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Scarfo S, Marsella AMA, Grigoriadou L, Moshfeghi Y, McGeown WJ. Neuroanatomical correlates and predictors of psychotic symptoms in Alzheimer's disease: a systematic review and meta-analysis. Neuropsychologia 2024:109006. [PMID: 39326784 DOI: 10.1016/j.neuropsychologia.2024.109006] [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: 05/21/2024] [Revised: 09/13/2024] [Accepted: 09/23/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Psychotic symptoms (hallucinations and delusions) are a type of neuropsychiatric symptom found during Alzheimer's Disease (AD). OBJECTIVE This systematic review aims to comprehensively capture, analyse, and evaluate the body of evidence that has investigated associations between brain regions/networks and psychotic symptoms in AD. METHODS The protocol, created according to the PRISMA guidelines, was pre-registered on OSF (https://osf.io/tg8xp/). Searches were performed using PubMed, Web of Science and PsycInfo. A partial coordinate-based meta-analysis (CBMA) was performed based on data availability. RESULTS Eighty-two papers were selected: delusions were found to be associated mainly with right fronto-temporal brain regions and the insula; hallucinations mainly with fronto-occipital areas; both were frequently associated with the anterior cingulate cortex. The CBMA, performed on the findings of fourteen papers on delusions, identified a cluster in the frontal lobe, one in the putamen, and a smaller one in the insula. CONCLUSIONS The available evidence highlights that key brain regions, predominantly in the right frontal lobe, the anterior cingulate cortex, and temporo-occipital areas, appear to underpin the different manifestations of psychotic symptoms in AD and MCI. The fronto-temporal areas identified in relation to delusions may underpin a failure to assimilate correct information and consider alternative possibilities (which might generate and maintain the delusional belief), and dysfunction within the salience network (anterior cingulate cortex and insula) may suggest a contribution for how internal and external stimuli are identified; the fronto-occipital areas linked to hallucinations may indicate diminished sensory processing and non-optimal predictive processing, that together contribute to misinterpretation of stimuli and misperceptions; the fronto-temporal and occipital areas, as well as the anterior cingulate cortex were linked to the psychotic cluster.
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Affiliation(s)
- Sara Scarfo
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | | | - Loulouda Grigoriadou
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Yashar Moshfeghi
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - William J McGeown
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.
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Tosi G, Nigro S, Urso D, Spinosa V, Gnoni V, Filardi M, Giaquinto F, Rizzi E, Iaia M, Macchitella L, Chiarello Y, Ferrari F, Angelelli P, Romano D, Logroscino G. The Network Structure of Cognitive Impairment: From Subjective Cognitive Decline to Alzheimer's Disease. J Neurosci 2024; 44:e1344232023. [PMID: 38830757 PMCID: PMC11223460 DOI: 10.1523/jneurosci.1344-23.2023] [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: 07/17/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 06/05/2024] Open
Abstract
It was proposed that a reorganization of the relationships between cognitive functions occurs in dementia, a vision that surpasses the idea of a mere decline of specific domains. The complexity of cognitive structure, as assessed by neuropsychological tests, can be captured by exploratory graph analysis (EGA). EGA was applied to the neuropsychological assessment of people (humans) with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD; total N = 638). Both sexes were included. In AD, memory scores detach from the other cognitive functions, and memory subdomains reduce their reciprocal relation. SCD showed a pattern of segregated neuropsychological domains, and MCI showed a noisy and less stable pattern. Results suggest that AD drives a reorganization of cognitive functions toward a less-fractionated architecture compared with preclinical conditions. Cognitive functions show a reorganization that goes beyond the performance decline. Results also have clinical implications in test interpretations and usage.
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Affiliation(s)
- Giorgia Tosi
- Human and Social Sciences Department, University of Salento, Lecce 73100, Italy
- Psychology Department, University of Milano-Bicocca, Milano 20126, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, United Kingdom
| | - Vittoria Spinosa
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70121, Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, United Kingdom
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70121, Italy
| | - Francesco Giaquinto
- Human and Social Sciences Department, University of Salento, Lecce 73100, Italy
| | - Ezia Rizzi
- Human and Social Sciences Department, University of Salento, Lecce 73100, Italy
| | - Marika Iaia
- Human and Social Sciences Department, University of Salento, Lecce 73100, Italy
| | - Luigi Macchitella
- Scientific Institute I.R.C.C.S. "E. Medea"- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Brindisi 72100, Italy
| | - Ylenia Chiarello
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
| | - Federico Ferrari
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
| | - Paola Angelelli
- Human and Social Sciences Department, University of Salento, Lecce 73100, Italy
| | - Daniele Romano
- Human and Social Sciences Department, University of Salento, Lecce 73100, Italy
- Psychology Department, University of Milano-Bicocca, Milano 20126, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at "Pia Fondazione Cardinale G. Panico", Lecce 73039, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70121, Italy
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Wiesman AI, Gallego-Rudolf J, Villeneuve S, Baillet S, Wilson TW. Alignments between cortical neurochemical systems, proteinopathy and neurophysiological alterations along the Alzheimer's disease continuum. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.13.24305551. [PMID: 38645027 PMCID: PMC11030470 DOI: 10.1101/2024.04.13.24305551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Two neuropathological hallmarks of Alzheimer's disease (AD) are the accumulation of amyloid-β (Aβ) proteins and alterations in cortical neurophysiological signaling. Despite parallel research indicating disruption of multiple neurotransmitter systems in AD, it has been unclear whether these two phenomena are related to the neurochemical organization of the cortex. We leveraged task-free magnetoencephalography and positron emission tomography, with a cortical atlas of 19 neurotransmitters to study the alignment and interactions between alterations of neurophysiological signaling, Aβ deposition, and the neurochemical gradients of the human cortex. In patients with amnestic mild cognitive impairment (N = 18) and probable AD (N = 20), we found that changes in rhythmic, but not arrhythmic, cortical neurophysiological signaling relative to healthy controls (N = 20) are topographically aligned with cholinergic, serotonergic, and dopaminergic neurochemical systems. These neuro-physio-chemical alignments are related to the severity of cognitive and behavioral impairments. We also found that cortical Aβ plaques are preferentially deposited along neurochemical boundaries, and mediate how beta-band rhythmic cortical activity maps align with muscarinic acetylcholine receptors. Finally, we show in an independent dataset that many of these alignments manifest in the asymptomatic stages of cortical Aβ accumulation (N = 33; N = 71 healthy controls), particularly the Aβ-neurochemical alignments (57.1%) and neuro-physio-chemical alignments in the alpha frequency band (62.5%). Overall, the present study demonstrates that the expression of pathology in pre-clinical and clinical AD aligns topographically with the cortical distribution of chemical neuromodulator systems, scaling with clinical severity and with implications for potential pharmacotherapeutic pathways.
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Zou C, Amos-Richards D, Jagannathan R, Kulshreshtha A. Effect of home-based lifestyle interventions on cognition in older adults with mild cognitive impairment: a systematic review. BMC Geriatr 2024; 24:200. [PMID: 38413870 PMCID: PMC10900825 DOI: 10.1186/s12877-024-04798-5] [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: 09/22/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Mild Cognitive Impairment (MCI) is frequently a precursor to dementia, affecting aspects of cognition such as language, thinking, or memory. Lifestyle interventions are increasingly studied as potential means to slow the progression from MCI to dementia. OBJECTIVE A systematic review was conducted to investigate the effectiveness of home-based lifestyle interventions in reducing cognitive decline in older adults with MCI. METHODS A systematic review of randomized controlled trials (RCTs) was conducted to identify home-based lifestyle interventions for individuals with MCI from 1980 to 2023. These interventions were either single-component or multi-component and included diet, physical activity, stress-reduction, or cognitive stimulation treatments to assess their impact on cognition. We performed a comprehensive search in the PubMed, Web of Science, Google Scholar, Embase, and MEDLINE databases. RESULTS From 320 abstracts, 20 (6.25%) studies met the criteria for inclusion, with five multi-component and fifteen single-component studies. Eighteen home-based lifestyle interventions for MCI patients were focused on physical activity, diet, and/or cognitive training, while two studies were identified that incorporated stress reduction training as a method to improve cognitive function. Nineteen studies reported significant improvements in cognitive performance between the experimental and control groups post-intervention for at least one aspect of cognition. Four studies reported nonsignificant improvements in cognitive function between the two groups for at least one area of cognition. CONCLUSIONS Home-based lifestyle interventions have the potential to improve cognition in elderly patients with MCI. However, future RCTs with larger sample sizes and longer intervention durations are needed to confirm these findings.
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Affiliation(s)
- Cynthia Zou
- Department of Family and Preventative Medicine, Emory University, Atlanta, USA.
| | | | - Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventative Medicine, Emory University, Atlanta, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
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Howard KA, Massimo L, Griffin SF, Gagnon RJ, Zhang L, Rennert L. Systematic examination of methodological inconsistency in operationalizing cognitive reserve and its impact on identifying predictors of late-life cognition. BMC Geriatr 2023; 23:547. [PMID: 37684556 PMCID: PMC10492336 DOI: 10.1186/s12877-023-04263-9] [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: 04/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Cognitive reserve (CR) is the ability to maintain cognitive performance despite brain pathology. CR is built through lifecourse experiences (e.g., education) and is a key construct in promoting healthy aging. However, the operationalization of CR and its estimated association with late-life cognition varies. The purpose of this study was to systematically examine the operationalization of CR and the relationship between its operationalization and late-life cognition. METHODS We performed a comprehensive review of experiences (proxies) used to operationalize CR. The review informed quantitative analyses using data from 1366 participants of the Memory and Aging Project to examine 1) relationships between proxies and 2) the relationship between operationalization and late-life cognition. We also conducted a factor analysis with all identified CR experiences to create a composite lifecourse CR score. Generalized linear mixed models examined the relationship between operationalizations and global cognition, with secondary outcomes of five domains of cognition to examine consistency. RESULTS Based on a review of 753 articles, we found the majority (92.3%) of the 28 commonly used proxies have weak to no correlation between one another. There was substantial variability in the association between operationalizations and late-life global cognition (median effect size: 0.99, IQR: 0.34 to 1.39). There was not strong consistency in the association between CR operationalizations and the five cognitive domains (mean consistency: 56.1%). The average estimate for the 28 operationalizations was 0.91 (SE = 0.48), compared to 2.48 (SE = 0.40) for the lifecourse score and it was associated with all five domains of cognition. CONCLUSIONS Inconsistent methodology is theorized as a major limitation of CR research and barrier to identification of impactful experiences for healthy cognitive aging. Based on the weak associations, it is not surprising that the relationship between CR and late-life cognition is dependent on the experience used to operationalize CR. Scores using multiple experiences across the lifecourse may help overcome such limitations. Adherence to a lifecourse approach and collaborative movement towards a consensus operationalization of CR are imperative shifts in the study of CR that can better inform research on risk factors related to cognitive decline and ultimately aid in the promotion of healthy aging.
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Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA.
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, 29634, USA.
| | - Lauren Massimo
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Ryan J Gagnon
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA.
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, 29634, USA.
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Minta K, Colombo G, Taylor WR, Schinazi VR. Differences in fall-related characteristics across cognitive disorders. Front Aging Neurosci 2023; 15:1171306. [PMID: 37358956 PMCID: PMC10289027 DOI: 10.3389/fnagi.2023.1171306] [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: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.
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Affiliation(s)
- Karolina Minta
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Giorgio Colombo
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - William R. Taylor
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Victor R. Schinazi
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Psychology, Bond University, Gold Coast, QLD, Australia
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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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Bidzan L, Grabowski J, Przybylak M, Ali S. Aggressive behavior and prognosis in patients with mild cognitive impairment. Dement Neuropsychol 2023; 17:e20200096. [PMID: 37223838 PMCID: PMC10202333 DOI: 10.1590/1980-5764-dn-2020-0096] [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: 10/08/2020] [Revised: 02/08/2021] [Accepted: 05/07/2021] [Indexed: 05/25/2023] Open
Abstract
The diagnosis of mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. When evaluating the further prognosis of MCI, the occurrence of neuropsychiatric symptoms, particularly aggressive and impulsive behavior, may play an important role. Objective The aim of this study was to evaluate the relationship between aggressive behavior and cognitive dysfunction in patients diagnosed with MCI. Methods The results are based on a 7-year prospective study. At the time of inclusion in the study, participants, recruited from an outpatient clinic, were assessed with Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). A reassessment was performed after 1 year using the MMSE scale in all patients. The time of next MMSE administration was depended on the clinical condition of patients took place at the end of follow-up, that is, at the time of diagnosis of the dementia or after 7 years from inclusion when the criteria for dementia were not met. Results Of the 193 patients enrolled in the study, 75 were included in the final analysis. Patients who converted to dementia during the observation period exhibited a greater severity of symptoms in each of the assessed CMAI categories. Moreover, there was a significant correlation between the global result of CMAI and the results of the physical nonaggressive and verbal aggressive subscales with cognitive decline during the first year of observation. Conclusions Despite several limitations to the study, aggressive and impulsive behaviors seem to be an unfavorable prognostic factor in the course of MCI.
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Affiliation(s)
- Leszek Bidzan
- Medical University of Gdańsk, Faculty of Medicine, Department of Developmental, Psychotic and Geriatric Psychiatry, Gdańsk, Poland
| | - Jakub Grabowski
- Medical University of Gdańsk, Faculty of Medicine, Department of Developmental, Psychotic and Geriatric Psychiatry, Gdańsk, Poland
| | - Mateusz Przybylak
- Medical University of Gdańsk, Faculty of Medicine, Department of Developmental, Psychotic and Geriatric Psychiatry, Gdańsk, Poland
| | - Shan Ali
- Medical University of Gdańsk, Faculty of Medicine, Department of Developmental, Psychotic and Geriatric Psychiatry, Adult Psychiatry Student’s Scientific Circle, Gdańsk, Poland
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Aguilar Barberà M, Soler Girabau P, Tabuenca Martín AI, Prieto Del Val L. Fortasyn Connect Improves Neuropsychiatric Symptoms in Patients with Mild Cognitive Impairment and Dementia: Results from a Retrospective Real-World Study. J Alzheimers Dis 2023; 93:621-631. [PMID: 37066911 DOI: 10.3233/jad-221122] [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: 04/18/2023]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) manifest in the early stages of the disease and impair patients' and caregivers' quality of life. OBJECTIVE To assess the effectiveness of the nutritional supplement Fortasyn Connect on BPSD for 12 months in people with mild cognitive impairment (MCI) and dementia in clinical practice. METHODS Retrospective, national, single-center study of 236 patients (158 MCI and 78 dementia; 55.1% of AD etiology). BPSD were assessed with the Neuropsychiatric Inventory (NPI) at month 3, 6, and 12. Cognition (Mini-Mental State Examination, MMSE), depression (Geriatric Depression Scale, GDS), and everyday functioning (Blessed Dementia Scale, BLS-D; Rapid Disability Rating Scale 2, RDRS2) were also evaluated. RESULTS Total NPI score, caregiver impact, and symptoms of depression, anxiety, apathy, and irritability improved after 3, 6, and 12 months from Fortasyn Connect initiation (p < 0.001). NPI decreases were more pronounced when baseline NPI score was higher than > 20 points (p < 0.001). The benefit was independent of gender, age, diagnosis, etiology, or concomitant treatment (p < 0.0001), although larger decreases in NPI total score were observed in MCI patients (p < 0.0001). After 12 months, GDS scores decreased (p = 0.042), and MMSE, BLS-D, and RDRS 2 scores remained stable. CONCLUSION Fortasyn Connect improved BPSD over at least a year in patients with MCI and dementia. Depression, anxiety, apathy, and irritability were the symptoms that improved the most. The benefit was independent of patients' characteristics and treatment but was greater if prescribed early and when baseline NPI scores were higher.
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Lucas R, Oury M, Alexandru H. Neuropsychiatric symptoms influence differently cognitive decline in older women and men. J Psychiatr Res 2022; 154:1-9. [PMID: 35863150 DOI: 10.1016/j.jpsychires.2022.07.002] [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: 01/24/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The potential impact of sex on cognitive performance in normal aging and participants with Alzheimer's disease (AD) has been outlined previously. Nevertheless, differences in neuropsychiatric symptoms (NPS) have been also outlined. We aimed to study a potential association between NPS and cognitive performances according to sex, in older individuals with and without cognitive impairment. METHODS Demographic, neuropsychiatric and neuropsychological data from the ADNI and NACC databases were merged into a dataset of 506 participants with healthy cognitive performance, 467 patients with mild cognitive impairment, and 238 patients with AD. Cognitive performance in each group was evaluated according to sex and the presence of NPS. RESULTS Based on sex, cognitive performance differed according to clinical stage: in the healthy controls and AD groups, women had better fluency performance, while in the mild cognitive impairment group, women had better working memory and men better oral naming. Regardless of sex, depression showed a negative effect on processing speed in AD. Finally, there was an interaction between sex and NPS in mild cognitive impairment, where women with apathy had better working memory performance, and in AD, women with depression had better fluency performance. The opposite pattern being was observed in men, where men with depression have worse focused attention. CONCLUSION Cognitive performance is influenced by sex, yet this influence has different manifestations at normal cognition, MCI or AD. Furthermore, apathy and depression seem to influence differently women and men at different types of cognitive decline.
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Affiliation(s)
- Ronat Lucas
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Département de Médecine, Faculté de Médecine, Université de Montréal, Québec, Canada
| | - Monchi Oury
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Faculté de Médecine, Université de Montréal, Québec, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Hanganu Alexandru
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Département de Psychologie, Faculté des Arts et des Sciences, Université de Montréal, Québec, Canada.
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Liu C, Su M, Jiao Y, Ji Y, Zhu S. Effects of Dance Interventions on Cognition, Psycho-Behavioral Symptoms, Motor Functions, and Quality of Life in Older Adult Patients With Mild Cognitive Impairment: A Meta-Analysis and Systematic Review. Front Aging Neurosci 2021; 13:706609. [PMID: 34616285 PMCID: PMC8488360 DOI: 10.3389/fnagi.2021.706609] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Dance interventions are considered beneficial for older patients with mild cognitive impairment in many aspects. We conducted a comprehensive systematic review and meta-analysis to assess the effects of dance on different aspects (cognitive function, emotions, physical function, and quality of life) of this population. Methods: A systematic search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, Embase, American Psychological Association PsycInfo, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, the Chinese BioMedical Literature Database, the VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang Data database was performed. Two reviewers independently assessed the study quality. Results: Fourteen studies were retrieved from the databases for analysis. The pooled results showed that dance interventions significantly improved global cognition (standardized mean difference [SMD] = 0.73, 95% confidence interval [CI]: 0.47 to 0.99, P < 0.00001), rote memory (mean difference [MD] = -2.12, 95% CI: -4.02 to -0.21, P = 0.03), immediate recall (SMD = 0.54, 95% CI: 0.30 to 0.78, P < 0.0001), delayed recall (SMD = 0.56, 95% CI: 0.26 to 0.86, P = 0.0002) and attention (SMD = 0.38, 95% CI: 0.13 to 0.64, P = 0.003). No significant improvement was found in executive function, language, depression, anxiety, dementia-related behavioral symptoms, motor function, and quality of life. Conclusion: Dance interventions benefit most aspects of cognitive functions. The evidence for the effects of dance on psycho-behavioral symptoms, motor function and quality of life remains unclear. More trials with rigorous study designs are necessary to provide this evidence.
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Affiliation(s)
- Chang Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Mengyu Su
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yuchen Jiao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan Ji
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
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Abstract
Although Alzheimer’s disease (AD) is primarily a neurocognitive disorder, it also results in prominent neuropsychiatric symptoms (NPS). Much literature has investigated the NPS of apathy and depression in association with AD, but relatively less is known regarding anxiety, the third most common NPS in this disorder. The prevalence of anxiety symptoms in AD is about 40%, and it can be a prelude of AD. Anxiety can be especially present among patients with mild cognitive impairment, mild dementia, or early-onset forms of the disease, and can promote progression or conversion to Alzheimer’s clinical syndrome. A number of studies have established that anxiety is associated with positive amyloid scans, mesial temporal changes with atrophy and hypometabolism in the entorhinal region, and neurofibrillary tangles present on pathological examination of this region. In addition to psychosocial factors, proposed neurobiological mechanisms for increased anxiety in AD include decreased sensorimotor gating, relatively increased activation of amygdalae or the Salience Network, and the presence of comorbid pathology, particularly Lewy bodies. Having management strategies for anxiety in patients with AD is important as anxiety can worsen cognitive deficits. Interventions involve psychological support, behavioral management, and the judicious use of the psychiatric armamentarium of medications.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA); Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Mendez MF. Degenerative dementias: Alterations of emotions and mood disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:261-281. [PMID: 34389121 DOI: 10.1016/b978-0-12-822290-4.00012-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Degenerative dementias such as Alzheimer's disease and frontotemporal dementia result in distinct alterations in emotional processing, emotional experiences, and mood. The neuropathology of these dementias extends to structures involved in emotional processing, including the basolateral limbic network (orbitofrontal cortex, anterior temporal lobe, amygdala, and thalamus), the insula, and ventromedial frontal lobe. Depression is the most common emotion and mood disorder affecting patients with Alzheimer's disease. The onset of depression can be a prodromal sign of this dementia. Anxiety can also be present early in the course of Alzheimer's disease and especially among patients with early-onset forms of the disease. In contrast, patients with behavioral variant frontotemporal dementia demonstrate hypoemotionality, deficits in the recognition of emotion, and decreased psychophysiological reactivity to emotional stimuli. They typically have a disproportionate impairment in emotional and cognitive empathy. One other unique feature of behavioral variant frontotemporal dementia is the frequent occurrence of bipolar disorder. The management strategies for these alterations of emotion and mood in degenerative dementias primarily involve the judicious use of the psychiatric armamentarium of medications.
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Affiliation(s)
- Mario F Mendez
- Behavioral Neurology Program, Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States; Neurology Service, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
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14
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Wiels WA, Wittens MMJ, Zeeuws D, Baeken C, Engelborghs S. Neuropsychiatric Symptoms in Mild Cognitive Impairment and Dementia Due to AD: Relation With Disease Stage and Cognitive Deficits. Front Psychiatry 2021; 12:707580. [PMID: 34483998 PMCID: PMC8415837 DOI: 10.3389/fpsyt.2021.707580] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The interaction between neuropsychiatric symptoms, mild cognitive impairment (MCI), and dementia is complex and remains to be elucidated. An additive or multiplicative effect of neuropsychiatric symptoms such as apathy or depression on cognitive decline has been suggested. Unraveling these interactions may allow the development of better prevention and treatment strategies. In the absence of available treatments for neurodegeneration, a timely and adequate identification of neuropsychiatric symptom changes in cognitive decline is highly relevant and can help identify treatment targets. Methods: An existing memory clinic-based research database of 476 individuals with MCI and 978 individuals with dementia due to Alzheimer's disease (AD) was reanalyzed. Neuropsychiatric symptoms were assessed in a prospective fashion using a battery of neuropsychiatric assessment scales: Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD), Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia (CSDD), and Geriatric Depression Scale (30 items). We subtyped subjects suffering from dementia as mild, moderate, or severe according to their Mini-Mental State Examination (MMSE) score and compared neuropsychiatric scores across these groups. A group of 126 subjects suffering from AD with a significant cerebrovascular component was examined separately as well. We compared the prevalence, nature, and severity of neuropsychiatric symptoms between subgroups of patients with MCI and dementia due to AD in a cross-sectional analysis. Results: Affective and sleep-related symptoms are common in MCI and remain constant in prevalence and severity across dementia groups. Depressive symptoms as assessed by the CSDD further increase in severe dementia. Most other neuropsychiatric symptoms (such as agitation and activity disturbances) progress in parallel with severity of cognitive decline. There are no significant differences in neuropsychiatric symptoms when comparing "pure" AD to AD with a significant vascular component. Conclusion: Neuropsychiatric symptoms such as frontal lobe symptoms, psychosis, agitation, aggression, and activity disturbances increase as dementia progresses. Affective symptoms such as anxiety and depressive symptoms, however, are more frequent in MCI than mild dementia but otherwise remain stable throughout the cognitive spectrum, except for an increase in CSDD score in severe dementia. There is no difference in neuropsychiatric symptoms when comparing mixed dementia (defined here as AD + significant cerebrovascular disease) to pure AD.
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Affiliation(s)
- Wietse A Wiels
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Mandy M J Wittens
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Dieter Zeeuws
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Chris Baeken
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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15
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Hauer K, Schwenk M, Englert S, Zijlstra R, Tuerner S, Dutzi I. Mismatch of Subjective and Objective Risk of Falling in Patients with Dementia. J Alzheimers Dis 2020; 78:557-572. [PMID: 33016908 DOI: 10.3233/jad-200572] [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: 11/15/2022]
Abstract
BACKGROUND Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. OBJECTIVE To analyze mismatch of objective and subjective fall risk and associated factors in PwD. METHOD Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti's Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. RESULTS In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression. CONCLUSION The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.
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Affiliation(s)
- Klaus Hauer
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Michael Schwenk
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Stefan Englert
- Institute of Medical Biometry und Informatics; Department of Medical Biometry at the University of Heidelberg, Heidelberg, Germany
| | - Rixt Zijlstra
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, Netherlands
| | - Sabine Tuerner
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Ilona Dutzi
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
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16
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Bateman DR, Gill S, Hu S, Foster ED, Ruthirakuhan MT, Sellek AF, Mortby ME, Matušková V, Ng KP, Tarawneh RM, Freund-Levi Y, Kumar S, Gauthier S, Rosenberg PB, Ferreira de Oliveira F, Devanand DP, Ballard C, Ismail Z. Agitation and impulsivity in mid and late life as possible risk markers for incident dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12016. [PMID: 32995467 PMCID: PMC7507499 DOI: 10.1002/trc2.12016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
To identify knowledge gaps regarding new-onset agitation and impulsivity prior to onset of cognitive impairment or dementia the International Society to Advance Alzheimer's Research and Treatment Neuropsychiatric Syndromes (NPS) Professional Interest Area conducted a scoping review. Extending a series of reviews exploring the pre-dementia risk syndrome Mild Behavioral Impairment (MBI), we focused on late-onset agitation and impulsivity (the MBI impulse dyscontrol domain) and risk of incident cognitive decline and dementia. This scoping review of agitation and impulsivity pre-dementia syndromes summarizes the current biomedical literature in terms of epidemiology, diagnosis and measurement, neurobiology, neuroimaging, biomarkers, course and prognosis, treatment, and ongoing clinical trials. Validations for pre-dementia scales such as the MBI Checklist, and incorporation into longitudinal and intervention trials, are needed to better understand impulse dyscontrol as a risk factor for mild cognitive impairment and dementia.
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Affiliation(s)
- Daniel R Bateman
- Department of Psychiatry Indiana University School of Medicine Indianapolis Indiana
- Indiana University Center for Aging Research Regenstrief Institute Indianapolis Indiana
| | - Sascha Gill
- Department of Clinical Neurosciences; and the Ron and Rene Ward Centre for Healthy Brain Aging Research; Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Sophie Hu
- Community Health Sciences, and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Erin D Foster
- Ruth Lilly Medical Library Indiana University School of Medicine Indianapolis Indiana
- University of California Berkeley Berkeley CA
| | - Myuri T Ruthirakuhan
- Hurvitz Brain Sciences Research Program Sunnybrook Research Institute Toronto Ontario Canada
- Department of Pharmacology and Toxicology University of Toronto Ontario Canada
| | | | - Moyra E Mortby
- School of Psychology University of New South Wales Sydney New South Wales Australia
- Neuroscience Research Australia University of New South Wales Sydney New South Wales Australia
| | - Veronika Matušková
- International Clinical Research Center St. Anne's University Hospital Brno Brno Czech Republic
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital Prague Czech Republic
| | - Kok Pin Ng
- Department of Neurology National Neuroscience Institute Singapore Singapore
| | - Rawan M Tarawneh
- Department of Neurology, College of Medicine The Ohio State University Columbus Ohio USA
| | - Yvonne Freund-Levi
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden
- School of Medical Sciences Örebro University Örebro Sweden
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health Toronto Ontario Canada
- Department of Psychiatry University of Toronto Ontario Canada
| | - Serge Gauthier
- McGill Center for Studies in Aging McGill University Montreal Quebec Canada
| | - Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral, Sciences Johns Hopkins University School of Medicine Baltimore Maryland
| | - Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina Federal University of São Paulo (UNIFESP), São Paulo São Paulo Brazil
| | - D P Devanand
- New York State Psychiatric Institute and Department of Psychiatry and Department of Psychiatry, College of Physicians and Surgeons Columbia University New York New York
| | - Clive Ballard
- College of Medicine and Health The University of Exeter Exeter UK
| | - Zahinoor Ismail
- Department of Clinical Neurosciences; and the Ron and Rene Ward Centre for Healthy Brain Aging Research; Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- Community Health Sciences, and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
- Department of Psychiatry, and the Mathison Centre for Mental Health Research & Education Cumming School of Medicine, University of Calgary Calgary Alberta Canada
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17
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Chimbí-Arias C, Santacruz-Escudero JM, Chavarro-Carvajal DA, Samper-Ternent R, Santamaría-García H. Behavioural Disturbances in Patients with Diagnosis of Neurocognitive Disorder in Bogotá (Colombia). REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:136-141. [PMID: 32888656 DOI: 10.1016/j.rcp.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/28/2018] [Accepted: 10/16/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The main aim of this study is to determine the prevalence of behavioural disturbances (BD) in a group of patients with diagnosis of neurocognitive disorders assessed by a memory clinic in a referral assessment centre in Bogotá, Colombia, in 2015. MATERIAL AND METHODS This is an observational, retrospective descriptive study of 507 patients with a diagnosis of neurocognitive disorder (according to DSM-5 criteria) evaluated in a referral centre in Bogotá, Colombia, in 2015. RESULTS Among the group of patients assessed, analyses reveal mean age for minor neurocognitive disorders of 71.04 years, and 75.32 years for major neurocognitive disorder (P <0.001). A total of 62.72% of the sample were female. The most prevalent aetiology of the neurocognitive disorders was Alzheimer's disease, followed by behavioural variant frontotemporal dementia and neurocognitive disorders due to multiple aetiologies. BD occur more frequently in neurocognitive disorder due to behavioural variant frontotemporal dementia (100%), Alzheimer's disease (77.29%) and vascular disease (76.19%). The most prevalent BD in the group assessed were apathy (50.75%), irritability (48.45%), aggression (16.6%), and emotional lability (14.76%). CONCLUSIONS BD are highly prevalent in patients with diagnosis of major neurocognitive disorder. BD are more prevalent in behavioural variant frontotemporal dementia than any other group. Apathy, irritability, emotional lability and aggression are the BD that occur with greater prevalence in our sample. We discuss the importance of BD in the clinical progression of neurocognitive disorders.
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Affiliation(s)
- Claudia Chimbí-Arias
- Unidad de Geriatría, Hospital Universitario San Ignacio, Bogotá, Colombia; Centro de Memoria y cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - José Manuel Santacruz-Escudero
- Centro de Memoria y cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Diego Andrés Chavarro-Carvajal
- Unidad de Geriatría, Hospital Universitario San Ignacio, Bogotá, Colombia; Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Rafael Samper-Ternent
- Departamento de Medicina Interna, División de Geriatría, Sealy Center on Aging, University of Texas Medical Branch, Houston, Texas, Estados Unidos
| | - Hernando Santamaría-García
- Centro de Memoria y cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Fisiología, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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18
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Ferreira AR, Simões MR, Moreira E, Guedes J, Fernandes L. Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs. Arch Gerontol Geriatr 2020; 86:103919. [DOI: 10.1016/j.archger.2019.103919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/01/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023]
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19
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Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls 2018; 3:185-193. [PMID: 32300707 PMCID: PMC7155353 DOI: 10.22540/jfsf-03-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. METHODS 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. RESULTS Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. CONCLUSIONS Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.
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Affiliation(s)
- Jonathan M. Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, UK
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, UK
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20
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Chen C, Hu Z, Jiang Z, Zhou F. Prevalence of anxiety in patients with mild cognitive impairment: A systematic review and meta-analysis. J Affect Disord 2018; 236:211-221. [PMID: 29747139 DOI: 10.1016/j.jad.2018.04.110] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/12/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prevalence rates of anxiety in patients with mild cognitive impairment (MCI) varied widely across studies and may confer a higher likelihood of progression to dementia. Our aim was to estimate the prevalence of anxiety in MCI and identify reasons for heterogeneity in the reported results. METHODS A computerized search in PubMed, EMBASE, and Psyc INFO for studies on anxiety in MCI was performed up to March 2017. The overall prevalence of anxiety in patients with MCI was pooled using a random-effects model. Heterogeneity was explored using stratification (recruitment resource; method of anxiety diagnosis; method of MCI diagnosis; and region) and random-effects meta-regression. RESULTS Of 2494 unique abstracts, 290 were selected for full-text review, and 39 studies, representing 10,587 patients, met all inclusion criteria. The overall pooled prevalence of depression in patients with MCI was 21.0% (95% CI, 16.2-26.7) with significant heterogeneity present (I2 = 97.2%, p < 0.001). When stratified by source, the prevalence of anxiety in patients with MCI in community-based samples was 14.3% (95% CI, 9.7-20.5) and was 31.2% (95% CI, 23.6-40.0) in clinic-based samples, which was significantly different (p < 0.01). The prevalence of anxiety estimates also differed significantly, when stratification by the method of anxiety diagnosis (p < 0.01). However, the criteria used for MCI diagnosis and geographical region did not significantly influence the prevalence estimate. LIMITATIONS We did not consider the usage of anti-anxiety drugs and language bias. CONCLUSIONS The prevalence of anxiety in patients with MCI was common and variability in prevalence of anxiety across studies can be attributed partly to the source of the sample and method of anxiety diagnosis. Further research is needed to identify sources of heterogeneity.
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Affiliation(s)
- Chunli Chen
- Department of Neurology, Second Xiangya Hospital, Hunan, PR China
| | - Zhiping Hu
- Department of Neurology, Second Xiangya Hospital, Hunan, PR China
| | - Zheng Jiang
- Department of Neurology, Second Xiangya Hospital, Hunan, PR China.
| | - Fangfang Zhou
- Department of Neurology, Second Xiangya Hospital, Hunan, PR China
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21
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Vloeberghs R, Opmeer EM, De Deyn PP, Engelborghs S, De Roeck EE. [Apathy, depression and cognitive functioning in patients with MCI and dementia]. Tijdschr Gerontol Geriatr 2018; 49:95-102. [PMID: 29488192 DOI: 10.1007/s12439-018-0248-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In dementia, apathy and depression are often seen as one disorder because of the many overlapping symptoms. However, for therapy a correct differentiation is essential. Moreover, apathy and depression are likely both associated with different cognitive deficits and progression of the disease. In this research we give an overview of cognitive domains associated with apathy and depression in MCI patients and report how often both disorders occur in a population sample. METHOD We administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to 117 cognitively healthy controls (GC), 97 patients with mild cognitive impairment (MCI) and 50 patients with dementia (DEM). In addition, the Apathy Evaluation Scale clinical version (AES-C) and the Geriatric Depression Scale (GDS) were administered. RESULTS The number of patients with apathy increased with cognitive decline with respectively 3.4%, 10.4% and 41.5% of patients in the GC, MCI and DEM group. The prevalence of isolated depression was highest in the MCI group (18.8%). Correlation analyses in the MCI group showed that apathy and not depression was associated with a deficit in encoding, attention and global cognitive functioning. CONCLUSION The prevalence of apathy and depressive symptoms is different in patients with MCI, DEM and GC, and within the MCI group apathy and depression are associated with different cognitive domains.
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Affiliation(s)
- Robin Vloeberghs
- Thomas More Hogeschool, Antwerpen, België
- Referentiecentrum voor Biologische Markers van Dementie, Universiteit Antwerpen, Antwerpen, België
| | - Esther M Opmeer
- Universitair Medisch Centrum Groningen, Afdeling Neurowetenschappen, Rijksuniversiteit Groningen, Groningen, Nederland
| | - Peter P De Deyn
- Referentiecentrum voor Biologische Markers van Dementie, Universiteit Antwerpen, Antwerpen, België
- Departement Neurologie en Geheugenkliniek, ZNA Middelheim en Hoge Beuken, Antwerpen, België
- Universitair Medisch Centrum Groningen, Afdeling Neurologie en Alzheimer Research Centrum, Rijksuniversiteit Groningen, Groningen, Nederland
| | - Sebastiaan Engelborghs
- Referentiecentrum voor Biologische Markers van Dementie, Universiteit Antwerpen, Antwerpen, België
- Departement Neurologie en Geheugenkliniek, ZNA Middelheim en Hoge Beuken, Antwerpen, België
| | - Ellen E De Roeck
- Referentiecentrum voor Biologische Markers van Dementie, Universiteit Antwerpen, Antwerpen, België.
- Departement psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.
- Departement Biomedische Wetenschappen, Campus Drie Eiken, Universiteit Antwerpen, Wilrijk, België.
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Delusions in Patients with Dementia with Lewy Bodies and the Associated Factors. Behav Neurol 2018; 2018:6707291. [PMID: 29854018 PMCID: PMC5964573 DOI: 10.1155/2018/6707291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/08/2018] [Indexed: 12/03/2022] Open
Abstract
Objective Delusions are common neuropsychiatric symptoms in patients with dementia with Lewy bodies (DLB). The aim of this study was to investigate the associated factors of delusions in patients with DLB. Method A retrospective study of outpatients with DLB registered in a regional hospital's database was performed. The associated factors including cognitive performance, clinical features, vascular risk factors, and neuropsychiatric symptoms between delusional and nondelusional patients with DLB were compared. Results Among 207 patients with DLB, 106 (51.2%) were delusional and 101 (48.8%) were not. Delusion of other persons are stealing was the most common symptom (35.3%). The delusional group had a significantly higher diagnostic rate of probable than possible DLB, higher disease severity, poorer cognitive performance, more severe neuropsychiatric symptoms, and higher caregiver burden (all p < 0.05). In addition, the delusional group had a significantly lower frequency of diabetes compared to the nondelusional group (odds ratio = 0.28, p < 0.001). Conclusion Delusion of other persons are stealing was the most common delusional symptom. The patients with DLB who presented with delusions had poorer cognitive function and more severe neuropsychiatric symptoms. A novel finding is that the DLB patients with diabetes had a lower frequency of delusions.
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Mendez MF, Fong SS, Ashla MM, Jimenez EE, Carr AR. Skin Conduction Levels Differentiate Frontotemporal Dementia From Alzheimer's Disease. J Neuropsychiatry Clin Neurosci 2018; 30:208-213. [PMID: 29621927 PMCID: PMC6081247 DOI: 10.1176/appi.neuropsych.17080168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) differ in basic emotional tone. Skin conduction levels (SCLs), a measure of sympathetic tone, may be a sensitive test for discriminating these two dementias early in their course. Previous research has shown differences in resting SCLs between patients with bvFTD and AD, but no study has evaluated the discriminability of SCLs during different environmental conditions. The authors compared bvFTD patients (N=8), AD patients (N=10), and healthy control subjects (N=9) on SCL measures pertaining to real-life vignettes or scenarios differing in valence and emotional intensity. The SCLs among the bvFTD patients were decreased across all conditions, whereas the SCLs among the AD patients were increased compared with control participants. On analysis, the SCLs in response to emotional stimuli differentiated bvFTD from AD with an area under the receiver operator characteristic curve of 95.3%. At a cutoff ≤0.77 μS, emotional vignettes distinguished bvFTD from AD with a sensitivity of 86% and a specificity of 96%. These preliminary results indicate the potential utility of SCLs for differentiating bvFTD from AD early in their course, regardless of environmental condition.
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Affiliation(s)
- Mario F. Mendez
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Sylvia S. Fong
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Mark M. Ashla
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Elvira E. Jimenez
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Andrew R. Carr
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
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Van Erum J, Van Dam D, De Deyn PP. Sleep and Alzheimer's disease: A pivotal role for the suprachiasmatic nucleus. Sleep Med Rev 2017; 40:17-27. [PMID: 29102282 DOI: 10.1016/j.smrv.2017.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Alzheimer's disease (AD), which accounts for most of the dementia cases, is, aside from cognitive deterioration, often characterized by the presence of non-cognitive symptoms. Society is desperately in need for interventions that alleviate the economic and social burden related to AD. Circadian dysrhythmia, one of these symptoms in particular, immensely decreases the self-care ability of AD patients and is one of the main reasons of caregiver exhaustion. Studies suggest that these circadian disturbances form the root of sleep-wake problems, diagnosed in more than half of AD patients. Sleep abnormalities have generally been considered merely a consequence of AD pathology. Recent evidence suggests that a bidirectional relationship exists between sleep and AD, and that poor sleep might negatively impact amyloid burden, as well as cognition. The suprachiasmatic nucleus (SCN), the main circadian pacemaker, is subjected to several alterations during the course of the disease. Its functional deterioration might fulfill a crucial role in the relation between AD pathophysiology and the development of sleep abnormalities. This review aims to give a concise overview of the anatomy and physiology of the SCN, address how AD pathology precisely impacts the SCN and to what degree these alterations can contribute to the progression of the disease.
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Affiliation(s)
- Jan Van Erum
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Peter Paul De Deyn
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen (UMCG), Groningen, The Netherlands; Department of Neurology, Memory Clinic of Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.
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25
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Suhonen NM, Hallikainen I, Hänninen T, Jokelainen J, Krüger J, Hall A, Pikkarainen M, Soininen H, Remes AM. The Modified Frontal Behavioral Inventory (FBI-mod) for Patients with Frontotemporal Lobar Degeneration, Alzheimer’s Disease, and Mild Cognitive Impairment. J Alzheimers Dis 2017; 56:1241-1251. [DOI: 10.3233/jad-160983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Noora-Maria Suhonen
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Maria Pikkarainen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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Karve SJ, Jimenez E, Mendez MF. Initial Heart Rate Reactivity to Socioemotional Pictures in Early-Onset Alzheimer's Disease. J Alzheimers Dis 2017; 60:1325-1332. [PMID: 29036817 DOI: 10.3233/jad-170319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with Alzheimer's disease (AD) often have generalized anxiety, particularly in early-onset AD (EOAD) or the first stages of their disease. This increased anxiety could be associated with decreased sensorimotor gating with increased attention to significant stimuli from AD pathology in the entorhinal cortex. We investigated whether widening initial attention to socioemotional stimuli was association with anxiety among 16 patients with first stage EOAD compared to 19 normal controls (NCs). The participants underwent assessment of their initial heart rate deceleration ("orienting response"; OR), a measure of attentional refocusing, to pictures (International Affective Picture Stimuli) varying in pleasant-unpleasant valence and social-nonsocial content. The results showed group differences; the EOAD patients had significantly larger ORs than the NCs across conditions, with larger ORs in each valence and social condition. In addition, the EOAD patients, but not the NCs, showed ORs to normally less threatening stimuli, particularly pleasant, but also less significantly, social stimuli. On the Neuropsychiatric Inventory, the ORs among the EOAD patients significantly correlated with anxiety scores. Together, these findings suggest that anxiety in mild EOAD may be associated with widening attentional refocusing to socioemotional stimuli, possibly reflecting decreased sensorimotor gating in the entorhinal cortex. This finding could be a potential biomarker for the first stages of AD.
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Affiliation(s)
- Simantini J Karve
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Elvira Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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27
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Rehm IC, Stargatt J, Willison AT, Reser MP, Bhar SS. Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study. J Cogn Psychother 2017; 31:72-88. [PMID: 32755919 DOI: 10.1891/0889-8391.31.1.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.
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Affiliation(s)
- Imogen C Rehm
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jennifer Stargatt
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Aaron T Willison
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Maree P Reser
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil S Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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von Gunten A, Schlaefke S, Überla K. Efficacy of Ginkgo biloba extract EGb 761 ® in dementia with behavioural and psychological symptoms: A systematic review. World J Biol Psychiatry 2016. [PMID: 26223956 DOI: 10.3109/15622975.2015.1066513] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To review current evidence of efficacy of Ginkgo biloba extract EGb 761® in dementia with behavioural and psychological symptoms (BPSD). METHODS Randomized, placebo-controlled trials assessing the effects of EGb 761® in dementia patients with BPSD were included if the diagnosis was made in accordance with internationally accepted criteria, the treatment period was at least 22 weeks, outcome measures covered BPSD and at least two of the following domains of assessment, i.e. cognition, activities of daily living and clinical global assessment, and methodological quality was adequate. An analysis of covariance (ANCOVA) model was used to calculate the pooled effect estimates and to compare effects of EGb 761® and placebo; furthermore, combined risk differences of response rates were calculated. RESULTS Four published trials were identified, involving altogether 1,628 outpatients with mild to moderate dementia. Least-square mean differences for change from baseline in cognition, BPSD (including caregiver distress rating), activities of daily living, clinical global impression, and quality of life favoured EGb 761® (P < 0.001 for all comparisons). CONCLUSIONS The pooled analyses provide evidence of efficacy of EGb 761® at a daily dose of 240 mg in the treatment of out-patients suffering from Alzheimer's, vascular or mixed dementia with BPSD.
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Affiliation(s)
- Armin von Gunten
- a Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Department of Psychiatry , Centre Hospitalier Universitaire Vaudois , Prilly , Switzerland
| | | | - Karl Überla
- c Prof. em. for Epidemiology, Ludwig-Maximilian-University , Munich , Germany
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29
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Van den Bossche T, Sleegers K, Cuyvers E, Engelborghs S, Sieben A, De Roeck A, Van Cauwenberghe C, Vermeulen S, Van den Broeck M, Laureys A, Peeters K, Mattheijssens M, Vandenbulcke M, Vandenberghe R, Martin JJ, De Deyn PP, Cras P, Van Broeckhoven C. Phenotypic characteristics of Alzheimer patients carrying an ABCA7 mutation. Neurology 2016; 86:2126-33. [PMID: 27037232 PMCID: PMC4917260 DOI: 10.1212/wnl.0000000000002628] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/12/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To generate a clinical and pathologic phenotype of patients carrying rare loss-of-function mutations in ABCA7, identified in a Belgian Alzheimer patient cohort and in an autosomal dominant family. Methods: We performed a retrospective review of available data records, medical records, results of CSF analyses and neuroimaging studies, and neuropathology data. Results: The mean onset age of the mutation carriers (n = 22) was 73.4 ± 8.4 years with a wide age range of 36 (54–90) years, which was independent of APOE genotype and cerebrovascular disease. The mean disease duration was 5.7 ± 3.0 years (range 2–12 years). A positive family history was recorded for 10 carriers (45.5%). All patient carriers except one presented with memory complaints. The 4 autopsied brains showed typical immunohistochemical changes of late-onset Alzheimer disease. Conclusions: All patients carrying a loss-of-function mutation in ABCA7 exhibited a classical Alzheimer disease phenotype, though with a striking wide onset age range, suggesting the influence of unknown modifying factors.
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Affiliation(s)
- Tobi Van den Bossche
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Kristel Sleegers
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Elise Cuyvers
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Sebastiaan Engelborghs
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Anne Sieben
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Arne De Roeck
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Caroline Van Cauwenberghe
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Steven Vermeulen
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Marleen Van den Broeck
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Annelies Laureys
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Karin Peeters
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Maria Mattheijssens
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Mathieu Vandenbulcke
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Rik Vandenberghe
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Jean-Jacques Martin
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Peter P De Deyn
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
| | - Patrick Cras
- From the Neurodegenerative Brain Diseases Group (T.V.d.B., K.S., E.C., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., C.V.B.), Department of Molecular Genetics, VIB, Antwerp; Institute Born-Bunge (T.V.d.B., K.S., E.C., S.E., A.S., A.D.R., C.V.C., S.V., M.V.d.B., A.L., K.P., M.M., J.-J.M., P.P.D.D., P.C., C.V.B.), University of Antwerp; Department of Neurology (T.V.d.B., P.C.), Antwerp University Hospital, Edegem; Department of Neurology and Memory Clinic (T.V.d.B., S.E., P.P.D.D.), Hospital Netwerk Antwerp (ZNA), Middelheim and Hoge Beuken; Department of Neurology (A.S.), University Hospital Ghent and University of Ghent; Department of Neurosciences (M.V., R.V.), Faculty of Medicine, KU Leuven; Department of Old Age Psychiatry and Memory Clinic (M.V.) and Department of Neurology (R.V.), University Hospitals Leuven, Belgium; and Department of Neurology and Alzheimer Research Center (P.P.D.D.), University of Groningen and University Medical Center Groningen, the Netherlands
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Van der Mussele S, Mariën P, Saerens J, Somers N, Goeman J, De Deyn PP, Engelborghs S. Psychosis associated behavioral and psychological signs and symptoms in mild cognitive impairment and Alzheimer's dementia. Aging Ment Health 2016; 19:818-28. [PMID: 25323000 DOI: 10.1080/13607863.2014.967170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study is to determine the prevalence of psychosis in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia, and to characterize the associated behavioral and psychological signs and symptoms of dementia (BPSD). METHOD A cross-sectional analysis of baseline data from an ongoing, prospective, longitudinal study on BPSD was performed, including 270 MCI and 402 AD patients. BPSD assessment was performed through Middelheim Frontality Score (MFS), Behave-AD, Cohen-Mansfield Agitation Inventory (CMAI) and Cornell Scale for Depression in Dementia (CSDD). Psychosis was considered to be clinically relevant when delusions and/or hallucinations occurred at least once in the last two weeks prior to the BPSD assessment. RESULTS The prevalence of psychosis in AD (40%) was higher than in MCI (14%; p < 0.001). AD patients with psychosis showed more severe frontal lobe, BPSD, agitation and depressive symptoms (MFS, Behave-AD, CMAI and CSDD total scores), whereas MCI patients with psychosis only showed more severe frontal lobe and physically non-aggressive agitated behavior. In addition, only in psychotic AD patients, all BPSD and types of agitation were more severe compared to non-psychotic AD patients. Comparing MCI and AD patients, MCI patients with psychosis did not show more severe frontal lobe, behavioral and psychological (Behave-AD), depressive symptoms or agitation than AD patients without psychosis. CONCLUSION AD patients clearly display psychosis associated BPSD, whereas MCI patients only display more severe frontal lobe symptoms and physically non-aggressive agitated behavior, but also less pronounced than in AD.
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Affiliation(s)
- Stefan Van der Mussele
- a Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge , University of Antwerp (UAntwerp) , Antwerp , Belgium
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Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, Xu W, Li JQ, Wang J, Lai TJ, Yu JT. The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis. J Affect Disord 2016; 190:264-271. [PMID: 26540080 DOI: 10.1016/j.jad.2015.09.069] [Citation(s) in RCA: 508] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are being increasingly recognized as common serious problems in Alzheimer's disease (AD). However, published data on the prevalence of NPS in persons with AD are conflicting. This meta-analysis aimed to estimate the prevalence of NPS in persons with AD. METHODS Studies published from 1964 to September 30, 2014, were identified from PubMed and Embase database, reference lists and conference abstracts. We calculated prevalence rates and conducted meta-regression analysis with random-effects model, according to study characteristics, population demographics or condition information. RESULTS We identified 48 eligible articles, which provided data for 12 NPS reported in Neuropsychiatric Inventory (NPI). The most frequent NPS was apathy, with an overall prevalence of 49% (95% CI 41-57%), followed by depression, aggression, anxiety and sleep disorder, the pooled prevalence estimates of which were 42% (95% CI 37-46%), 40% (95% CI 33-46%), 39% (95% CI 32-46%) and 39% (95% CI 30-47%), respectively. The less prevalent NPS were irritability (36%, 31-41%), appetite disorder (34%, 27-41%), aberrant motor behavior (32%, 25-38%), delusion (31%, 27-35%), disinhibition (17%, 12-21%) and hallucination (16%, 13-18%). Least common was euphoria, with an overall prevalence of 7% (95% CI 5-9%). LIMITATIONS Several aspects, such as the quality of included studies were not always optimal and there was significant heterogeneity of prevalence estimate across studies. CONCLUSIONS NPS were observed to be highly prevalent in AD patients. Disease duration, age, education level, population origin and the severity of cognitive impairment had influence on the prevalence of some NPS.
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Affiliation(s)
- Qing-Fei Zhao
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China; Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, China; College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China.
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, China
| | - Teng Jiang
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, China
| | - Meng-Shan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Lin Tan
- College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Jie-Qiong Li
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Jun Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Te-Jen Lai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China; Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, China; College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China; Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
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Behavioural and psychological symptoms of dementia in Down syndrome: Early indicators of clinical Alzheimer's disease? Cortex 2015; 73:36-61. [DOI: 10.1016/j.cortex.2015.07.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022]
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Effects of Mild Cognitive Impairment on the Development of Fear of Falling in Older Adults: A Prospective Cohort Study. J Am Med Dir Assoc 2015; 16:1104.e9-13. [DOI: 10.1016/j.jamda.2015.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/31/2015] [Accepted: 09/25/2015] [Indexed: 12/25/2022]
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Abstract
Psychosis is relatively common in later life and can present in a wide variety of contexts, including early-onset and late-onset schizophrenia, delusional disorder, mood disorders, and various dementias. It can also occur as the result of numerous medical and neurological diseases and from the use of certain medications. Although identifying the cause of psychosis in older patients can be challenging, the unique clinical features associated with the different disorders can help in making the diagnosis. Accurate diagnosis of psychosis in older populations is essential, as its treatment varies depending on the context in which it appears. Despite the safety concerns regarding the use of antipsychotics in older patients, certain pharmacological treatments appear to be both efficacious and reasonably safe in treating psychosis in older populations. Additionally, although research is limited, numerous psychosocial therapies appear promising. This review summarizes the literature on the epidemiology, clinical characteristics, neuroimaging, and treatment of psychosis in later life, and serves as an update to past reviews on this topic.
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Van der Mussele S, Le Bastard N, Saerens J, Somers N, Mariën P, Goeman J, De Deyn PP, Engelborghs S. Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer's dementia. Aging Ment Health 2015; 19:247-57. [PMID: 24962058 DOI: 10.1080/13607863.2014.924900] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study is to determine the prevalence of agitation in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia (AD), and to characterize the associated behavioral symptoms. METHOD A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms was performed, including 268 MCI and 393 AD patients. Behavioral assessment was performed through Middelheim Frontality Score (MFS), Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cornell Scale for Depression in Dementia (CSDD). Agitated behavior was considered to be clinically relevant when one or more items of the Cohen-Mansfield Agitation Inventory (CMAI) occurred at least once a week. RESULTS The prevalence of agitation in AD (76%) was higher than in MCI (60%; p < 0.001). Patients with agitation showed more severe frontal lobe, behavioral and depressive symptoms (MFS, Behave-AD and CSDD total scores). In agitated AD patients, all behavioral symptoms and types of agitation were more severe compared to non-agitated AD patients, but in agitated MCI patients only for diurnal rhythm disturbances. This resulted in more severe Behave-AD global scores in patients with agitation as compared to patients without agitation. Comparing MCI and AD patients, MCI patients with agitation showed more severe behavioral and depressive symptoms than AD patients without agitation. The structure of agitation in AD consisted of more aggressive and physically non-aggressive behavior than in MCI. CONCLUSION Frontal lobe, behavioral and depressive symptoms are more severe in MCI and AD patients with clinically relevant agitation as compared to patients without agitation. However, this association is less pronounced in MCI.
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Affiliation(s)
- Stefan Van der Mussele
- a Laboratory of Neurochemistry and Behavior, Reference Centre for Biological Markers of Dementia (BIODEM), Institute Born-Bunge , University of Antwerp (UA) , Antwerp , Belgium
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Mukaetova-Ladinska EB, Abdel-All Z, Andrade J, Alves da Silva J, O'Brien JT, Kalaria RN. Plasma and platelet clusterin ratio is altered in Alzheimer's disease patients with distinct neuropsychiatric symptoms: findings from a pilot study. Int J Geriatr Psychiatry 2015; 30:368-75. [PMID: 24921239 DOI: 10.1002/gps.4145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/21/2014] [Accepted: 04/25/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clusterin protein in plasma has been found to differentiate between people with and without cognitive changes. However, these findings are not conclusive, despite the clusterin gene variations repeatedly being linked to increased risk for dementia, in particular Alzheimer's disease (AD). METHOD We analysed the level of clusterin in platelet and plasma in 25 subjects with a clinical diagnosis of AD and 26 subjects with no cognitive impairment. RESULTS In the current study, we report that the levels of both plasma and platelet clusterin are similar between AD and cognitively intact individuals. Clusterin plasma and platelet levels, as well as the plasma/platelet clusterin ratio, were not affected by age, gender, cognitive impairment and/or overt behavioural symptomatology, including presence of hallucinations and delusions, as well as depression. However, the plasma/platelet clusterin ratio was positively associated in with the Neuropsychiatric Inventory measures of agitation, apathy, irritability and motor aberrant behaviour in AD subjects. CONCLUSION Previous inconsistencies in reported blood clusterin levels may be a result of underlying non-cognitive symptoms in people with AD. Our findings need now to be replicated in larger group of dementia subjects.
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Soysal P, Isik AT. Severe Hyponatremia Due to Escitalopram Treatment in an Elderly Adult with Alzheimer's Disease. J Am Geriatr Soc 2014; 62:2462-3. [DOI: 10.1111/jgs.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pinar Soysal
- Faculty of Medicine; Department of Geriatric Medicine; Dokuz Eylul University; Izmir Turkey
| | - Ahmet Turan Isik
- Faculty of Medicine; Department of Geriatric Medicine; Dokuz Eylul University; Izmir Turkey
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Clinical workout for the early detection of cognitive decline and dementia. Eur J Clin Nutr 2014; 68:1186-91. [PMID: 25271010 DOI: 10.1038/ejcn.2014.189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/18/2014] [Indexed: 02/02/2023]
Abstract
Aging is the major risk factor for the development of human neurodegenerative maladies such as Alzheimer's, Huntington's and Parkinson's diseases (PDs) and prion disorders, all of which stem from toxic protein aggregation. All of these diseases are correlated with cognitive decline. Cognitive Decline is a dynamic state from normal cognition of aging to dementia. According to the original criteria for Alzheimer's Disease (AD) (1984), a clinical diagnosis was possible only when someone was already demented. The prevalence rates of Cognitive Decline (mild cognitive impairment plus dementia) are very high now and will be higher in future because of the increasing survival time of people. Many neurological and psychiatric diseases are correlated with cognitive decline. Diagnosis of cognitive decline is mostly clinical (clinical criteria), but there are multiple biomarkers that could help us mostly in research programs such as short or long, paper and pencil or computerized neuropsychological batteries for cognition, activities of daily living and behavior, electroencephalograph, event-related potentials, and imaging-structural magnetic resonance imaging (MRI) and functional (fMRI, Pittsburgh bound positron emission tomography, FDG-PET, single photon emission computerized tomography and imaging of tau pathology)-cerebrospinal fluid proteins (Abeta, tau and phospho-tau in AD and α-synuclein (αSyn) for PD). Blood biomarkers need more studies to confirm their usefulness. Genetic markers are also studied but until now are not used in clinical praxis. Finally, in everyday clinical praxis and in research workout for early detection of cognitive decline, the combination of biomarkers is useful.
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Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, Pariente A, Bégaud B. Benzodiazepine use and risk of Alzheimer's disease: case-control study. BMJ 2014; 349:g5205. [PMID: 25208536 PMCID: PMC4159609 DOI: 10.1136/bmj.g5205] [Citation(s) in RCA: 332] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the relation between the risk of Alzheimer's disease and exposure to benzodiazepines started at least five years before, considering both the dose-response relation and prodromes (anxiety, depression, insomnia) possibly linked with treatment. DESIGN Case-control study. SETTING The Quebec health insurance program database (RAMQ). PARTICIPANTS 1796 people with a first diagnosis of Alzheimer's disease and followed up for at least six years before were matched with 7184 controls on sex, age group, and duration of follow-up. Both groups were randomly sampled from older people (age >66) living in the community in 2000-09. MAIN OUTCOME MEASURE The association between Alzheimer's disease and benzodiazepine use started at least five years before diagnosis was assessed by using multivariable conditional logistic regression. Ever exposure to benzodiazepines was first considered and then categorised according to the cumulative dose expressed as prescribed daily doses (1-90, 91-180, >180) and the drug elimination half life. RESULTS Benzodiazepine ever use was associated with an increased risk of Alzheimer's disease (adjusted odds ratio 1.51, 95% confidence interval 1.36 to 1.69; further adjustment on anxiety, depression, and insomnia did not markedly alter this result: 1.43, 1.28 to 1.60). No association was found for a cumulative dose <91 prescribed daily doses. The strength of association increased with exposure density (1.32 (1.01 to 1.74) for 91-180 prescribed daily doses and 1.84 (1.62 to 2.08) for >180 prescribed daily doses) and with the drug half life (1.43 (1.27 to 1.61) for short acting drugs and 1.70 (1.46 to 1.98) for long acting ones). CONCLUSION Benzodiazepine use is associated with an increased risk of Alzheimer's disease. The stronger association observed for long term exposures reinforces the suspicion of a possible direct association, even if benzodiazepine use might also be an early marker of a condition associated with an increased risk of dementia. Unwarranted long term use of these drugs should be considered as a public health concern.
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Affiliation(s)
| | - Yola Moride
- Research Center, University of Montreal Hospital Center, Montreal, Canada Faculty of Pharmacy, University of Montreal, Montreal, Canada
| | - Thierry Ducruet
- Research Center, University of Montreal Hospital Center, Montreal, Canada
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics, U897-Team Neuroepidemiology, F-33000 Bordeaux, France University of Bordeaux, College of Health Sciences, F-33000 Bordeaux, France
| | - Hélène Verdoux
- INSERM, U657-Pharmacoepidemiology, Université de Bordeaux, F-33000 Bordeaux, France Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France
| | - Marie Tournier
- INSERM, U657-Pharmacoepidemiology, Université de Bordeaux, F-33000 Bordeaux, France Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France
| | - Antoine Pariente
- INSERM, U657-Pharmacoepidemiology, Université de Bordeaux, F-33000 Bordeaux, France
| | - Bernard Bégaud
- INSERM, U657-Pharmacoepidemiology, Université de Bordeaux, F-33000 Bordeaux, France
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Borges SDM, Radanovic M, Forlenza OV. Fear of falling and falls in older adults with mild cognitive impairment and Alzheimer's disease. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:312-21. [PMID: 24992289 DOI: 10.1080/13825585.2014.933770] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cognitive impairment and fear of falling are risk factors for falls in older adults. Recurrent falls are more prevalent in older adults with cognitive impairment. We examined the number of previous falls, self-reported fear of falling, and the Falls Efficacy Scale-International (FES-I) in 104 older adults [26 with mild Alzheimer's disease (AD), 42 with mild cognitive impairment (MCI) and 36 cognitively healthy]. Older adults with AD and MCI had a higher number of falls (1.1 ± 1.2 and 1.5 ± 1.5, respectively) compared to the control group (0.3 ± 0.5, P < .001). Older adults with MCI more often reported fear of falling (74%) than patients with AD (31%) (P ≤ .002) and scored higher on the FES-I (29.7 and 23.8, respectively, P ≤ .01). The prevalence of falls in older adults with MCI and AD is higher than in subjects cognitively healthy. Older adults with MCI and AD differ in terms of reported fear of falling and falls self-efficacy.
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Affiliation(s)
- Sheila de Melo Borges
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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Uemura K, Shimada H, Makizako H, Doi T, Tsutsumimoto K, Yoshida D, Anan Y, Ito T, Lee S, Park H, Suzuki T. Effects of mild and global cognitive impairment on the prevalence of fear of falling in community-dwelling older adults. Maturitas 2014; 78:62-6. [PMID: 24685290 DOI: 10.1016/j.maturitas.2014.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/11/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Few studies have reported the relationship between fear of falling (FoF) and mild and global cognitive impairment in community-dwelling older adults. We aimed to determine whether the status of cognitive impairment affects the prevalence of FoF in community-dwelling older adults. STUDY DESIGN Cross-sectional study among 4474 community-dwelling older adults who participated in the Obu Study of Health Promotion for the Elderly. MAIN OUTCOME MEASURES Participants underwent cognitive tests and were divided into three groups: cognitive healthy, mild cognitive impairment (MCI), and global cognitive impairment (GCI). FoF and related variables, such as fall history, physical function, and depression, were also investigated. RESULTS The prevalence of FoF was significantly different by group (p<0.001; healthy: 43.6%, MCI: 50.6%, GCI: 40.6%). Logistic regression analysis showed that GCI (odds ratio=0.63; 95% confidence interval=0.526-0.76) was independently associated with FoF, after controlling for confounding factors. Older adults with GCI showed the lowest prevalence of FoF, although they had the lowest physical function comparing with the other groups (p<0.001). CONCLUSION MCI and GCI in community-dwelling older adults affect the prevalence of FoF in a completely different manner. Further study is required to determine whether insensitivity to FoF with GCI increases the risk of falling in older adults.
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The development and validation of a patient-reported quality of life measure for people with mild cognitive impairment. Int Psychogeriatr 2014; 26:487-97. [PMID: 24308688 DOI: 10.1017/s1041610213002251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND No validated patient-reported outcome measure (PROM) exists specifically to assess quality of life in mild cognitive impairment (MCI); we report a study conducted to develop such a measure. METHODS Semi-structured in-depth interviews were carried out with 23 people with MCI in order to determine items for a draft questionnaire. These interviews were audio-recorded, transcribed, and content analyzed. The draft questionnaire was refined following feedback from a focus group. 280 questionnaires were posted to subjects recruited from memory clinics and research databases, the response rate was 56% i.e. 146 questionnaires were included in the final analysis. The completed questionnaires were analyzed using factor analytic techniques to produce the final measure; construct validity was assessed by correlation with a generic patient-reported outcome measure, the SF-12v2. RESULTS Factor analysis produced a 13-item measure tapping two domains of patient-reported quality of life ("Emotional Effects" and "Practical Concerns"). Internal consistency reliability was high for both domains (α was 0.91 and 0.85 respectively). Both dimensions were highly and significantly correlated with the Mental Component Summary score of the SF-12v2 ("emotional effects" ρ = -0.43, p < 0.001 and "practical concerns" ρ = -0.56, p < 0.001). CONCLUSIONS The Mild Cognitive Impairment Questionnaire (MCQ) is a 13-item measure developed specifically to measure patient-reported outcomes in people with MCI. It was created on the basis of patient report and has been shown to have good psychometric properties. It is likely to prove valuable in the evaluation of treatment regimes in this patient group.
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Wettstein M, Seidl U, Wahl HW, Shoval N, Heinik J. Behavioral Competence and Emotional Well-Being of Older Adults with Mild Cognitive Impairment. GEROPSYCH 2014. [DOI: 10.1024/1662-9647/a000107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We examined whether older individuals with mild cognitive impairment (MCI) differed from healthy controls (HC) and persons with dementia (AD) in objective and perceived behavioral competence as well as in emotional well-being. We used a merged sample of 257 older adults aged 59 to 91 years (M = 72.9; SD = 6.4) stemming from Israel and Germany. Objective behavioral competence (assessed based on global positioning system (GPS)-based tracking data and a structured questionnaire) of MCI individuals was mostly similar to the HC group. Regarding perceived behavioral competence and emotional well-being, MCI individuals were more similar to the AD group and below the HC group’s mean levels. Findings suggest that a differentiated view of MCI individual’s competence and emotional well-being is in place.
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Affiliation(s)
- Markus Wettstein
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Germany
| | - Hans-Werner Wahl
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Noam Shoval
- Geography Department, Hebrew University Jerusalem, Israel
| | - Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Allgaier AK, Kramer D, Saravo B, Mergl R, Fejtkova S, Hegerl U. Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes. Int J Geriatr Psychiatry 2013; 28:1197-204. [PMID: 23463576 DOI: 10.1002/gps.3944] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 01/22/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.
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Affiliation(s)
- Antje-Kathrin Allgaier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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