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Ercoli T, Bagella CF, Frau C, Ruiu E, Othmani S, Gusinu G, Masala C, Sechi LA, Solla P, Defazio G. Phantosmia in Parkinson's Disease: A Systematic Review of the Phenomenology of Olfactory Hallucinations. Neurol Int 2023; 16:20-32. [PMID: 38251050 PMCID: PMC10801480 DOI: 10.3390/neurolint16010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Olfactory dysfunction is a prevalent non-motor symptom in Parkinson's disease (PD), affecting approximately 65-90% of subjects. PD patients may also report odor perception in the absence of any external source, often referred to as olfactory hallucinations (OHs) or phantosmia. This study aims to explore the current understanding of OHs in PD and offer a comprehensive overview of their prevalence and characteristics. We conducted a systematic search of the literature published on PubMed from inception to July 2023 regarding OHs in PD, following PRISMA guidelines. From the 2875 studies identified through database searching, 29 studies fulfilled the necessary criteria and underwent data extraction. The frequency of OHs in PD patients varies widely, ranging from 0.5% to 18.2%, with female prevalence ranging from 36% to 75% of the patients. Olfactory experiences may vary widely, ranging from pleasant scents to unpleasant odors. Several studies have indicated the concurrent presence of other types of hallucinations alongside phantosmia, especially visual and auditory hallucinations. OHs in PD are a type of hallucination that has been largely overlooked. To gain a deeper understanding of OHs in PD patients, the next crucial step should involve the development and validation of a dedicated questionnaire.
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Affiliation(s)
- Tommaso Ercoli
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Caterina Francesca Bagella
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Claudia Frau
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Elisa Ruiu
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Sabrine Othmani
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Giansalvo Gusinu
- Department of Biomedical Sciences, Sassari University, 07100 Sassari, Italy; (G.G.); (L.A.S.)
| | - Carla Masala
- Department of Biomedical Sciences, University of Cagliari, SP 8 Cittadella Universitaria, 09042 Monserrato, Italy
| | - Leonardo Antonio Sechi
- Department of Biomedical Sciences, Sassari University, 07100 Sassari, Italy; (G.G.); (L.A.S.)
| | - Paolo Solla
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70121 Bari, Italy;
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Non-visual hallucinations in Parkinson's disease: a systematic review. J Neurol 2023; 270:2857-2889. [PMID: 36702960 DOI: 10.1007/s00415-022-11545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Non-visual hallucinations in Parkinson's disease (PD) can be prevalent and distressing. Most existing research has however, focused on visual hallucinations as well as related risk factors. The current study thus conducted a systematic review to collate existing evidence on non-visual hallucinations in PD, focusing on their prevalence, phenomenology, and clinical-cognitive correlates. METHODS Ninety-one relevant studies were included from a systematic search across PsycINFO APA, PubMed, and Web of Science, for peer-reviewed publications in the English language, from 1970 to the present. These comprised a mix of case (30 studies; n = 56) and group design (62 studies; n = 7346) studies, divided into three somewhat overlapping collections to address our three research foci. RESULTS Prevalence estimates for hallucinations were: auditory 1.5-72.0%, olfactory 1.6-21.0%, somatic-tactile 0.4-22.5%, gustatory 1.0-15.0%, and sensed presence 0.9-73.3%. Phenomenological inquiries revealed descriptions of vivid, consuming events replete with elaborate detail, adversely affecting PD patients in different ways. Overt experiences of multisensory hallucinations were also highly variable (0.4-80%) but exceedingly common, reported by almost half of the 45 included prevalence studies. There was some evidence for modality-specific hallucination predictors, but this was largely tentative, pending robust replication. CONCLUSIONS Marked prevalence figures coupled with phenomenological descriptions implicating distress denote that non-visual and multisensory hallucinations in PD are of clinical significance. More direct research and clinical attention need to be devoted to the study and management of such hallucinatory experiences.
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Rodriguez-Porcel F, Wyman-Chick KA, Abdelnour Ruiz C, Toledo JB, Ferreira D, Urwyler P, Weil RS, Kane J, Pilotto A, Rongve A, Boeve B, Taylor JP, McKeith I, Aarsland D, Lewis SJG. Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations. Transl Neurodegener 2022; 11:24. [PMID: 35491418 PMCID: PMC9059356 DOI: 10.1186/s40035-022-00299-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/31/2022] [Indexed: 12/28/2022] Open
Abstract
The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer's or Parkinson's disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials.
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Affiliation(s)
- Federico Rodriguez-Porcel
- Department of Neurology, Medical University of South Carolina, 208b Rutledge Av., Charleston, SC, 29403, USA.
| | - Kathryn A Wyman-Chick
- Department of Neurology, Center for Memory and Aging, HealthPartners, Saint Paul, MN, USA
| | | | - Jon B Toledo
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer's Research, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Prabitha Urwyler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - Joseph Kane
- Centre for Public Health, Queen's University, Belfast, UK
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arvid Rongve
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway
- Institute of Clinical Medicine (K1), The University of Bergen, Bergen, Norway
| | - Bradley Boeve
- Department of Neurology, Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
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4
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Contribution of neuropsychiatric symptoms in Parkinson's disease to different domains of caregiver burden. J Neurol 2021; 268:2961-2972. [PMID: 33629181 PMCID: PMC8289810 DOI: 10.1007/s00415-021-10443-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Abstract
Introduction Caregiver burden is high among caregivers of PD patients (CPD). Neuropsychiatric symptoms are leading contributors to CPD burden, but whether different symptoms differentially impact domains of caregiver burden is not known. Our objective was to examine which neuropsychiatric symptoms and demographic factors contribute to different domains of caregiver burden in PD. Methods This was a cross-sectional online survey study. Participants were recruited from the Fox Insight (FI) study and were eligible if they identified themselves as a CPD. The primary outcome was the Caregiver Burden Inventory (CBI) total score and its 5 sub-domain scores. The Neuropsychiatric Inventory Questionnaire (NPI-Q) assessed caregiver-reported neuropsychiatric symptoms in the care recipient. Multivariable linear regression models were used to characterize the associations between NPI-Q symptom severity scores and CBI scores. Covariates were caregiver age, sex, education, and caregiving duration. Results The sample consisted of 450 CPD, mean age 65.87 (SD 10.39) years, 74% females. After adjusting for covariates, CBI total score was predicted by NPI-Q total score (β = 1.96, p < 0.001); model adjusted R2 = 39.2%. Anxiety severity had the largest effect size [standardized β (sβ) = 0.224] on the time-dependency domain, which was also associated with female sex (sβ = − 0.133) and age (sβ = 0.088). Severity of disinhibition (sβ = 0.218), agitation (sβ = 0.199), and female sex (sβ = 0.104) were associated with greater emotional burden. Conclusion Our findings indicate that demographic characteristics and specific neuropsychiatric symptoms contribute differentially to domains of caregiver burden. Tailored interventions to support CPD are needed. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10443-7.
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Horne KL, MacAskill MR, Myall DJ, Livingston L, Grenfell S, Pascoe MJ, Young B, Shoorangiz R, Melzer TR, Pitcher TL, Anderson TJ, Dalrymple-Alford JC. Neuropsychiatric Symptoms Are Associated with Dementia in Parkinson's Disease but Not Predictive of it. Mov Disord Clin Pract 2021; 8:390-399. [PMID: 33816668 DOI: 10.1002/mdc3.13151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/27/2020] [Accepted: 01/07/2021] [Indexed: 11/12/2022] Open
Abstract
Background Neuropsychiatric symptoms in Parkinson's disease (PD) may increase dementia (PDD) risk. The predictive value of these symptoms, however, has not been compared to clinical and demographic predictors of future PDD. Objectives Determine if neuropsychiatric symptoms are useful markers of PDD risk. Methods 328 PD participants completed baseline neuropsychiatric and MDS-Task Force-Level II assessments. Of these, 202 non-demented individuals were followed-up over a four-years period to detect conversion to PDD; 51 developed PDD. ROC analysis tested associations between baseline neuropsychiatric symptoms and future PDD. The probability of developing PDD was also modeled as a function of neuropsychiatric inventory (NPI)-total score, PD Questionnaire (PDQ)-hallucinations, PDQ-anxiety, and contrasted to cognitive ability, age, and motor function. Leave-one-out information criterion was used to evaluate which models provided useful information when predicting future PDD. Results The PDD group experienced greater levels of neuropsychiatric symptoms compared to the non-PDD groups at baseline. Few differences were found between the PD-MCI and PD-N groups. Six neuropsychiatric measures were significantly, but weakly, associated with future PDD. The strongest was NPI-total score: AUC = 0.66 [0.57-0.75]. There was, however, no evidence it contained useful out-of-sample predictive information of future PDD (delta ELPD = 1.8 (SD 2.5)); Similar results held for PDQ-hallucinations and PDQ-anxiety. In contrast, cognitive ability (delta ELPD = 36 (SD 8)) and age (delta ELPD = 11 (SD 5)) provided useful predictive information of future PDD. Conclusions Cognitive ability and age strongly out-performed neuropsychiatric measures as markers of developing PDD within 4 years. Therefore, neuropsychiatric symptoms do not appear to be useful markers of PDD risk.
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Affiliation(s)
- Kyla-Louise Horne
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand.,School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Michael R MacAskill
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand
| | - Daniel J Myall
- New Zealand Brain Research Institute Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand
| | - Leslie Livingston
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand
| | - Sophie Grenfell
- New Zealand Brain Research Institute Christchurch New Zealand
| | - Maddie J Pascoe
- New Zealand Brain Research Institute Christchurch New Zealand
| | - Bob Young
- New Zealand Brain Research Institute Christchurch New Zealand
| | - Reza Shoorangiz
- New Zealand Brain Research Institute Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand.,Department of Electrical and Computer Engineering University of Canterbury Christchurch New Zealand
| | - Tracy R Melzer
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand
| | - Toni L Pitcher
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand
| | - Tim J Anderson
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand.,Department of Neurology Christchurch Hospital Christchurch New Zealand
| | - John C Dalrymple-Alford
- New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine University of Otago Christchurch New Zealand.,Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research Excellence Christchurch New Zealand.,School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
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6
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Mantri S, Edison B, Alzyoud L, Albert SM, Daeschler M, Kopil C, Marras C, Chahine LM. Knowledge, Responsibilities, and Peer Advice From Care Partners of Patients With Parkinson Disease Psychosis. Front Neurol 2021; 12:633645. [PMID: 33597918 PMCID: PMC7882678 DOI: 10.3389/fneur.2021.633645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction: Care partners (CPs) of individuals with Parkinson disease psychosis (PDP) experience increased strain and rely on informal support networks. The objective of this study was to characterize CP responsibilities, sources of support, and peer advice. Methods: This was a mixed-methods cross-sectional study. The sample was recruited from the online Fox Insight study cohort. CPs who indicated their care recipient suffered hallucinations and/or delusions were administered a questionnaire regarding their caregiving experience to person with PDP. A free-text question asked CPs to give advice to a hypothetical peer CP. Responses to multiple-choice questions were tabulated; responses to the free-text question were grouped into advice categories. Results: 145 CP of individuals with PDP were included in this analysis, mean age (standard deviation, SD) 66.4 (9.4) years; 110 (75.9%) were women. Most (115, 79.3%) provided caregiving on a daily basis, with a range of responsibilities. Only 16 (11%) learned about PDP from a physician; communication challenges included perceived embarrassment or having to prioritize other issues in a limited appointment time. The most common peer advice was to alert the care recipient's neurologist (n = 38, 30.4%); only 8 (6.4%) suggested medication changes. Conclusion: CPs face challenges with clinician communication and learn about psychosis from a variety of informal sources. Few CPs advocate for medications to control PDP, instead preferring non-pharmacological management strategies. Peer advice favored alerting the care recipient's physician, suggesting that CPs do desire more information from the medical team.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, United States
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lamees Alzyoud
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven M Albert
- Department of Behavioral and Community Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Margaret Daeschler
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Catherine Kopil
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
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7
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Pimavanserin Treatment for Parkinson's Disease Psychosis in Clinical Practice. PARKINSONS DISEASE 2021; 2021:2603641. [PMID: 33489083 PMCID: PMC7801085 DOI: 10.1155/2021/2603641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023]
Abstract
Background Parkinson's disease psychosis (PDP) is a common, nonmotor symptom of Parkinson's disease (PD), which may affect up to 60% of patients and is associated with impaired quality of life, increased healthcare costs, and nursing home placement, among other adverse outcomes. Characteristic symptoms of PDP include illusions; visual, auditory, tactile, and olfactory hallucinations; and delusions. PDP symptoms typically progress over its course from being mild, infrequent, and often untroubling to complex, sometimes constant, and potentially highly disturbing. PDP has traditionally been treated with atypical antipsychotics (e.g., clozapine and quetiapine) although these are not approved for this indication and clozapine requires frequent white blood cell count monitoring due to the risk of agranulocytosis. Pimavanserin is a newer atypical antipsychotic with highly selective binding to serotonergic receptors, no evidence for worsening motor symptoms in PD, and no need for white blood cell count monitoring. It is currently the only approved medication indicated for PDP treatment. However, because it was approved relatively recently (2016), clinical experience with pimavanserin is limited. Case Presentations. A wide variety of representative clinical scenarios are presented, each with distinct variables and complications. Issues addressed include distinguishing PDP from similar symptoms caused by other disorders such as dementia, coordinating pimavanserin with other PD medications and with deep brain stimulation, adapting pimavanserin dosing for optimal benefit and tolerability, and recognizing variability of PDP symptoms due to patients' changing life circumstances. Conclusions These scenarios provide multiple insights regarding PDP management and the role of pimavanserin. Effective treatment of PDP may reduce disturbing symptoms of psychosis, thus improving patient function and quality of life. In addition, effective pharmacotherapy for PDP may also facilitate the use of other medications needed to treat neurological symptoms of PD (e.g., tremor, bradykinesia, and dyskinesia), although they may also have adverse effects that contribute to symptoms of PDP.
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Abstract
Introduction: Hallucinations in Parkinson's disease are common, can complicate medication management and significantly impact upon the quality of life of patients and their carers.Areas covered: This review aims to examine current evidence for the management of hallucinations in Parkinson's disease.Expert opinion: Treatment of hallucinations in Parkinson's disease should be both individualized and multifaceted. Screening, education, medication review and the avoidance of common triggers are important. For well-formed visual hallucinations, acetylcholinesterase inhibitors are recommended first-line. Refractory or severe symptoms may require the cautious use of atypical antipsychotics. Antidepressants may be beneficial in the appropriate setting. Unfortunately, current therapies for hallucinations offer only limited benefits and future research efforts are desperately required to improve the management of these challenging symptoms.
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Affiliation(s)
- Alice Powell
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, the University of Sydney, Camperdown, Australia.,Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, Australia
| | - Elie Matar
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, the University of Sydney, Camperdown, Australia
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, the University of Sydney, Camperdown, Australia
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Neuropsychiatric Symptoms as a Reliable Phenomenology of Cerebellar Ataxia. THE CEREBELLUM 2020; 20:141-150. [PMID: 33000380 DOI: 10.1007/s12311-020-01195-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
While cerebellar ataxia (CA) is a neurodegenerative disease known for motor impairment, changes in mood have also been reported. A full account of neuropsychiatric symptomology in CA may guide improvements in treatment regimes, measure the presence and severity of sub-clinical neuropsychiatric disturbance symptomology in CA, and compare patient versus informant symptom recognition. Neuropsychiatric phenomena were gathered from CA patients with genetic and unknown etiologies and their informants (e.g., spouse or parent). Information was obtained from in-person interviews and the Center for Epidemiologic Studies Depression Scale. Responses were converted to the Neuropsychiatric Inventory-Questionnaire (NPI-Q) scores by consensus ratings. Patient NPI-Q scores were evaluated for symptom prevalence and severity relative to those obtained from healthy controls. Patient-informant NPI-Q score disagreements were evaluated. In this cohort, 95% of patients presented with at least one neuropsychiatric symptom and 51% of patients with three or more symptoms. The most common symptoms were anxiety, depression, nighttime behaviors (e.g., interrupted sleep), irritability, disinhibition, abnormal appetite, and agitation. The prevalence of these neuropsychiatric symptoms was uniform across patients with genetic versus unknown etiologies. Patient and informant symptom report disagreements reflected that patients noted sleep impairment and depression, while informants noted irritability and agitation. Neuropsychiatric disturbance is highly prevalent in patients with CA and contributes to the phenomenology of CA, regardless of etiology. Clinicians should monitor psychiatric health in their CA patients, considering that supplemental information from informants can help gauge the impact on family members and caregivers.
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Badcock JC, Larøi F, Kamp K, Kelsall-Foreman I, Bucks RS, Weinborn M, Begemann M, Taylor JP, Collerton D, O’Brien JT, El Haj M, Ffytche D, Sommer IE. Hallucinations in Older Adults: A Practical Review. Schizophr Bull 2020; 46:1382-1395. [PMID: 32638012 PMCID: PMC7707075 DOI: 10.1093/schbul/sbaa073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.
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Affiliation(s)
- Johanna C Badcock
- School of Psychological Science, University of Western Australia, Perth, Australia
- Perth Voices Clinic, Murdoch, Australia
- To whom correspondence should be addressed; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, 6009; tel: 0423123665, fax: 61864881006, e-mail:
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liege, Liege, Belgium
- Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Karina Kamp
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus C, Denmark
| | | | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Marieke Begemann
- Department of Biomedical Sciences of Cells and Systems, University Medical Center, Rijks Universiteit Groningen (RUG), Groningen, The Netherlands
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Collerton
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mohamad El Haj
- Laboratoire de Psychologie des Pays de la Loire (LPPL-EA 4638), Nantes Université, Univ Angers, Nantes, France
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Iris E Sommer
- Rijks Universiteit Groningen (RUG), Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, The Netherlands
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Cholerton B, Poston KL, Tian L, Quinn JF, Chung KA, Hiller AL, Hu SC, Specketer K, Montine TJ, Edwards KL, Zabetian CP. Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease. Mov Disord Clin Pract 2019; 7:61-69. [PMID: 31970213 DOI: 10.1002/mdc3.12870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/16/2019] [Accepted: 11/04/2019] [Indexed: 01/13/2023] Open
Abstract
Introduction Cognitive dysfunction is common in Parkinson's disease (PD) and associated with reduced functional abilities and increased dependence. To date, however, little is known about the relationship between performance of instrumental activities of daily living (IADLs) and cognitive stages in PD, and there are conflicting reports as to whether declines in specific cognitive domains predict IADL impairment. Methods Participants with PD were drawn from the Pacific Udall Center and included in the study if both participant and study partner IADL ratings and cognitive tests were completed (n = 192). Logistic regression analyses were performed to determine whether participant and/or study partner rating predicted mild cognitive impairment or dementia. Correlations are reported for the relationship between participant/study partner IADL reports as well as for specific cognitive tests. Results Although both participant and study partner ratings of IADL performance were associated with a diagnosis of PD with dementia, only participant self-rating of functional ability was significantly associated with a diagnosis of PD with mild cognitive impairment. Functional ability correlated most strongly with measures of processing speed, auditory working memory, and immediate verbal recall for both the participant and study partner ratings. Conclusion For participants with PD in the early stages of cognitive decline, self-rating may be more sensitive to the impact of cognitive changes on IADL function than ratings made by a knowledgeable study partner. Changes in executive function, processing speed, and learning may indicate a higher likelihood of IADL impairment. Careful assessment of cognition and IADL performance is recommended to permit individualized interventions prior to significant disability.
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Affiliation(s)
- Brenna Cholerton
- Department of Pathology Stanford University School of Medicine Palo Alto California USA
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences Stanford School of Medicine Palo Alto California USA
| | - Lu Tian
- Department of Biomedical Data Science Stanford University School of Medicine Palo Alto CA USA
| | - Joseph F Quinn
- Parkinson's Disease Research, Education, and Clinical Center Portland Veterans Affairs Health Care System Portland Oregon USA.,Department of Neurology Oregon Health and Science University Portland Oregon USA
| | - Kathryn A Chung
- Parkinson's Disease Research, Education, and Clinical Center Portland Veterans Affairs Health Care System Portland Oregon USA.,Department of Neurology Oregon Health and Science University Portland Oregon USA
| | - Amie L Hiller
- Parkinson's Disease Research, Education, and Clinical Center Portland Veterans Affairs Health Care System Portland Oregon USA.,Department of Neurology Oregon Health and Science University Portland Oregon USA
| | - Shu-Ching Hu
- Geriatric Research, Education, and Clinical Center Veterans Affairs Puget Sound Health Care System Seattle Washington USA.,Department of Neurology University of Washington School of Medicine Seattle Washington USA
| | - Krista Specketer
- Geriatric Research, Education, and Clinical Center Veterans Affairs Puget Sound Health Care System Seattle Washington USA
| | - Thomas J Montine
- Department of Pathology Stanford University School of Medicine Palo Alto California USA
| | - Karen L Edwards
- Department of Epidemiology University of California, Irvine, School of Medicine Irvine California USA
| | - Cyrus P Zabetian
- Geriatric Research, Education, and Clinical Center Veterans Affairs Puget Sound Health Care System Seattle Washington USA.,Department of Neurology University of Washington School of Medicine Seattle Washington USA
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