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Burling JE, Katz Z, Yuan Z, Munro C, Mimmack K, Ma G, Hanseeuw BJ, Papp KV, Amariglio RE, Vannini P, Rentz DM, Quiroz YT, Johnson KA, Sperling RA, Blacker D, Marshall GA, Yang HS, Gatchel JR. Study Partner Report of Apathy in Older Adults is Associated with AD Biomarkers: Findings from the Harvard Aging Brain Study. Am J Geriatr Psychiatry 2024; 32:909-919. [PMID: 38443298 DOI: 10.1016/j.jagp.2024.01.020] [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: 10/12/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES We examined relationships between apathy (self and study-partner-reported) and markers of Alzheimer's disease (AD) in older adults. DESIGN The study utilized a well-characterized sample of participants from the Harvard Aging Brain Study (HABS), a longitudinal cohort study. Participants were cognitively unimpaired without clinically significant neuropsychiatric symptoms at HABS baseline. The dependent variables, apathy evaluation scale-self (AES-S) and informant (AES-I), were administered cross-sectionally between years 6-9 and compared to the independent variables, amyloid and tau PET neuroimaging, from the same year. SETTING Community-dwelling participants assessed at research visits in an academic medical center. PARTICIPANTS Participants (n = 170) completed assessments within 1.5 years of their neuroimaging visit. At the time of apathy assessment, N = 156 were cognitively unimpaired and 14 had progressed to mild cognitive impairment (n = 8) or dementia (n = 6). MEASUREMENTS We utilized linear regression models to assess cross-sectional associations of AES-S and AES-I with AD PET imaging measures (beta-amyloid (Pittsburgh Compound B) and tau (Flortaucipir)), covarying for age, sex, education, and the time between PET scan-apathy assessment. RESULTS AES-I was significantly associated with beta-amyloid and temporal lobe tau, and the associations were retained after further adjusting for depressive symptoms. The associations between AES-S and AD biomarkers were not significant. In an exploratory subgroup analysis of cognitively unimpaired individuals with elevated Aβ, we observed an association between AES-I and inferior temporal tau. CONCLUSIONS Study-partner-reported, but not self-reported, apathy in older adults is associated with AD pathology, and we observed this relationship starting from the preclinical stage. Our findings highlight the importance of collateral information in capturing AD-related apathy.
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Affiliation(s)
- Jessa E Burling
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA
| | - Zoe Katz
- Washington University School of Medicine in St. Louis (ZK), St. Louis, MO
| | - Ziwen Yuan
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA
| | - Catherine Munro
- Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Department of Psychiatry (CM, YTQ, DB, JRG), Massachusetts General Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Kayden Mimmack
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA
| | - Grace Ma
- Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA; Department of Psychiatry (GM), Brigham and Women's Hospital, Boston, MA
| | - Bernard J Hanseeuw
- Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA; Department of Radiology (BJH), Massachusetts General Research Institute, Boston, MA; Department of Neurology (BJH), Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kathryn V Papp
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Rebecca E Amariglio
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Patrizia Vannini
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Dorene M Rentz
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Yakeel T Quiroz
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Psychiatry (CM, YTQ, DB, JRG), Massachusetts General Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Keith A Johnson
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA; Department of Radiology (KAJ), Massachusetts General Hospital, Boston, MA
| | - Reisa A Sperling
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Deborah Blacker
- Department of Psychiatry (CM, YTQ, DB, JRG), Massachusetts General Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA; Department of Epidemiology (DB), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Gad A Marshall
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Hyun-Sik Yang
- Department of Neurology (JEB, ZY, KM, KVP, REA, PV, DMR, YTQ, KAJ, RAS, GAM, H-SY), Massachusetts General Hospital, Boston, MA; Department of Neurology (CM, KVP, REA, PV, DMR, KAJ, RAS, GAM, H-SY), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA
| | - Jennifer R Gatchel
- Department of Psychiatry (CM, YTQ, DB, JRG), Massachusetts General Hospital, Boston, MA; Harvard Medical School (CM, GM, BJH, KVP, REA, PV, DMR, YTQ, KAJ, RAS, DB, GAM, H-SY, JRG), Boston, MA; Department of Psychiatry (JRG), Massachusetts General Hospital, Boston MA; Department of Psychiatry (JRG), McLean Hospital, Belmont, MA; Department of Psychiatry (JRG), Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center (JRG), Houston, TX.
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Zhu CW, Schneider LS, Elder GA, Soleimani L, Grossman HT, Aloysi A, Schimming C, Sano M. Neuropsychiatric Symptom Profile in Alzheimer's Disease and Their Relationship With Functional Decline. Am J Geriatr Psychiatry 2024:S1064-7481(24)00375-0. [PMID: 39013750 DOI: 10.1016/j.jagp.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Understanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline. METHODS Longitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation. RESULTS Apathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p <0.001). Over time, rate of functional decline was faster in those with intermittent and persistent/always apathy (intermittent: 0.454±0.091, 95% CI=[0.276, 0.632]; persistent/always: 0.635±0.102, 95% CI=[0.436, 0.835], both p <0.001). Worse agitation, delusions, and hallucinations also correlated with functional decline, but magnitudes of the estimates were smaller. CONCLUSION Individual NPS may be sensitive targets for tracking longitudinal change in function. The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.
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Affiliation(s)
- Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine (CWZ), Icahn School of Medicine at Mount Sinai, New York, NY; James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Lon S Schneider
- Department of Psychiatry, Neurology, and Gerontology (LSS), Keck School of Medicine and Leonard Davis School of Gerontology, University of Southern, CA
| | - Gregory A Elder
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laili Soleimani
- Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hillel T Grossman
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Aloysi
- Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Corbett Schimming
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Sano
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
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Liampas I, Siokas V, Zoupa E, Kyriakoulopoulou P, Stamati P, Provatas A, Tsouris Z, Tsimourtou V, Lyketsos CG, Dardiotis E. Neuropsychiatric symptoms and white matter hyperintensities in older adults without dementia. Int Psychogeriatr 2024:1-13. [PMID: 38639110 DOI: 10.1017/s1041610224000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE We aimed to examine associations between neuropsychiatric symptoms (NPS) and white matter hyperintensities (WMH) status in older adults without dementia under the hypothesis that WMH increased the odds of having NPS. DESIGN Longitudinal analysis of data acquired from the National Alzheimer's Coordinating Center Uniform Data Set. SETTINGS Data were derived from 46 National Institute on Aging - funded Alzheimer's Disease Research Centers. PARTICIPANTS NACC participants aged ≥50 years with available data on WMH severity with a diagnosis of mild cognitive impairment (MCI) or who were cognitively unimpaired (CU) were studied. Among 4617 CU participants, 376 had moderate and 54 extensive WMH. Among 3170 participants with MCI, 471 had moderate and 88 had extensive WMH. MEASUREMENTS Using Cardiovascular Health Study (CHS) scores, WMH were coded as no to mild (CHS score: 0-4), moderate (score: 5-6) or extensive (score: 7-8). NPS were quantified on the Neuropsychiatric Inventory Questionnaire. Binary logistic regression models estimated the odds of reporting each of 12 NPS by WMH status separately for individuals with MCI or who were CU. RESULTS Compared to CU individuals with no to mild WMH, the odds of having elation [9.87, (2.63-37.10)], disinhibition [4.42, (1.28-15.32)], agitation [3.51, (1.29-9.54)] or anxiety [2.74, (1.28-5.88)] were higher for the extensive WMH group, whereas the odds of having disinhibition were higher for the moderate WMH group [1.94, (1.05-3.61)]. In the MCI group, he odds of NPS did not vary by WMH status. CONCLUSIONS Extensive WMH were associated with higher odds of NPS in CU older adults but not in those with MCI.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Elli Zoupa
- Larisa Day Care Center of People with Alzheimer's Disease, Association for Regional Development and Mental Health (EPAPSY), Marousi, Greece
| | | | - Polyxeni Stamati
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Antonios Provatas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vana Tsimourtou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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4
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Forbes M, Lotfaliany M, Mohebbi M, Reynolds CF, Woods RL, Orchard S, Chong T, Agustini B, O'Neil A, Ryan J, Berk M. Depressive symptoms and cognitive decline in older adults. Int Psychogeriatr 2024:1-12. [PMID: 38623851 DOI: 10.1017/s1041610224000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Few studies have examined the impact of late-life depression trajectories on specific domains of cognitive function. This study aims to delineate how different depressive symptom trajectories specifically affect cognitive function in older adults. DESIGN Prospective longitudinal cohort study. SETTING Australia and the United States of America. PARTICIPANTS In total, 11,035 community-dwelling older adults with a mean age of 75 years. MEASUREMENTS Depressive trajectories were modelled from depressive symptoms according to annual Centre for Epidemiological Studies Depression Scale 10 (CES-D-10) surveys. Four trajectories of depressive symptoms were identified: low ("nondepressed"), consistently mild ("subthreshold depression"), consistently moderate ("persistent depression"), and initially low but increasing ("emerging depression"). Global cognition (Modified Mini-Mental State Examination [3MS]), verbal fluency (Controlled Oral Word Association Test [COWAT]), processing speed (Symbol Digit Modalities Test [SDMT]), episodic memory (Hopkins Verbal Learning Test - Revised [HVLT-R]), and a composite z-score were assessed over a subsequent median 2 years. RESULTS Subthreshold depression predicted impaired performance on the SDMT (Cohen's d -0.04) and composite score (-0.03); emerging depression predicted impaired performance on the SDMT (-0.13), HVLT-R (-0.09), 3 MS (-0.08) and composite score (-0.09); and persistent depression predicted impaired performance on the SDMT (-0.08), 3 MS (-0.11), and composite score (-0.09). CONCLUSIONS Depressive symptoms are associated with later impaired processing speed. These effects are small. Diverse depression trajectories have different impacts on cognitive function.
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Affiliation(s)
- Malcolm Forbes
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Mojtaba Lotfaliany
- School of Medicine, Barwon Health, Deakin University, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, VC, Australia
| | - Mohammadreza Mohebbi
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Trevor Chong
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bruno Agustini
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Adrienne O'Neil
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
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Ronat L, Hanganu A, Chylinski D, Van Egroo M, Narbutas J, Besson G, Muto V, Schmidt C, Bahri MA, Phillips C, Salmon E, Maquet P, Vandewalle G, Collette F, Bastin C. Prediction of cognitive decline in healthy aging based on neuropsychiatric symptoms and PET-biomarkers of Alzheimer's disease. J Neurol 2024; 271:2067-2077. [PMID: 38114820 DOI: 10.1007/s00415-023-12131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
Neuropsychiatric symptoms (NPS) have been associated with a risk of accelerated cognitive decline or conversion to dementia of the Alzheimer's Disease (AD) type. Moreover, the NPS were also associated with higher AD biomarkers (brain tau and amyloid burden) even in non-demented patients. But the effect of the relationship between NPS and biomarkers on cognitive decline has not yet been studied. This work aims to assess the relationship between longitudinal cognitive changes and NPS, specifically depression and anxiety, in association with AD biomarkers in healthy middle-aged to older participants. The cohort consisted of 101 healthy participants aged 50-70 years, 66 of whom had neuropsychological assessments of memory, executive functions, and global cognition at a 2-year follow-up. At baseline, NPS were assessed using the Beck Depression and Anxiety Inventories while brain tau and amyloid loads were measured using positron emission topography. For tau burden, THK5351 uptake is used as a proxy of tau and neuroinflammation. Participants, declining or remaining stable at follow-up, were categorized into groups for each cognitive domain. Group classification was investigated using binary logistic regressions based on combined AD biomarkers and the two NPS. The results showed that an association between anxiety and prefrontal amyloid burden significantly classified episodic memory decline, while the classification of global cognitive decline involved temporal and occipital amyloid burden but not NPS. Moreover, depression together with prefrontal and hippocampal tau burden were associated with a decline in memory. The classification of participants based on executive decline was related to depression and mainly prefrontal tau burden. These findings suggest that the combination of NPS and brain biomarkers of AD predicts the occurrence of cognitive decline in aging.
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Affiliation(s)
- Lucas Ronat
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, QC, Canada
- Research Centre, University Institute of Geriatrics of Montreal, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Alexandru Hanganu
- Research Centre, University Institute of Geriatrics of Montreal, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Faculty of Arts and Sciences, Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Daphné Chylinski
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Maxime Van Egroo
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Justinas Narbutas
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
| | - Gabriel Besson
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Vincenzo Muto
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Christina Schmidt
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Christophe Phillips
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Eric Salmon
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
- Department of Neurology, CHU Liege, 4000, Liege, Belgium
| | - Pierre Maquet
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Department of Neurology, CHU Liege, 4000, Liege, Belgium
| | - Gilles Vandewalle
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Fabienne Collette
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Christine Bastin
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, 4000, Liège, Belgium.
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liege, 4000, Liege, Belgium.
- F.R.S.-Fonds National de la Recherche Scientifique, Brussels, Belgium.
- Bât. B30 GIGA CRC In Vivo Imaging - Aging and Memory, Quartier Agora, Allée du 6 Août 8, 4000, Liege, Belgium.
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Chen YJ, Chang MC, Jhang KM, Wang WF, Liao YC. Neuropsychiatric Symptoms Predict Faster Cognitive Decline in Dementia Collaborative Care Than Antipsychotic Use. Neuropsychiatr Dis Treat 2024; 20:689-696. [PMID: 38559771 PMCID: PMC10981370 DOI: 10.2147/ndt.s454943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Background To compare short-term cognitive outcomes among groups with and without neuropsychiatric symptoms (NPSs) or antipsychotic prescription and to determine which disease status or treatment modality is associated with relatively faster cognitive decline. Methods We retrospectively analyzed a prospective cohort of patients diagnosed with dementia and mild cognitive impairment. All participants were evaluated using the Cognitive Abilities Screening Instrument (CASI) during their initial clinical assessments and at the annual follow-up. The dependent variable was annual delta CASI. Multivariate linear regression analysis was used to assess the degree of association between NPS, antipsychotic use, and cognitive decline after adjusting for confounding factors. Neuropsychiatric symptoms were examined individually to determine their predictive value for cognitive decline. Results A total of 407 (N = 407) patients were included in the study. NPSs, rather than antipsychotic use, led to faster cognitive decline. A higher baseline NPI total score predicted a significantly faster decline in CASI scores (1-year delta CASI = -0.22, 95% CI = -0.38~ -0.05, p = 0.010). Specific items (delusions, agitation, depression, anxiety, euphoria, and apathy) in the NPS significantly increased cognitive decline. Conclusion Certain neuropsychiatric symptoms, rather than antipsychotic use, lead to faster cognitive decline in a dementia collaborative care model. Checking for and providing appropriate interventions for NPS in people with dementia and their caregivers are highlighted.
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Affiliation(s)
- Yen-Jen Chen
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
- Department of Psychiatry, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Cheng Liao
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
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Gontrum EQ, Paolillo EW, Lee S, Diaz V, Ehrenberg A, Saloner R, Mundada NS, La Joie R, Rabinovici G, Kramer JH, Casaletto KB. Neuropsychiatric Profiles and Cerebral Amyloid Burden in Adults without Dementia. Dement Geriatr Cogn Disord 2024; 53:119-127. [PMID: 38513620 PMCID: PMC11187670 DOI: 10.1159/000538376] [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: 09/24/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION We comprehensively evaluated how self- and informant-reported neuropsychiatric symptoms (NPS) were differentially associated with cerebral amyloid-beta (Aβ) PET levels in older adults without dementia. METHODS Two hundred and twenty-one participants (48% female, age = 73.4 years ± 8.4, Clinical Dementia Rating = 0 [n = 184] or 0.5 [n = 37]) underwent an Aβ-PET scan (florbetapir or PIB), comprehensive neuropsychological testing, and self-reported (Geriatric Depression Scale - 30 item [GDS-30]) and informant-reported interview (Neuropsychiatric Inventory Questionnaire [NPI-Q]) of NPS. Cerebral Aβ burden was quantified using centiloids (CL). NPI-Q and GDS-30 queried the presence of NPS within 4 subdomains and 6 subscales, respectively. Regression models examined the relationship between NPS and Aβ-PET CL. RESULTS Both higher self- and informant-reported NPS were associated with higher Aβ burden. Among specific NPI-Q subdomains, informant-reported changes in depression, anxiety, and irritability were all associated with higher Aβ-PET. Similarly, self-reported (GDS-30) subscales of depression, apathy, anxiety, and cognitive concern were associated with higher Aβ-PET. When simultaneously entered, only self-reported cognitive concern was associated with Aβ-PET in the GDS-30 model, while both informant-reported anxiety and depression were associated with Aβ-PET in the NPI-Q model. Clinical status moderated the association between self-reported NPS and Aβ-PET such that the positive relationship between self-perceived NPS and Aβ burden strengthened with increasing functional difficulties. CONCLUSIONS In a cohort of older adults without dementia, both self- and informant-reported measures of global NPS, particularly patient-reported cognitive concerns and informant-reported anxiety and depression, corresponded with cerebral Aβ burden. NPS may appear early in the prodromal disease state and relate to initial AD proteinopathy burden, a relationship further exaggerated in those with greater clinical severity.
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Affiliation(s)
- Eva Q Gontrum
- UCSF, Memory and Aging Center, San Francisco, California, USA,
| | | | - Shannon Lee
- UCSF, Memory and Aging Center, San Francisco, California, USA
| | - Valentina Diaz
- UCSF, Memory and Aging Center, San Francisco, California, USA
| | - Alexander Ehrenberg
- UCSF, Memory and Aging Center, San Francisco, California, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, USA
- Innovative Genomics Institute, University of California, Berkeley, California, USA
| | - Rowan Saloner
- UCSF, Memory and Aging Center, San Francisco, California, USA
| | - Nidhi S Mundada
- UCSF, Memory and Aging Center, San Francisco, California, USA
| | - Renaud La Joie
- UCSF, Memory and Aging Center, San Francisco, California, USA
| | - Gil Rabinovici
- UCSF, Memory and Aging Center, San Francisco, California, USA
| | - Joel H Kramer
- UCSF, Memory and Aging Center, San Francisco, California, USA
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Syrjanen JA, Krell-Roesch J, Kremers WK, Fields JA, Scharf EL, Knopman DS, Petersen RC, Vassilaki M, Geda YE. Association of Anxiety and Unspecified Emotional Distress Obtained from a Medical Records Linkage System with Incident Cognitive Outcomes in a Population-Based Setting. J Alzheimers Dis 2024; 100:1355-1364. [PMID: 38995789 PMCID: PMC11380226 DOI: 10.3233/jad-240213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Studies that assess cognition prospectively and study in detail anxiety history in the participants' medical records within the context of brain aging and Alzheimer's disease are limited. Objective To examine the associations of anxiety and unspecified emotional distress (UED) acquired throughout a person's life with prospectively collected cognitive outcomes. Methods Mayo Clinic Study of Aging participants who were cognitively unimpaired at baseline were included. Anxiety and UED data were abstracted from the medical record using the Rochester Epidemiology Project (REP) resources and were run separately as predictors in our models. The data were analyzed using Cox proportional hazards models for the outcomes of incident mild cognitive impairment (MCI) and dementia and using linear mixed effects models for the outcomes of global and domain specific cognitive z-scores and included key covariates. Results The study sample (n = 1,808) had a mean (standard deviation) age of 74.5 (7.3) years and 51.4% were male. Anxiety was associated with increased risk of MCI and dementia and was associated with lower baseline cognitive z-scores and accelerated decline over time in the global, memory, and attention domains. UED was associated with faster decline in all domains except visuospatial but did not show evidence of association with incident cognitive outcomes. These results varied by medication use and timing of anxiety. Conclusions Anxiety and UED both showed inverse associations with cognition. Utilization of anxiety and UED data from across the life course, as available, from the REP system adds robustness to our results.
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Affiliation(s)
- Jeremy A Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Janina Krell-Roesch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald C Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Yonas E Geda
- Department of Neurology and the Franke Barrow Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
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Frank B, Walsh M, Hurley L, Groh J, Blennow K, Zetterberg H, Tripodis Y, Budson AE, O'Connor MK, Martin B, Weller J, McKee A, Qiu W, Stein TD, Stern RA, Mez J, Henson R, Long J, Aschenbrenner AJ, Babulal GM, Morris JC, Schindler S, Alosco ML. Cognition Mediates the Association Between Cerebrospinal Fluid Biomarkers of Amyloid and P-Tau and Neuropsychiatric Symptoms. J Alzheimers Dis 2024; 100:1055-1073. [PMID: 38995786 DOI: 10.3233/jad-240125] [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] [Indexed: 07/14/2024]
Abstract
Background Neuropsychiatric symptoms (NPS) can be an early manifestation of Alzheimer's disease (AD). However, the associations among NPS, cognition, and AD biomarkers across the disease spectrum are unclear. Objective We analyzed cross-sectional mediation pathways between cerebrospinal fluid (CSF) biomarkers of AD (Aβ1-42, p-tau181), cognitive function, and NPS. Methods Primary models included 781 participants from the National Alzheimer's Coordinating Center (NACC) data set who had CSF analyzed for AD biomarkers using Lumipulse. NPS were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q). We assessed cognition with the harmonized MMSE/MoCA, as well as neuropsychological tests sensitive to AD pathology: story recall, naming, animal fluency, and Trails B. The Clinical Dementia Rating (CDR®) scale assessed dementia severity. Mediation models were estimated with Kemeny metric covariance in a structural equation model framework, controlling for age, education, sex, and APOEɛ4. Results The sample was older adults (M = 73.85, SD = 6.68; 49.9% male, 390; 27.9% dementia, 218) who were predominantly white (n = 688, 88.1%). Higher p-tau181/Aβ1-42 ratio predicted higher NPI-Q, which was partially mediated by the MMSE/MoCA and, in a second model, story recall. No other pathway was statistically significant. Both the MMSE/MoCA and NPI-Q independently mediated the association between p-tau181/Aβ1-42 ratio and CDR global impairment. With dementia excluded, p-tau181/Aβ1-42 ratio was no longer associated with the NPI-Q. Conclusions NPS may be secondary to cognitive impairment and AD pathology through direct and indirect pathways. NPS independently predict dementia severity in AD. However, AD pathology likely plays less of a role in NPS in samples without dementia.
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Affiliation(s)
- Brandon Frank
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Michael Walsh
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Landon Hurley
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Jenna Groh
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Andrew E Budson
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Maureen K O'Connor
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA, USA
| | - Brett Martin
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Jason Weller
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Ann McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Wendy Qiu
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Rachel Henson
- Knight Alzheimer Disease Research Center (ADRC), Washington University, St. Louis, MO, USA
| | - Justin Long
- Knight Alzheimer Disease Research Center (ADRC), Washington University, St. Louis, MO, USA
| | - Andrew J Aschenbrenner
- Knight Alzheimer Disease Research Center (ADRC), Washington University, St. Louis, MO, USA
| | - Ganesh M Babulal
- Knight Alzheimer Disease Research Center (ADRC), Washington University, St. Louis, MO, USA
| | - John C Morris
- Knight Alzheimer Disease Research Center (ADRC), Washington University, St. Louis, MO, USA
| | - Suzanne Schindler
- Knight Alzheimer Disease Research Center (ADRC), Washington University, St. Louis, MO, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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Celis K, Zaman A, Adams LD, Gardner O, Farid R, Starks TD, Lacroix FC, Hamilton-Nelson K, Mena P, Tejada S, Laux R, Song YE, Caban-Holt A, Feliciano-Astacio B, Vance JM, Haines JL, Byrd GS, Beecham GW, Pericak-Vance MA, Cuccaro ML. Neuropsychiatric features in a multi-ethnic population with Alzheimer disease and mild cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e5992. [PMID: 37655494 PMCID: PMC10518518 DOI: 10.1002/gps.5992] [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: 02/18/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Alzheimer disease (AD) is more prevalent in African American (AA) and Hispanic White (HIW) compared to Non-Hispanic White (NHW) individuals. Similarly, neuropsychiatric symptoms (NPS) vary by population in AD. This is likely the result of both sociocultural and genetic ancestral differences. However, the impact of these NPS on AD in different groups is not well understood. METHODS Self-declared AA, HIW, and NHW individuals were ascertained as part of ongoing AD genetics studies. Participants who scored higher than 0.5 on the Clinical Dementia Rating (CDR) Scale (CDR) were included. Group similarities and differences on Neuropsychiatric Inventory Questionnaire (NPI-Q) outcomes (NPI-Q total score, NPI-Q items) were evaluated using univariate ANOVAs and post hoc comparisons after controlling for sex and CDR stage. RESULTS Our sample consisted of 498 participants (26% AA; 30% HIW; 44% NHW). Overall, NPI-Q total scores differed significantly between our groups, with HIW having the highest NPI-Q total scores, and by AD stage as measured by CDR. We found no significant difference in NPI-Q total score by sex. There were six NPI-Q items with comparable prevalence in all groups and six items that significantly differed between the groups (Anxiety, Apathy, Depression, Disinhibition, Elation, and Irritability). Further, within the HIW group, differences were found between Puerto Rican and Cuban American Hispanics across several NPI-Q items. Finally, Six NPI-Q items were more prevalent in the later stages of AD including Agitation, Appetite, Hallucinations, Irritability, Motor Disturbance, and Nighttime Behavior. CONCLUSIONS We identified differences in NPS among HIW, AA, and NHW individuals. Most striking was the high burden of NPS in HIW, particularly for mood and anxiety symptoms. We suggest that NPS differences may represent the impact of sociocultural influences on symptom presentation as well as potential genetic factors rooted in ancestral background. Given the complex relationship between AD and NPS it is crucial to discern the presence of NPS to ensure appropriate interventions.
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Affiliation(s)
- Katrina Celis
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olivia Gardner
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rajabli Farid
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Faina C Lacroix
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kara Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pedro Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Renee Laux
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yeunjoo E Song
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan L Haines
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Institute for Computational Biology, Cleveland, Ohio, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
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Dantas EHM, Figueira OA, Figueira AA, Höekelmann A, Vale RGDS, Figueira JA, Figueira HA. The Association between Physical Activity and Anxiety in Aging: A Comparative Analysis. Healthcare (Basel) 2023; 11:2164. [PMID: 37570404 PMCID: PMC10418810 DOI: 10.3390/healthcare11152164] [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: 07/11/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: As the worldwide aging population is growing, there is a need to embrace the role of physical activity in the anxiety of older people. Objectives: To analyze anxiety in older people practitioners and non-practitioners of physical activity; (2) Methods: ample composed of 690 older people of both genders, unselected volunteers, residing in Brazil, present (as participants or observers) in selected street races in the state of Rio de Janeiro, Brazil, between 30 October 2019, and 12 March 2020. An instrument composed of the sociodemographic questionnaire and questions from the Beck Anxiety Inventory, BAI, and the Physical Activity Inventory for older people, Baecke-Old. Design: Ex-post-facto observational analytical descriptive research; (3) Results: The average age of the sample was in the range of 65 to 69y, 74% female, 94% completed high school, 69% living with the family, 84% practicing physical activity. Anxiety levels were 26% (without), 35% (mild), 21% (moderate), and 18% (severe). The comparison of anxiety showed a difference between the groups of active and sedentary elderly. Logistic regression analysis considering anxiety (yes or no; dichotomous variable) and physical activity (yes or no; dichotomous variable) and Odds Ratio were performed to identify possible influences of the independent variables PA, gender, marital status, and education on anxiety. Only physical activity was associated with anxiety. (4) Conclusions: The sample data of this research point to the conclusion that physical activity influences anxiety levels with 98% certainty, and it is suggested that it be enriched in the future with different studies with different designs. The older people practitioners of physical activity with a high level of education presented as 26% without, 35% mild, 21% moderate, and 18% severe anxiety. More active individuals are less likely to develop anxiety.
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Affiliation(s)
- Estelio Henrique Martin Dantas
- Laboratorio de Biociencias da Motricidade Humana (LABIMH), Programa de Pos-Graduacao em Enfermagem e Biociencias (PPGEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil; (E.H.M.D.); (O.A.F.)
| | - Olivia Andrade Figueira
- Laboratorio de Biociencias da Motricidade Humana (LABIMH), Programa de Pos-Graduacao em Enfermagem e Biociencias (PPGEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil; (E.H.M.D.); (O.A.F.)
| | - Alan Andrade Figueira
- Mestrado em Bioetica, Escola de Medicina e Ciencias da Vida, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba 80215-901, Brazil; (A.A.F.); (J.A.F.)
| | - Anita Höekelmann
- Seniorenzanz-Zentrum, Institut fur Sportwissenschaft, Otto-von-Guericke Universität, 39106 Magdeburg, Germany;
| | - Rodrigo Gomes de Souza Vale
- Departamento de Ciencias da Atividade Fisica (DCAF), Instituto de Educacao Fisica e Desportos (IEFD), Universidade Estácio de Sá (UNESA-RJ), Rio de Janeiro 20071-004, Brazil;
| | - Joana Andrade Figueira
- Mestrado em Bioetica, Escola de Medicina e Ciencias da Vida, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba 80215-901, Brazil; (A.A.F.); (J.A.F.)
| | - Helena Andrade Figueira
- Laboratorio de Biociencias da Motricidade Humana (LABIMH), Programa de Pos-Graduacao em Enfermagem e Biociencias (PPGEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil; (E.H.M.D.); (O.A.F.)
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Krell-Roesch J, Zaniletti I, Syrjanen JA, Kremers WK, Algeciras-Schimnich A, Dage JL, van Harten AC, Fields JA, Knopman DS, Jack CR, Petersen RC, Vassilaki M, Geda YE. Plasma-derived biomarkers of Alzheimer's disease and neuropsychiatric symptoms: A community-based study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12461. [PMID: 37529120 PMCID: PMC10387518 DOI: 10.1002/dad2.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION We examined associations between plasma-derived biomarkers of Alzheimer's disease (AD) and neuropsychiatric symptoms (NPS) in community-dwelling older adults. METHODS Cross-sectional study involving 1005 persons ≥50 years of age (mean 74 years, 564 male, 118 cognitively impaired), who completed plasma-derived biomarker (amyloid beta 42 [Aβ42]/Aβ40, phosphorylated tau 181 [p-tau181], p-tau217, total tau [t-tau], neurofilament light [NfL]), and NPS assessment. RESULTS P-tau181 (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.41-3.00, p < 0.001), p-tau217 (OR 1.70, 95% CI 1.10-2.61, p = 0.016), and t-tau (OR 1.44, 95% CI 1.08-1.92, p = 0.012) were associated with appetite change. We also found that p-tau181 and p-tau217 were associated with increased symptoms of agitation (OR 1.93, 95% CI 1.20-3.11, p = 0.007 and OR 2.04, 95% CI 1.21-3.42, p = 0.007, respectively), and disinhibition (OR 2.39, 95% CI 1.45-3.93, p = 0.001 and OR 2.30, 95% CI 1.33-3.98, p = 0.003, respectively). Aβ42/Aβ40 and NfL were not associated with NPS. CONCLUSION Higher plasma-derived p-tau181 and p-tau217 levels are associated with increased symptoms of appetite change, agitation, and disinhibition. These findings may support the validity of plasma tau biomarkers for predicting behavioral symptoms that often accompany cognitive impairment. HIGHLIGHTS We studied 1005 community-dwelling persons aged ≥ 50 yearsHigher plasma tau levels are associated with increased neuropsychiatric symptomsAβ42/Aβ40 and NfL are not associated with neuropsychiatric symptomsClinicians should treat neuropsychiatric symptoms in persons with high plasma-derived tau.
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Affiliation(s)
- Janina Krell-Roesch
- Institute of Sports and Sports Science Karlsruhe Institute of Technology Karlsruhe Germany
- Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA
| | - Isabella Zaniletti
- Department of Quantitative Health Sciences Mayo Clinic Scottsdale Arizona USA
| | - Jeremy A Syrjanen
- Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA
| | | | - Jeffrey L Dage
- Department of Neurology and Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis Indiana USA
| | - Argonde C van Harten
- Alzheimer Center, Department of Neurology Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Julie A Fields
- Department of Psychiatry and Psychology Mayo Clinic Rochester Minnesota USA
| | | | | | - Ronald C Petersen
- Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA
- Department of Neurology Mayo Clinic Rochester Minnesota USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA
| | - Yonas E Geda
- Department of Neurology and the Franke Barrow Global Neuroscience Education Center Barrow Neurological Institute Phoenix Arizona USA
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Liampas I, Siokas V, Lyketsos CG, Dardiotis E. Associations between neuropsychiatric symptoms and incident Alzheimer's dementia in men versus women. J Neurol 2023; 270:2069-2083. [PMID: 36572715 PMCID: PMC10025238 DOI: 10.1007/s00415-022-11541-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine whether associations between individual neuropsychiatric symptoms (NPS) and incident Alzheimer's dementia (AD) differ in men versus women. METHODS Data were acquired from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set. Two sets of older (≥ 60 years) participants were formed: one of cognitively unimpaired (CU) individuals, and one of participants with mild cognitive impairment (MCI). NPS were assessed using the Neuropsychiatric Inventory Questionnaire. Cox proportional hazards models examined associations between individual NPS and AD incidence separately for each participant set. These models featured individual NPS, sex, NPS by sex interactions as well as a number of covariates. RESULTS The analysis involved 9,854 CU individuals followed for 5.5 ± 3.8 years and 6,369 participants with MCI followed for 3.8 ± 3.0 years. NPS were comparably associated with future AD in men and women with MCI. Regarding CU participants, the following significant sex by NPS interactions were noted: female sex moderated the risk conferred by moderate/severe apathy (HR = 7.36, 3.25-16.64) by 74%, mitigated the risk conferred by moderate/severe depression (HR = 3.61, 2.08-6.28) by 52%, and augmented the risks conferred by mild depression (HR = 1.00, 0.60-1.68) and agitation (HR = 0.81, 0.40-1.64) by 83% and 243%, respectively. CONCLUSIONS Apathy, depression and agitation were differentially associated with incident AD in CU men and women. No individual NPS was associated with different risks of future AD in men versus women with MCI.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo Hill, 41100, Larissa, Greece.
| | - Vasileios Siokas
- Department of Neurology, Faculty of Medicine, School of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo Hill, 41100, Larissa, Greece
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo Hill, 41100, Larissa, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
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Figueira HA, Figueira OA, Figueira AA, Figueira JA, Polo-Ledesma RE, Lyra da Silva CR, Dantas EHM. Impact of Physical Activity on Anxiety, Depression, Stress and Quality of Life of the Older People in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1127. [PMID: 36673880 PMCID: PMC9858750 DOI: 10.3390/ijerph20021127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Population aging all over the world invites older people to be active, considering physical activity (PA) as associated with reduced anxiety, depression and stress and a high quality of life (QOL) in older people. OBJECTIVE To analyze anxiety, depression, stress and QOL as a function of PA in older people. METHODOLOGY Descriptive analytical research. Six hundred and ninety older people answered the instrument composed of sociodemographic questions, followed by questions from the WHOQOL-Old, Baecke-Old, WHOQOL-SRPB, Stress Perception Scale, Beck Anxiety Inventory and Beck Depression Inventory. RESULTS The beneficial effect of PA on the elderly is evident in this sample with such a high QoL (73%) and such a high level of physical activity (84%), and even with an advanced level of education (75%) and high spirituality (99.6%). The influence of PA on the anxiety and stress cluster showed Pearson's chi-square = 9.9, DF = 4, p = 0.04239, critical value = 9.5. The influence of PA on the anxiety, depression and stress cluster showed Pearson's chi-square = 6.8; DF = 5; p-value = 0.24; critical value = 11.1. CONCLUSION In the elderly, PA has a significant relationship with anxiety, stress and QOL. In addition, the high level of QOL of the elderly in the sample demonstrates the capacity for PA, educational level and spirituality for personal satisfaction.
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Affiliation(s)
- Helena Andrade Figueira
- Programa de Pos-Graducao em Enfermagem e Biociencias (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-180, Brazil
| | - Olivia Andrade Figueira
- Programa de Pos-Graducao em Enfermagem e Biociencias (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-180, Brazil
| | - Alan Andrade Figueira
- Escola de Ciencias da Vida do Programa de Pos-Graduacao em Bioetica (PPgB), Pontificia Universidade Catolica do Parana (PUR-PR), Curitiba 80215-901, Brazil
| | - Joana Andrade Figueira
- Escola de Ciencias da Vida do Programa de Pos-Graduacao em Bioetica (PPgB), Pontificia Universidade Catolica do Parana (PUR-PR), Curitiba 80215-901, Brazil
| | | | - Carlos Roberto Lyra da Silva
- Programa de Pos-Graducao em Enfermagem e Biociencias (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-180, Brazil
| | - Estelio Henrique Martin Dantas
- Programa de Pos-Graducao em Enfermagem e Biociencias (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-180, Brazil
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Pink A, Krell‐Roesch J, Syrjanen JA, Christenson LR, Lowe VJ, Vemuri P, Fields JA, Stokin GB, Kremers WK, Scharf EL, Jack CR, Knopman DS, Petersen RC, Vassilaki M, Geda YE. Interactions Between Neuropsychiatric Symptoms and Alzheimer's Disease Neuroimaging Biomarkers in Predicting Longitudinal Cognitive Decline. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 5:4-15. [PMID: 36909142 PMCID: PMC9997077 DOI: 10.1176/appi.prcp.20220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 01/22/2023] Open
Abstract
Objective To examine interactions between Neuropsychiatric symptoms (NPS) with Pittsburgh Compound B (PiB) and fluorodeoxyglucose positron emission tomography (FDG-PET) in predicting cognitive trajectories. Methods We conducted a longitudinal study in the setting of the population-based Mayo Clinic Study of Aging in Olmsted County, MN, involving 1581 cognitively unimpaired (CU) persons aged ≥50 years (median age 71.83 years, 54.0% males, 27.5% APOE ɛ4 carriers). NPS at baseline were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Brain glucose hypometabolism was defined as a SUVR ≤ 1.47 (measured by FDG-PET) in regions typically affected in Alzheimer's disease. Abnormal cortical amyloid deposition was measured using PiB-PET (SUVR ≥ 1.48). Neuropsychological testing was done approximately every 15 months, and we calculated global and domain-specific (memory, language, attention, and visuospatial skills) cognitive z-scores. We ran linear mixed-effect models to examine the associations and interactions between NPS at baseline and z-scored PiB- and FDG-PET SUVRs in predicting cognitive z-scores adjusted for age, sex, education, and previous cognitive testing. Results Individuals at the average PiB and without NPS at baseline declined over time on cognitive z-scores. Those with increased PiB at baseline declined faster (two-way interaction), and those with increased PiB and NPS declined even faster (three-way interaction). We observed interactions between time, increased PiB and anxiety or irritability indicating accelerated decline on global z-scores, and between time, increased PiB and several NPS (e.g., agitation) showing faster domain-specific decline, especially on the attention domain. Conclusions NPS and increased brain amyloid deposition synergistically interact in accelerating global and domain-specific cognitive decline among CU persons at baseline.
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Affiliation(s)
- Anna Pink
- First Department of MedicineParacelsus Medical UniversitySalzburgAustria
| | - Janina Krell‐Roesch
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
- Institute of Sports and Sports ScienceKarlsruhe Institute of TechnologyKarlsruheGermany
| | - Jeremy A. Syrjanen
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Luke R. Christenson
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Val J. Lowe
- Department of RadiologyMayo Clinic RochesterRochesterMinnesotaUSA
| | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Gorazd B. Stokin
- International Clinical Research Center/St. Anne HospitalBrnoCzech Republic
| | - Walter K. Kremers
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Eugene L. Scharf
- Department of NeurologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Clifford R. Jack
- Department of RadiologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - David S. Knopman
- Department of NeurologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Ronald C. Petersen
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Maria Vassilaki
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Yonas E. Geda
- Department of NeurologyFranke Global Neuroscience Education CenterBarrow Neurological InstitutePhoenixArizonaUSA
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Liampas I, Siokas V, Lyketsos CG, Dardiotis E. The Relationship between Neuropsychiatric Symptoms and Cognitive Performance in Older Adults with Normal Cognition. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1586. [PMID: 36363543 PMCID: PMC9694960 DOI: 10.3390/medicina58111586] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives: To explore whether specific Neuropsychiatric Symptoms (NPS) are related to worse performance in particular cognitive domains. Materials and Methods: A cross-sectional analysis of the baseline evaluations of older (≥60 years), cognitively unimpaired (CU) participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set was performed. Data were derived from 43 Alzheimer's Disease Research Centers. Cognitively impaired individuals, participants with psychiatric disorders and/or under treatment with antipsychotic, anxiolytic, sedative, or hypnotic agents were excluded. NPS were assessed using the Neuropsychiatric Inventory Questionnaire. The association of NPS with participants' performance on episodic memory, semantic memory, language, attention, processing speed and executive function was analysed using an adjusted (considering important demographic and medical factors) multivariate general linear model. Results: A total of 7179 CU, older, predominantly female, Caucasian, and well-educated participants were included in the present analysis. Among them, 1856 individuals had one or more NPS. Our analysis revealed that moderate/severe anxiety was related to worse performance on semantic memory, attention and executive function, the presence of hallucinations was linked to worse processing speed and executive function scores, while the presence of elation/euphoria and aberrant motor behaviour were associated with poorer attention and language performance, respectively. In the context of a secondary, exploratory analysis, the presence of moderate/severe delusions was related to worse processing speed and executive function performance. Conclusions: The relationship between specific NPS and worse performance in particular cognitive domains could inform the formulation of individualized preventive strategies directed to the ''fortification'' of specific cognitive functions in CU individuals with NPS.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece
| | - Constantine George Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Zainal NH, Newman MG. Elevated Anxious and Depressed Mood Relates to Future Executive Dysfunction in Older Adults: A Longitudinal Network Analysis of Psychopathology and Cognitive Functioning. Clin Psychol Sci 2022; 11:218-238. [PMID: 36993876 PMCID: PMC10046395 DOI: 10.1177/21677026221114076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vulnerability models posit that executive-functioning (EF) problems centrally affect future common (vs. rare) psychopathology symptoms. Conversely, scar theory postulates that depression/anxiety (vs. other psychopathology) symptoms centrally influence reduced EF. However, most studies so far have been cross-sectional. We used cross-lagged panel network analysis to determine temporal and component-to-component relations on this topic. Community older adults participated across four time points. Cognitive tests and the caregiver-rated Neuropsychiatric Inventory assessed nine psychopathology and eight cognitive-functioning nodes. Nodes with the highest bridge expected influence cross-sectionally were agitation and episodic memory. Episodic memory had the strongest inverse relation with age. Agitation had the strongest negative association with global cognition. EF nodes tended to be centrally affected by prior depressed and anxious moods rather than influential on any future nodes. Heightened anxious and depressed mood (vs. other nodes) centrally predicted future decreased EF-related (vs. non-EF-related) nodes in older adults, supporting scar (vs. vulnerability) theory.
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Affiliation(s)
- Nur Hani Zainal
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
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18
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Ronat L, Hoang VT, Hanganu A. Establishing an individualized model of conversion from normal cognition to Alzheimer's disease after 4 years, based on cognitive, brain morphology and neuropsychiatric characteristics. Int J Geriatr Psychiatry 2022; 37. [PMID: 35445762 DOI: 10.1002/gps.5718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The impact of neuropsychiatric symptoms (NPS) on cognitive performance has been reported, and this impact was better defined in the aging population. Yet the potential of using the impact of NPS on brain and cognitive performance in a longitudinal setting, as prediction of conversion - have remained questionable. This study proposes to establish a predictive model of conversion to Alzheimer's disease (AD) and mild cognitive impairment (MCI) based on current cognitive performance, NPS and their associations with brain morphology. METHODS 156 participants with MCI from the Alzheimer's Disease Neuroimaging Initiative database cognitively stable after a 4-year follow-up were compared to 119 MCI participants who converted to AD. Each participant underwent a neuropsychological assessment evaluating verbal memory, language, executive and visuospatial functions, a neuropsychiatric inventory evaluation and a 3 Tesla MRI. The statistical analyses consisted of 1) baseline comparison between the groups; 2) analysis of covariance model (controlling demographic parameters including functional abilities) to specify the variables that distinguish the two subgroups and; 3) used the significant ANCOVA variables to construct a binary logistic regression model that generates a probability equation to convert to a lower cognitive performance state. RESULTS Results showed that MCI who converted to AD in comparison to stable MCI, exhibited a higher NPS prevalence, a lower cognitive performance and a higher number of involved brain structures. Functional abilities, memory performance and the sizes of inferior temporal, hippocampal and amygdala sizes were significant predictors of MCI to AD conversion. We also report two models of conversion that can be implemented on an individual basis for calculating the percentage risk of conversion after 4 years. CONCLUSION These analytical methods might be a good way to anticipate cognitive and brain declines.
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Affiliation(s)
- Lucas Ronat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
- Faculté de Médecine, Département de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Van-Tien Hoang
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Alexandru Hanganu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
- Faculté des Arts et des Sciences, Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
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19
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Butler LM, Houghton R, Abraham A, Vassilaki M, Durán-Pacheco G. Comorbidity Trajectories Associated With Alzheimer's Disease: A Matched Case-Control Study in a United States Claims Database. Front Neurosci 2021; 15:749305. [PMID: 34690684 PMCID: PMC8531650 DOI: 10.3389/fnins.2021.749305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Trajectories of comorbidities among individuals at risk of Alzheimer's disease (AD) may differ from those aging without AD clinical syndrome. Therefore, characterizing the comorbidity burden and pattern associated with AD risk may facilitate earlier detection, enable timely intervention, and help slow the rate of cognitive and functional decline in AD. This case-control study was performed to compare the prevalence of comorbidities between AD cases and controls during the 5 years prior to diagnosis (or index date for controls); and to identify comorbidities with a differential time-dependent prevalence trajectory during the 5 years prior to AD diagnosis. Methods: Incident AD cases and individually matched controls were identified in a United States claims database between January 1, 2000 and December 31, 2016. AD status and comorbidities were defined based on the presence of diagnosis codes in administrative claims records. Generalized estimating equations were used to assess evidence of changes over time and between AD and controls. A principal component analysis and hierarchical clustering was performed to identify groups of AD-related comorbidities with respect to prevalence changes over time (or trajectory), and differences between AD and controls. Results: Data from 186,064 individuals in the IBM MarketScan Commercial Claims and Medicare Supplementary databases were analyzed (93,032 AD cases and 93,032 non-AD controls). In total, there were 177 comorbidities with a ≥ 5% prevalence. Five main clusters of comorbidities were identified. Clusters differed between AD cases and controls in the overall magnitude of association with AD, in their diverging time trajectories, and in comorbidity prevalence. Three clusters contained comorbidities that notably increased in frequency over time in AD cases but not in controls during the 5-year period before AD diagnosis. Comorbidities in these clusters were related to the early signs and/or symptoms of AD, psychiatric and mood disorders, cerebrovascular disease, history of hazard and injuries, and metabolic, cardiovascular, and respiratory complaints. Conclusion: We demonstrated a greater comorbidity burden among those who later developed AD vs. controls, and identified comorbidity clusters that could distinguish these two groups. Further investigation of comorbidity burden is warranted to facilitate early detection of individuals at risk of developing AD.
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Affiliation(s)
| | | | | | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
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20
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The interplay between depressive symptoms, cognitive function, activities of daily living and cognitive reserve in older adults. Int Psychogeriatr 2021; 33:759-761. [PMID: 33823954 DOI: 10.1017/s1041610221000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Zhang M, Chen B, Zhong X, Zhou H, Wang Q, Mai N, Wu Z, Chen X, Peng Q, Zhang S, Yang M, Lin G, Ning Y. Neuropsychiatric Symptoms Exacerbate the Cognitive Impairments in Patients With Late-Life Depression. Front Psychiatry 2021; 12:757003. [PMID: 34867543 PMCID: PMC8639522 DOI: 10.3389/fpsyt.2021.757003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Neuropsychiatric symptoms (NPS) and cognitive impairments are both common in patients with late-life depression (LLD). However, the relationship between NPS and cognitive functions in LLD patients remains unclear. The current study aims to explore the effects of NPS on cognitive impairments in LLD patients. Methods: Two hundred and sixty-two LLD patients and 141 normal controls (NC) were recruited. Exploratory factor analysis was used to extract factors from the Neuropsychiatric Inventory (NPI). Correlation, mediation, and moderation analyses were used to explore whether NPS exacerbated the cognitive impairments in LLD and whether NPS exhibited different effects on cognitive impairments in acute-state LLD (aLLD) and recovery-state LLD (rLLD). Results: Three main factors were extracted from the NPI, including emotional, behavioral, and psychotic factors. The patients with LLD exhibited worse cognition and higher NPI scores, and the scores of NPI-total and three extracted factors were negatively associated with cognitive scores. The mediation analyses exhibited that NPI-total and behavioral factor scores increase the difference in cognition scores between LLD and NC groups. The mediation analyses exhibited that behavioral factor score played a greater effect on impairing MMSE in the rLLD group than in the aLLD group. Additionally, behavioral factor score was in a trend to be negatively associated with Mini-Mental State Examination (MMSE) score changes at a one-year follow-up (p = 0.051). Conclusions: NPS, especially behavioral symptoms, exacerbate cognitive impairments in LLD and may contribute to residual cognitive impairment in rLLD patients. Early intervention for behavioral symptoms in LLD patients may be beneficial to their long-term clinical prognosis.
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Affiliation(s)
- Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ben Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huarong Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Naikeng Mai
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhangying Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinru Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Peng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Si Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minfeng Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gaohong Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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