1
|
Sabates J, Chiu WH, Loi S, Lampit A, Gavelin HM, Chong T, Launder N, Goh AMY, Brodtmann A, Lautenschlager N, Bahar-Fuchs A. The Associations Between Neuropsychiatric Symptoms and Cognition in People with Dementia: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2024; 34:581-597. [PMID: 37477839 PMCID: PMC11166771 DOI: 10.1007/s11065-023-09608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
Most people with dementia experience neuropsychiatric symptoms (NPS), including anxiety, depression or disinhibition. There is growing interest in the relationship between NPS and cognitive impairment, but data is still limited. This study aimed to investigate the specific associations between NPS and cognition in people with dementia. MEDLINE, EMBASE and PsycINFO were searched for published, peer-reviewed studies of associations between at least one NPS and one cognitive ability in people with dementia. The quality of the studies was assessed with the NIH National Heart, Lung and Blood Institute's quality assessment tools. A meta-analysis was conducted using Robumeta package for R. Ninety studies were included. We found significant associations between NPS, global cognition and cognitive domains, e.g. apathy was associated with global cognitive and memory impairment; dysphoria was associated with worse attention; delusions with executive dysfunction. Increased NPS in people with dementia are associated with worse cognitive performance. There were few studies looking at associations between some neuropsychiatric clusters and cognitive abilities, and there was little research on causal relationships. Our review was limited by the inclusion of studies that reported associations in specific formats, and most included people with a diagnosis of Alzheimer's disease (AD). However, given the large number of studies, this is unlikely to have biased results. More research is needed that includes diverse people with different dementia syndromes. Registration: PROSPERO 2020 CRD42020165565.
Collapse
Affiliation(s)
- Julieta Sabates
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia.
| | - Wei-Hsuan Chiu
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
| | - Samantha Loi
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Royal Melbourne Hospital, Parkville, Australia
| | - Amit Lampit
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
| | - Hanna M Gavelin
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Department of Psychology, Umea University, Umea, Sweden
| | - Terence Chong
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Royal Melbourne Hospital, Parkville, Australia
- St Vincent's Hospital, Melbourne, Australia
| | - Nathalie Launder
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
| | - Anita M Y Goh
- National Ageing Research Institute &, The University of Melbourne, Parkville, Australia
| | - Amy Brodtmann
- Central Clinical School, Cognitive Health Initiative, Monash University, Melbourne, Australia
| | | | - Alex Bahar-Fuchs
- The University of Melbourne, 151 Barry Street, Carlton, VIC, Australia
- Deakin University, Melbourne, Australia
| |
Collapse
|
3
|
Clark C, Richiardi J, Maréchal B, Bowman GL, Dayon L, Popp J. Systemic and central nervous system neuroinflammatory signatures of neuropsychiatric symptoms and related cognitive decline in older people. J Neuroinflammation 2022; 19:127. [PMID: 35643540 PMCID: PMC9148517 DOI: 10.1186/s12974-022-02473-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neuroinflammation may contribute to psychiatric symptoms in older people, in particular in the context of Alzheimer's disease (AD). We sought to identify systemic and central nervous system (CNS) inflammatory alterations associated with neuropsychiatric symptoms (NPS); and to investigate their relationships with AD pathology and clinical disease progression. METHODS We quantified a panel of 38 neuroinflammation and vascular injury markers in paired serum and cerebrospinal fluid (CSF) samples in a cohort of cognitively normal and impaired older subjects. We performed neuropsychiatric and cognitive evaluations and measured CSF biomarkers of AD pathology. Multivariate analysis determined serum and CSF neuroinflammatory alterations associated with NPS, considering cognitive status, AD pathology, and cognitive decline at follow-up visits. RESULTS NPS were associated with distinct inflammatory profiles in serum, involving eotaxin-3, interleukin (IL)-6 and C-reactive protein (CRP); and in CSF, including soluble intracellular cell adhesion molecule-1 (sICAM-1), IL-8, 10-kDa interferon-γ-induced protein, and CRP. AD pathology interacted with CSF sICAM-1 in association with NPS. Presenting NPS was associated with subsequent cognitive decline which was mediated by CSF sICAM-1. CONCLUSIONS Distinct systemic and CNS inflammatory processes are involved in the pathophysiology of NPS in older people. Neuroinflammation may explain the link between NPS and more rapid clinical disease progression.
Collapse
Affiliation(s)
- Christopher Clark
- Institute for Regenerative Medicine, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lengstrasse 31, Zürich, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technologies Group, Siemens Healthcare Switzerland, 1015 Lausanne, Switzerland
| | - Gene L. Bowman
- Nestlé Institute of Health Sciences, Nestlé Research, EPFL Innovation Park, Bâtiment H, 1015 Lausanne, Switzerland
- Department of Neurology, NIA-Layton Aging and Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon USA
| | - Loïc Dayon
- Nestlé Institute of Health Sciences, Nestlé Research, EPFL Innovation Park, Bâtiment H, 1015 Lausanne, Switzerland
- Nestlé Institute of Food Safety & Analytical Sciences, Nestlé Research, EPFL Innovation Park, Bâtiment H, CH-1015 Lausanne, Switzerland
- Institut Des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
| | - Julius Popp
- Institute for Regenerative Medicine, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
- Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Department of Geriatric Psychiatry, Centre for Gerontopsychiatric Medicine, University Hospital of Psychiatry Zürich, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
| |
Collapse
|
4
|
Eikelboom WS, van den Berg E, Singleton EH, Baart SJ, Coesmans M, Leeuwis AE, Teunissen CE, van Berckel BNM, Pijnenburg YAL, Scheltens P, van der Flier WM, Ossenkoppele R, Papma JM. Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations. Neurology 2021; 97:e1276-e1287. [PMID: 34413181 PMCID: PMC8480405 DOI: 10.1212/wnl.0000000000012598] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives To investigate the prevalence and trajectories of neuropsychiatric symptoms (NPS) in relation to cognitive functioning in a cohort of β-amyloid–positive (A+) individuals across the Alzheimer disease (AD) clinical spectrum. Methods In this single-center observational study, we included all individuals who visited the Alzheimer Center Amsterdam and had a clinical diagnosis of subjective cognitive decline (SCD), mild cognitive impairment (MCI), or probable AD dementia and were A+. We measured NPS with the Neuropsychiatric Inventory (NPI), examining total scores and the presence of specific NPI domains. Cognition was assessed across 5 cognitive domains and with the Mini-Mental State Examination (MMSE). We examined trajectories including model-based trends for NPS and cognitive functioning over time. We used linear mixed models to relate baseline NPI scores to cognitive functioning at baseline (whole-sample) and longitudinal time points (subsample n = 520, mean 1.8 [SD 0.7] years follow-up). Results We included 1,524 A+ individuals from the Amsterdam Dementia Cohort with A+ SCD (n = 113), A+ MCI (n = 321), or A+ AD dementia (n = 1,090). NPS were prevalent across all clinical AD stages (≥1 NPS 81.4% in SCD, 81.2% in MCI, 88.7% in dementia; ≥1 clinically relevant NPS 54.0% in SCD, 50.5% in MCI, 66.0% in dementia). Cognitive functioning showed a uniform gradual decline; while in contrast, large intraindividual heterogeneity of NPS was observed over time across all AD groups. At baseline, we found associations between NPS and cognition in dementia that were most pronounced for NPI total scores and MMSE (range β = −0.18 to −0.11, false discovery rate [FDR]–adjusted p < 0.05), while there were no cross-sectional relationships in SCD and MCI (range β = −0.32 to 0.36, all FDR-adjusted p > 0.05). There were no associations between baseline NPS and cognitive functioning over time in any clinical stage (range β = −0.13 to 0.44, all FDR-adjusted p > 0.05). Discussion NPS and cognitive symptoms are both prevalent across the AD clinical spectrum, but show a different evolution during the course of the disease.
Collapse
Affiliation(s)
- Willem S Eikelboom
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Esther van den Berg
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Ellen H Singleton
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Sara J Baart
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Michiel Coesmans
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Annebet E Leeuwis
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Charlotte E Teunissen
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Bart N M van Berckel
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Yolande A L Pijnenburg
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Philip Scheltens
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Wiesje M van der Flier
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Rik Ossenkoppele
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Janne M Papma
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden.
| |
Collapse
|