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Salvadori E. Intelligence, cognition, and major neurocognitive disorders: From constructs to measures. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100185. [PMID: 37736144 PMCID: PMC10510085 DOI: 10.1016/j.cccb.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
The study of intelligence's role in development of major neurocognitive disorders (MND) is influenced by the approaches used to conceptualize and measure these constructs. In the field of cognitive impairment, the use of single 'intelligence' tests is a common approach to estimate intelligence. Despite being a practical compromise between feasibility and constructs, variance of these tests is only partially explained by general intelligence, and some tools (e.g., lexical tasks for premorbid intelligence) presented inherent limitations. Alternatively, factorial models allow an actual measure of intelligence as a latent factor superintending all mental abilities. Royall and colleagues used structural equation modeling to decompose the Spearman's general intelligence factor g in δ (shared variance across cognitive and functional measures) and g' (shared variance across cognitive measures only). Authors defined δ as the 'cognitive correlates of functional status', and thus a 'phenotype for all cause dementia'. Compared to g', δ explained a little rate of cognitive measures' variance, but it demonstrated a higher accuracy in dementia case-finding. From the methodological perspective, given g 'indifference' to its indicators, further studies are needed to identify the minimal set of tools necessary to extract g, and to test also non-cognitive variables as measures of δ. From the clinical perspective, general intelligence seems to influence MND presence and severity more than domain specific cognitive abilities. Giving δ 'blindness' to etiology, its association with biomarkers and contribution to differential diagnosis might be limited. Classical neuropsychological approaches based on patterns of performances at cognitive tests remained fundamental for differential diagnosis.
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Affiliation(s)
- Emilia Salvadori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
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Gil M, Alliey-Rodriguez N, Lopez-Alvarenga JC, Diego V, Gaona CA, Mata L, Pirela RV, Chavez CA, de Erausquin GA, Melgarejo JD, Maestre GE. Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study. J Alzheimers Dis 2021; 82:S251-S261. [PMID: 33612541 PMCID: PMC8354010 DOI: 10.3233/jad-201144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. OBJECTIVE We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. METHODS We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). RESULTS The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. CONCLUSION Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.
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Affiliation(s)
- Mario Gil
- Department of Psychological Science, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Juan Carlos Lopez-Alvarenga
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Vincent Diego
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
- SOM South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Ciro A. Gaona
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ledys Mata
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Rosa V. Pirela
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Carlos A. Chavez
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Gabriel A. de Erausquin
- Department of Neurology, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jesus D. Melgarejo
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Gladys E. Maestre
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
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Cagnin A, Di Lorenzo R, Marra C, Bonanni L, Cupidi C, Laganà V, Rubino E, Vacca A, Provero P, Isella V, Vanacore N, Agosta F, Appollonio I, Caffarra P, Pettenuzzo I, Sambati R, Quaranta D, Guglielmi V, Logroscino G, Filippi M, Tedeschi G, Ferrarese C, Rainero I, Bruni AC. Behavioral and Psychological Effects of Coronavirus Disease-19 Quarantine in Patients With Dementia. Front Psychiatry 2020; 11:578015. [PMID: 33033486 PMCID: PMC7509598 DOI: 10.3389/fpsyt.2020.578015] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In March 2020, the World Health Organization declared a global pandemic due to the novel coronavirus SARS-CoV-2 and several governments planned a national quarantine in order to control the virus spread. Acute psychological effects of quarantine in frail elderly subjects with special needs, such as patients with dementia, have been poorly investigated. The aim of this study was to assess modifications of neuropsychiatric symptoms during quarantine in patients with dementia and their caregivers. METHODS This is a sub-study of a multicenter nation-wide survey. A structured telephone interview was delivered to family caregivers of patients with diagnosis of Alzheimer disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VD), followed regularly at 87 Italian memory clinics. Variations in behavioral and psychological symptoms (BPSD) were collected after 1 month since quarantine declaration and associations with disease type, severity, gender, and caregiver's stress burden were analyzed. RESULTS A total of 4,913 caregivers participated in the survey. Increased BPSD was reported in 59.6% of patients as worsening of preexisting symptoms (51.9%) or as new onset (26%), and requested drug modifications in 27.6% of these cases. Irritability, apathy, agitation, and anxiety were the most frequently reported worsening symptoms and sleep disorder and irritability the most frequent new symptoms. Profile of BPSD varied according to dementia type, disease severity, and patients' gender. Anxiety and depression were associated with a diagnosis of AD (OR 1.35, CI: 1.12-1.62), mild to moderate disease severity and female gender. DLB was significantly associated with a higher risk of worsening hallucinations (OR 5.29, CI 3.66-7.64) and sleep disorder (OR 1.69, CI 1.25-2.29), FTD with wandering (OR 1.62, CI 1.12-2.35), and change of appetite (OR 1.52, CI 1.03-2.25). Stress-related symptoms were experienced by two-thirds of caregivers and were associated with increased patients' neuropsychiatric burden (p<0.0001). CONCLUSION Quarantine induces a rapid increase of BPSD in approximately 60% of patients and stress-related symptoms in two-thirds of caregivers. Health services need to plan a post-pandemic strategy in order to address these emerging needs.
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Affiliation(s)
| | - Raffaele Di Lorenzo
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Catanzaro, Italy
| | - Camillo Marra
- Memory Clinic, Fondazione Policlinico Gemelli, IRCCS Università, Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Cupidi
- CDCD Ospedale del Delta, AUSL Ferrara, Ferrara, Italy
| | - Valentina Laganà
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Catanzaro, Italy
| | - Elisa Rubino
- Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Vacca
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Turin, Italy
| | - Paolo Provero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Isella
- Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano – Bicocca, Monza, Italy
| | | | - Federica Agosta
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Ildebrando Appollonio
- Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano – Bicocca, Monza, Italy
| | | | | | - Renato Sambati
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari, Bari, Italy
- Department of Basic Medicine Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, Italy
| | - Davide Quaranta
- Memory Clinic, Fondazione Policlinico Gemelli, IRCCS Università, Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Guglielmi
- Memory Clinic, Fondazione Policlinico Gemelli, IRCCS Università, Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari, Bari, Italy
- Department of Basic Medicine Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, Italy
| | - Massimo Filippi
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gioacchino Tedeschi
- Department of Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carlo Ferrarese
- Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano – Bicocca, Monza, Italy
| | - Innocenzo Rainero
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Turin, Italy
| | - Amalia C. Bruni
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Catanzaro, Italy
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