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Ferreira DA, Macedo LBC, Foss MP. Neuropsychiatric symptoms as a prodromal factor in Alzheimer's type neurodegenerative disease: A scoping review. Clin Neuropsychol 2024; 38:1031-1059. [PMID: 37881945 DOI: 10.1080/13854046.2023.2273574] [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] [Received: 05/21/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Objective: Identifying neuropsychiatric symptoms (NPS) can aid in the early detection of Alzheimer's disease (AD); however, there is still a need for a greater consensus. This review aims to delineate the predominant NPS, compile a comprehensive list of the most commonly employed NPS assessment tools, and corroborate the principal findings regarding the link between NPS and neuropsychological assessment and neurobiological substrates. Methods: To conduct this scoping review, we followed the Preferred Reporting Items for Systematic Reviews guidelines and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched for relevant articles published between 2017 and 2023 in MEDLINE, PsycINFO, PubMed, Web of Science, and Cochrane Library. Results: Of the 61 eligible articles, depression, anxiety, and apathy were the main NPSs. The Neuropsychiatric Inventory Questionnaire and Neuropsychiatric Inventory were the primary assessment tools used to evaluate NPS. Correlations between NPS severity and neurobiological markers were considered clinically significant. Furthermore, clinical procedures prioritized the use of global cognitive screening tools, assessments of executive functions, and functionality evaluations. Conclusion: Standardization of procedures is necessary because of the diversity of methods. The data show that NPS can predict the etiology, severity, form, and type of disease progression, serving as a precursor sign of AD. The results of the most common cognitive screening tools and NPS instruments provided an interesting overview of future clinical approaches.
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Affiliation(s)
- Diego Alves Ferreira
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lorena Barbosa Cunha Macedo
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Paula Foss
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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2
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Alb'ool B, Abu Khait A. The presence and severity of neuropsychiatric symptoms and their association with quality of life among patients with dementia. Cogn Neuropsychiatry 2023; 28:307-325. [PMID: 37665567 DOI: 10.1080/13546805.2023.2255342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/10/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms are common manifestations of dementia. The presence and severity of these symptoms differ depending on different personal and contextual factors. PURPOSE This study aimed to investigate the presence and predictors of neuropsychiatric symptoms and the association between the severity of these symptoms and the quality of life in a sample of patients with dementia in Jordan. METHODS In this cross-sectional study, 112 patients with dementia residing in Jordanian nursing homes were recruited using the consecutive sampling method. RESULTS The mean severity of neuropsychiatric symptoms was 9.58. The most prevalent neuropsychiatric symptoms among patients were depression (61.6%), followed by irritability (55.4%), and a feeling of euphoria (54.5%). The regression analysis results indicated that gender, marital status, and dementia severity significantly predicted the neuropsychiatric symptoms severity score and explained 17.70% of the variance. A significant negative correlation between the severity of neuropsychiatric symptoms and quality of life was found. CONCLUSION The study's results indicate that our sample reported mild neuropsychiatric symptoms. These symptoms' high prevalence and persistence negatively impact patients' quality of life. The study's results can help mental health nurses determine the factors impacting effective treatment strategies to combat these symptoms. Future longitudinal studies are warranted to help explain the importance of early diagnosis and management of these symptoms in preventing dementia progression.
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Affiliation(s)
- Banan Alb'ool
- Department of Health Care, Vocational Training Corporation, Irbid, Jordan
| | - Abdallah Abu Khait
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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3
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Jiang J, Hong Y, Li W, Wang A, Jiang S, Jiang T, Wang Y, Wang L, Yang S, Ren Q, Zou X, Xu J. Chain Mediation Analysis of the Effects of Nutrition and Cognition on the Association of Apolipoprotein E ɛ4 with Neuropsychiatric Symptoms in Alzheimer's Disease. J Alzheimers Dis 2023; 96:669-681. [PMID: 37840496 DOI: 10.3233/jad-230577] [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: 10/17/2023]
Abstract
BACKGROUND Apolipoprotein E (APOE) is the most recognized risk gene for cognitive decline and clinical progression of late-onset Alzheimer's disease (AD); nonetheless, its association with neuropsychiatric symptoms (NPSs) remains inconclusive. OBJECTIVE To investigate the association of APOE ɛ4 with NPSs and explore nutritional status and cognition as joint mediators of this association. METHODS Between June 2021 and October 2022, patients with amnestic mild cognitive impairment (aMCI) or AD were recruited from the Chinese Imaging, Biomarkers, and Lifestyle Study. NPSs were assessed using the Neuropsychiatric Inventory, while global cognition and nutritional status were evaluated using the Mini-Mental State Examination (MMSE) and Mini-Nutritional Assessment (MNA), respectively. Simple mediation and multiple chain mediation models were developed to examine the mediating effects of the MNA and MMSE scores on the relationship between APOE ɛ4 and specific neuropsychiatric symptom. RESULTS Among 310 patients, 229 (73.87%) had NPSs, and 110 (35.48%) carried APOE ɛ4. Patients with APOE ɛ4 were more likely to have hallucinations (p = 0.014), apathy (p = 0.008), and aberrant motor activity (p = 0.018). MNA and MMSE scores mediated the association between APOE ɛ4 and hallucinations (17.97% and 37.13%, respectively), APOE ɛ4 and apathy (30.73% and 57.72%, respectively), and APOE ɛ4 and aberrant motor activity (17.82% and 34.24%), respectively. Chain-mediating effects of MNA and MMSE scores on the association of APOE ɛ4 with hallucinations, apathy, and aberrant motor activity after adjusting for confounding factors were 6.84%, 11.54%, and 6.19%, respectively. CONCLUSION Nutritional status and cognition jointly mediate the association between APOE ɛ4 and neuropsychiatric symptoms in patients with aMCI or AD.
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Affiliation(s)
- Jiwei Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Yin Hong
- Department of Health Management, Beijing Tian Tan Hospital, Capital Medical University, Fengtai District, Beijing, China
| | - Wenyi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Shirui Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Tianlin Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Yanli Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Linlin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Shiyi Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Qiwei Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Xinying Zou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
- National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China
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4
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Fresnais D, Humble MB, Bejerot S, Meehan AD, Fure B. Apathy as a Predictor for Conversion From Mild Cognitive Impairment to Dementia: A Systematic Review and Meta-Analysis of Longitudinal Studies. J Geriatr Psychiatry Neurol 2023; 36:3-17. [PMID: 35446723 PMCID: PMC9755689 DOI: 10.1177/08919887221093361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Apathy is one of the most prevalent neurobehavioral manifestations in mild cognitive impairment (MCI) and is included among the behavioral and psychological symptoms of dementia (BPSD). Studies suggest that the presence of apathy could be associated with increased dementia risk. The role of apathy in conversion from MCI to dementia, and whether apathy could be a relevant predictor for dementia progression, are still matters of investigation. AIM To study the relationship between apathy and progression to dementia in individuals with MCI. METHODS A systematic literature search in Medline, Embase, Cochrane Library, Epistemonikos, PsychINFO, and CINAHL was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included longitudinal studies reporting on the association between apathy and dementia. RESULTS The main outcome was pooled unadjusted hazard ratios (HR) of apathy in dementia conversion and included 11 studies with 9504 individuals. There was a significant association between apathy and dementia conversion, HR = 1.54; 95% CI, 1.29, 1.84. Subgroup analysis showed a significant association between apathy and progression to AD. CONCLUSION Apathy was associated with an increased risk of conversion to AD and all-cause dementia in patients with MCI. The role of apathy as a marker for incident dementia needs to be investigated in large, high-quality studies.
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Affiliation(s)
- David Fresnais
- School of Medical Sciences, Örebro University, Örebro, Sweden,Department of Internal Medicine, Central Hospital Karlstad, Region Värmland, Sweden
| | - Mats B. Humble
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Adrian D. Meehan
- School of Medical Sciences, Örebro University, Örebro, Sweden,Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Brynjar Fure
- School of Medical Sciences, Örebro University, Örebro, Sweden,Department of Internal Medicine, Central Hospital Karlstad, Region Värmland, Sweden,Brynjar Fure, School of Medical Sciences, Örebro University, Fakultetsgatan 1, Örebro 702 81, Sweden.
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5
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McGrattan AM, Pakpahan E, Siervo M, Mohan D, Reidpath DD, Prina M, Allotey P, Zhu Y, Shulin C, Yates J, Paddick SM, Robinson L, Stephan BCM. Risk of conversion from mild cognitive impairment to dementia in low- and middle-income countries: A systematic review and meta-analysis. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12267. [PMID: 35310524 PMCID: PMC8918697 DOI: 10.1002/trc2.12267] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/11/2022] [Indexed: 01/29/2023]
Abstract
Introduction With no treatment for dementia, there is a need to identify high risk cases to focus preventive strategies, particularly in low‐ and middle‐income countries (LMICs) where the burden of dementia is greatest. We evaluated the risk of conversion from mild cognitive ompairment (MCI) to dementia in LMICs. Methods Medline, Embase, PsycINFO, and Scopus were searched from inception until June 30, 2020. The search was restricted to observational studies, conducted in population‐based samples, with at least 1 year follow‐up. There was no restriction on the definition of MCI used as long as it was clearly defined. PROSPERO registration: CRD42019130958. Results Ten thousand six hundred forty‐seven articles were screened; n = 11 retained. Of the 11 studies, most were conducted in China (n = 7 studies), with only two studies from countries classified as low income. A qualitative analysis of n = 11 studies showed that similar to high‐income countries the conversion rate to dementia from MCI was variable (range 6.0%–44.8%; average follow‐up 3.7 years [standard deviation = 1.2]). A meta‐analysis of studies using Petersen criteria (n = 6 studies), found a pooled conversion rate to Alzheimer's disease (AD) of 23.8% (95% confidence interval = 15.4%–33.4%); approximately one in four people with MCI were at risk of AD in LMICs (over 3.0–5.8 years follow‐up). Risk factors for conversion from MCI to dementia included demographic (e.g., age) and health (e.g., cardio‐metabolic disease) variables. Conclusions MCI is associated with high, but variable, conversion to dementia in LMICs and may be influenced by demographic and health factors. There is a notable absence of data from low‐income settings and countries outside of China. This highlights the urgent need for research investment into aging and dementia in LMIC settings. Being able to identify those individuals with cognitive impairment who are at highest risk of dementia in LMICs is necessary for the development of risk reduction strategies that are contextualized to these unique settings.
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Affiliation(s)
- Andrea M McGrattan
- School of Biomedical, Nutritional and Sports Sciences, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Eduwin Pakpahan
- Department Mathematics, Physics and Electrical Engineering Northumbria University Newcastle upon Tyne UK
| | - Mario Siervo
- School of Life Sciences The University of Nottingham Medical School Nottingham UK
| | - Devi Mohan
- Global Public Health Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia Subang Jaya Malaysia
| | - Daniel D Reidpath
- Global Public Health Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia Subang Jaya Malaysia.,International Centre for Diarrhoeal Disease Research, ICDDR,B Dhaka Bangladesh
| | - Matthew Prina
- Department of Health Service and Population Research King's College London London UK
| | - Pascale Allotey
- Global Public Health Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia Subang Jaya Malaysia
| | - Yueping Zhu
- Department of Psychology and Behavioural Sciences Zhejiang University Hangzhou China
| | - Chen Shulin
- Department of Psychology and Behavioural Sciences Zhejiang University Hangzhou China
| | - Jennifer Yates
- Institute of Mental Health Nottingham University Nottingham UK
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK.,Gateshead NHS Community Health Foundation Trust Gateshead UK
| | - Louise Robinson
- Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
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6
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Dissanayake AS, Tan YB, Bowie CR, Butters MA, Flint AJ, Gallagher D, Golas AC, Herrmann N, Ismail Z, Kennedy JL, Kumar S, Lanctot KL, Mah L, Mulsant BH, Pollock BG, Rajji TK, Tau M, Maraj A, Churchill NW, Tsuang D, Schweizer TA, Munoz DG, Fischer CE. Sex Modifies the Associations of APOEɛ4 with Neuropsychiatric Symptom Burden in Both At-Risk and Clinical Cohorts of Alzheimer's Disease. J Alzheimers Dis 2022; 90:1571-1588. [PMID: 36314203 DOI: 10.3233/jad-220586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent work suggests that APOEɛ4/4 females with Alzheimer's disease (AD) are more susceptible to developing neuropsychiatric symptoms (NPS). OBJECTIVE To examine the interaction of sex and APOEɛ4 status on NPS burden using two independent cohorts: 1) patients at risk for AD with mild cognitive impairment and/or major depressive disorder (n = 252) and 2) patients with probable AD (n = 7,261). METHODS Regression models examined the interactive effects of sex and APOEɛ4 on the number of NPS experienced and NPS Severity. APOEɛ3/4 and APOEɛ4/4 were pooled in the at-risk cohort due to the sample size. RESULTS In the at-risk cohort, there was a significant sex*APOEɛ4 interaction (p = 0.007) such that the association of APOEɛ4 with NPS was greater in females than in males (incident rate ratio (IRR) = 2.0). APOEɛ4/4 females had the most NPS (mean = 1.9) and the highest severity scores (mean = 3.5) of any subgroup. In the clinical cohort, APOEɛ4/4 females had significantly more NPS (IRR = 1.1, p = 0.001, mean = 3.1) and higher severity scores (b = 0.31, p = 0.015, mean = 3.7) than APOEɛ3/3 females (meanNPS = 2.9, meanSeverity = 3.3). No association was found in males. CONCLUSION Our study suggests that sex modifies the association of APOEɛ4 on NPS burden. APOEɛ4/4 females may be particularly susceptible to increased NPS burden among individuals with AD and among individuals at risk for AD. Further investigation into the mechanisms behind these associations are needed.
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Affiliation(s)
- Andrew S Dissanayake
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Yu Bin Tan
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Christopher R Bowie
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Queen's University, Kingston, ON, Canada
| | - Meryl A Butters
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Alastair J Flint
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Damien Gallagher
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Angela C Golas
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - James L Kennedy
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctot
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Linda Mah
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Science Centre, Toronto, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G Pollock
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Michael Tau
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Unity Health, St. Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anika Maraj
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Unity Health, St. Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nathan W Churchill
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Unity Health, St. Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Debby Tsuang
- GRECC, VA Puget Sound and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Unity Health, St. Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David G Munoz
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Unity Health, St. Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Unity Health, St. Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
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7
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Moazzami K, Garcia M, Young A, Almuwaqqat Z, Lima BB, Martini A, Alkhalaf M, Shah AJ, Goldstein FC, Hajjar I, Levey AI, Bremner JD, Quyyumi AA, Vaccarino V. Association between symptoms of psychological distress and cognitive functioning among adults with coronary artery disease. Stress Health 2021; 37:538-546. [PMID: 33319483 PMCID: PMC8395370 DOI: 10.1002/smi.3018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/14/2022]
Abstract
Greater psychological distress is associated with cognitive impairment in healthy adults. Whether such associations also exist in patients with coronary artery disease (CAD) is uncertain. We assessed cognitive function in 496 individuals with CAD using the verbal and visual memory subtests of the Wechsler Memory Scale and executive functioning measured by the Trail Making Test Parts A and B. We used a composite score of psychological distress derived through summation of Z-transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility and perceived stress) and scores for each individual psychological scale. Multivariable linear regression models were used to determine the association between memory scores (as outcomes) and the psychological distress scores (both composite score and individual scales). After adjusting for demographic and cardiovascular risk factors, a higher psychological distress score was independently associated with worse memory and executive functioning. Each standard deviation increase in psychological distress score was associated with 3% (95% confidence interval [CI], 1%-5%) to 5% (95% CI, 3-7%) worse cognitive performance (higher Trail A and Trail B, and lower verbal and visual memory scores). Among individuals with CAD, a higher level of psychological distress is independently associated with worse cognitive performance. These findings suggest that psychological risk factors play a role in cognitive trajectories of persons with CAD.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mariana Garcia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - An Young
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zakaria Almuwaqqat
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bruno B Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Afif Martini
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA.,Goizuetta Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA.,Goizuetta Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA.,Goizuetta Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J Douglas Bremner
- Atlanta VA Medical Center, Decatur, Georgia, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
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