). The moderate to high adherence to self-performed physical training and motivational strategies proved the feasibility of the home-based PA program in older persons with CI following inpatient rehabilitation.
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Affiliation(s)
- Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Bastian Abel
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Werner Christian
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
- Centre of Geriatric Medicine, University of Heidelberg, 69117 Heidelberg, Germany
| | - Rainer Kiss
- Department of Health and Social Affairs FHM Bielefeld, University of Applied Sciences, Ravensberger Str. 10G, 33602 Bielefeld, Germany
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
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Hu C, Wang L, Zhao X, Zhu B, Tian M, Qin H. Investigation of risk factors for the conversion of mild cognitive impairment to dementia. Int J Neurosci 2020; 131:1173-1180. [PMID: 32532166 DOI: 10.1080/00207454.2020.1782905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is an intermediate state between normal aging and dementia and is characterized by pathological cognitive decline. The study aimed at revealing the risk of MCI progressing to dementia through a follow-up investigation. METHODS In 2011, 441 MCI subjects were recruited, and the disease status was tracked by the follow-up survey in 2017. Subjects with MCI stable (MCIs; N = 356) and MCI progressed into dementia (MCIp; N = 77) were analysed in our study. Community-dwelling old people of age ≥ 55 were recruited from 30 streets and 24 committees (or communities) of the Pudong New District (Shanghai, China). Neuropsychological tests of MMSE, MoCA, 17-item HAMD-17, ADL and HIS were performed. Additionally, the correlations of neuropsychological items and MCIp were explored by univariate and multivariate regression analyses. RESULTS MCIp patients had the lower MMSE and MoCA total scores, whereas the ADL, and HIS total score in MCIp group were higher than in MCIs group. The univariate analysis revealed age, attention (MoCA), visuospatial/executive, number of births, marital status and attention and calculation were significant predictors of MCI progression. In multivariate analysis, age was an independent risk factor of MCI aggravating, while attention (MoCA) was independent protective factor for MCI progression. CONCLUSIONS Age and worsening attention but not depression in MCI patients were independently associated with the progression of dementia in a 6-year follow-up period.
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Affiliation(s)
- Chengping Hu
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Ling Wang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Xudong Zhao
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Binggen Zhu
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Ming Tian
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyun Qin
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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12
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Jacus JP, Mayelle A, Voltzenlogel V, Cuervo-Lombard CV, Antoine P. Modelling Awareness in Alzheimer's Disease. J Alzheimers Dis 2020; 76:89-95. [PMID: 32417778 DOI: 10.3233/jad-200017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to provide a model of awareness in Alzheimer's disease using the stage of the disease as a risk factor. Awareness was assessed using three methods (patient-caregiver discrepancy, prediction-performance discrepancy, clinical rating). Twenty-five healthy control subjects and sixty-one patients participated, with measures of cognition, apathy, depression, and awareness. These measures were introduced into a manual backward regression. Confounding factors impacting at least 15% of the exposure factor estimate were maintained in the model. Except for the prediction performance discrepancy, also presenting cognitive associations, the other awareness assessments suggested a major role of depression and apathy as impacting factors.
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Affiliation(s)
- Jean-Pierre Jacus
- CH des vallées de l'Ariège, Consultations mémoire, Foix, France.,Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Amandine Mayelle
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Virginie Voltzenlogel
- CERPPS, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé, EA7411, Université Jean Jaurès, Toulouse, France
| | - Christine-Vanessa Cuervo-Lombard
- CERPPS, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé, EA7411, Université Jean Jaurès, Toulouse, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
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13
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Maresca G, Maggio MG, Latella D, Naro A, Portaro S, Calabrò RS. Understanding the role of social cognition in neurodegenerative Disease: A scoping review on an overlooked problem. J Clin Neurosci 2020; 77:17-24. [PMID: 32389547 DOI: 10.1016/j.jocn.2020.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022]
Abstract
Social cognition (SC) is the set of socio-cognitive processes that guide automatic and voluntary behaviors by modulating behavioral responses, it includes both cognitive (Theory of the mind - ToM) and affective aspects (Empathy). SC also includes representations of internal somatic states, self-knowledge, perception of others, communication with others and interpersonal motivations. SC is relevant in daily life and reflects the neural complexity of social processing. The purpose of this scoping review is to evaluate the role of SC in neurological disorders, also considering the pathophysiological mechanisms underlying SC and potential assessment tools. The included studies were carried out between 2010 and 2019 and were found on PubMed, Scopus, Cochrane, and Web of Sciences databases, using the combined terms "social cognition"; "dementia"; "multiple sclerosis"; "parkinson", "amyotrophic lateral sclerosis", "neurodegenerative disease". Our review has shown that different SC domains are affected by several neurological conditions, with regards to dementia and amyotrophic lateral sclerosis. Further studies are needed to investigate the association between cognitive and social deficits, for a better management of patients with neurological disorders.
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Affiliation(s)
| | | | | | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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14
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Guessoum SB, Le Strat Y, Dubertret C, Mallet J. A transnosographic approach of negative symptoms pathophysiology in schizophrenia and depressive disorders. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109862. [PMID: 31927053 DOI: 10.1016/j.pnpbp.2020.109862] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Negative Symptoms (blunted affect, alogia, anhedonia, avolition and asociality) are observed in schizophrenia but also in depressive disorders. OBJECTIVE To gather cognitive, neuroanatomical, neurofunctional and neurobiological knowledge of negative symptoms in studies on schizophrenia, depressive disorder, and transnosographic studies. RESULTS Blunted affect in schizophrenia is characterized by amygdala hyperactivation and frontal hypoactivation, also found in depressive disorder. Mirror neurons, may be related to blunted affect in schizophrenia. Alogia may be related to cognitive dysfunction and basal ganglia area impairments in schizophrenia. Data surrounding alogia in depressive disorder is scarce; wider speech deficits are often studied instead. Consummatory Anhedonia may be less affected than Anticipatory Anhedonia in schizophrenia. Anhedonia is associated with reward impairments and altered striatal functions in both diagnostics. Amotivation is associated with Corticostriatal Hypoactivation in both disorders. Anhedonia and amotivation are transnosographically associated with dopamine dysregulation. Asociality may be related to oxytocin. CONCLUSION Pathophysiological hypotheses are specific to each dimension of negative symptoms and overlap across diagnostic boundaries, possibly underpinning the observed clinical continuum.
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Affiliation(s)
- Sélim Benjamin Guessoum
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France
| | - Yann Le Strat
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France.
| | - Caroline Dubertret
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France.
| | - Jasmina Mallet
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France.
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15
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Bertrand E, Fischer A, Mograbi DC. Response: Commentary: Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review. Front Psychol 2020; 11:453. [PMID: 32265783 PMCID: PMC7105856 DOI: 10.3389/fpsyg.2020.00453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Elodie Bertrand
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychology, Universidade Do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Anna Fischer
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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16
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Gerridzen IJ, Joling KJ, Depla MF, Veenhuizen RB, Verschuur EM, Twisk JW, Hertogh CM. Awareness and its relationships with neuropsychiatric symptoms in people with Korsakoff syndrome or other alcohol-related cognitive disorders living in specialized nursing homes. Int J Geriatr Psychiatry 2019; 34:836-845. [PMID: 30854733 PMCID: PMC6593674 DOI: 10.1002/gps.5093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 03/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Impaired awareness of functional deficits is often observed in people with Korsakoff syndrome (KS) and may result in refusal of care, although this area has been understudied. This study aimed to investigate levels of impaired awareness and their relationships with neuropsychiatric symptoms (NPS) in people with KS residing in specialized nursing homes. METHODS A cross-sectional, observational study was conducted among 215 residents with KS or other alcohol-related cognitive disorders. Awareness was measured with the Patient Competency Rating Scale (PCRS). NPS and subsyndromes were measured with the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Adjusted multilevel regression analyses were performed to examine the relationships between the level of awareness and NPS. RESULTS The mean level of impaired awareness was 39.3 (SD = 19.9) indicating moderate impairment. Twenty-nine percent of the residents had no or mildly impaired awareness; 37% were moderately impaired, and 34% were severely impaired. Residents with moderately impaired awareness showed more severe apathy than residents with no or mildly impaired awareness (difference 1.23; 95% CI 1.02-1.48; p = 0.03). No associations were found between the level of awareness and other NPI outcomes. Cognitive functioning seems to have the strongest impact on the association between level of awareness and NPS in KS residents. CONCLUSIONS Impaired awareness of functional deficits is highly common in KS residents; however, apart from apathy, is not significantly related with NPS. Additional research should further examine, which interventions are effective in dealing with impaired awareness in these people, particularly when apathy is present.
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Affiliation(s)
- Ineke J. Gerridzen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands,Nursing home MarkenhofAtlantBeekbergenThe Netherlands
| | - Karlijn J. Joling
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
| | - Marja F. Depla
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
| | - Ruth B. Veenhuizen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
| | | | - Jos W.R. Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands
| | - Cees M.P.M. Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research instituteVU University Medical CenterAmsterdamThe Netherlands
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17
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Denney DA, Prigatano GP. Subjective ratings of cognitive and emotional functioning in patients with mild cognitive impairment and patients with subjective memory complaints but normal cognitive functioning. J Clin Exp Neuropsychol 2019; 41:565-575. [PMID: 30958091 DOI: 10.1080/13803395.2019.1588229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In a retrospective chart review, 39 patients referred for a clinical neuropsychological examination were identified as showing either mild cognitive impairment of the amnestic type (MCI-A; N = 21) or subjective memory complaints but with normal memory function (SMC; N = 18). During the clinical interview, patients and informants were routinely asked to make subjective ratings regarding the patient's cognitive and affective functioning in everyday life. The purpose of this study was to determine whether these two patient groups (and their informants) significantly differed in their subjective reports about level of cognitive and affective difficulties. It was predicted that SMC patients would report higher levels of cognitive and emotional dysfunction than MCI-A patients. It was further predicted that MCI-A patients would underreport cognitive difficulties (compared to informant reports); SMC patients would demonstrate the opposite pattern. Results supported these predictions and suggest that routine assessment of subjective experiences of patients in conjunction with informant ratings may aid clinical diagnosis, particularly when the primary complaint is a decline in memory.
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Affiliation(s)
- David A Denney
- a Department of Psychiatry , UT Southwestern Medical Center , Dallas , TX , USA
| | - George P Prigatano
- b Department of Clinical Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
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18
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Marra A, Naro A, Chillura A, Bramanti A, Maresca G, De Luca R, Manuli A, Bramanti P, Calabrò RS. Evaluating Peripersonal Space through the Functional Transcranial Doppler: Are We Paving the Way for Early Detecting Mild Cognitive Impairment to Dementia Conversion? J Alzheimers Dis 2019; 62:133-143. [PMID: 29439353 DOI: 10.3233/jad-170973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying the patients with mild cognitive impairment (MCI) who may develop dementia (MDC) is challenging. The study of peripersonal space (PPS) by using functional transcranial Doppler (fTCD) could be used for this purpose. OBJECTIVE To identify changes in cerebral blood flow (CBF) during motor tasks targeting PPS, which can predict MDC. METHODS We evaluated the changes in CBF in 22 patients with MCI and 23 with dementia [Alzheimer's disease (AD) and vascular dementia (VaD)] during a motor task (passive mobilization, motor imagery, and movement observation) in which the hand of the subject moved forward and backward the face. RESULTS CBF increased when the hand approached the face and decreased when the hand moved from the face in the healthy controls (HCs). CBF changed were detectable only in patients with MCI but not in those with the AD and those who were MDC after 8-month follow-up. On the other hand, the patients with VaD presented a paradoxical response to the motor task (i.e., a decrease of CBF rather than an increase, as observed in HCs and MCI). Therefore, we found a modulation of PPS-related CBF only in HCs and patients with stable MCI (at the 8-month follow-up). CONCLUSIONS fTCD may allow preliminarily differentiating and following-up the patients with MCI and MDC, thus allowing the physician to plan beforehand more individualized cognitive rehabilitative training.
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Affiliation(s)
- Angela Marra
- IRCCS centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Antonino Naro
- IRCCS centro Neurolesi "Bonino-Pulejo", Messina, Italy
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19
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Cysique LA, Brew BJ. Comorbid depression and apathy in HIV-associated neurocognitive disorders in the era of chronic HIV infection. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:71-82. [PMID: 31727231 DOI: 10.1016/b978-0-444-64012-3.00006-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
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20
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Jacus JP. Awareness, apathy, and depression in Alzheimer's disease and mild cognitive impairment. Brain Behav 2017; 7:e00661. [PMID: 28413709 PMCID: PMC5390841 DOI: 10.1002/brb3.661] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/17/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Results from studies on awareness disorders in Alzheimer's disease (AD) are controversial because the methodologies, the "objects" of awareness, and the patients' pathologic stage all vary. Our study aimed to compare scores and correlates of awareness according to the stage of the disease and the assessment method. METHODS We compared 20 mild AD patients to 20 mild cognitive impairment (MCI) patients, using the Patient Competency Rating Scale (PCRS; patient vs. caregiver report) and the Self-Consciousness Scale (rating scale). All patients underwent cognitive, psycho-affective and behavioral assessments (global cognition, executive functions, episodic memory, anxiety-depression, and apathy measures). RESULTS Groups were matched for age, education, and gender. They were comparable on the depression, anxiety, apathy and awareness scales (ps > .05), and differed for all cognitive variables (p < .05). Using the median split approach, greater apathy and lower depression were associated with poorer awareness on the Self-Consciousness Scale (respectively: odds ratio [OR] = 4.8, p = .03; OR = 4.84, p = .04), and the PCRS (only apathy: OR = 9.3, p = .003). Greater apathy plus lower depression were associated with poorer awareness in both scales (PCRS: OR = 40.5, p = .005; Self-consciousness scale: OR = 28, p = .012). CONCLUSION These results evidence comparable awareness between AD and MCI patients. The correlates were more affective and behavioral than cognitive, independently from assessment method.
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Affiliation(s)
- Jean-Pierre Jacus
- Consultations Mémoire Centre Hospitalier du val d'Ariège Foix Cedex France.,Laboratoire Epsylon, EA 4556 Université Paul-Valery Montpellier France
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