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Argyriou S, Fullard JF, Krivinko JM, Lee D, Wingo TS, Wingo AP, Sweet RA, Roussos P. Beyond memory impairment: the complex phenotypic landscape of Alzheimer's disease. Trends Mol Med 2024:S1471-4914(24)00119-9. [PMID: 38821772 DOI: 10.1016/j.molmed.2024.04.016] [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: 02/12/2024] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 06/02/2024]
Abstract
Neuropsychiatric symptoms (NPSs) in Alzheimer's disease (AD) constitute multifaceted behavioral manifestations that reflect processes of emotional regulation, thinking, and social behavior. They are as prevalent in AD as cognitive impairment and develop independently during the progression of neurodegeneration. As studying NPSs in AD is clinically challenging, most AD research to date has focused on cognitive decline. In this opinion article we summarize emerging literature on the prevalence, time course, and the underlying genetic, molecular, and pathological mechanisms related to NPSs in AD. Overall, we propose that NPSs constitute a cluster of core symptoms in AD, and understanding their neurobiology can lead to a more holistic approach to AD research, paving the way for more accurate diagnostic tests and personalized treatments embracing the goals of precision medicine.
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Affiliation(s)
- Stathis Argyriou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - John F Fullard
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Josh M Krivinko
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Donghoon Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Thomas S Wingo
- Goizueta Alzheimer's Disease Center, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Aliza P Wingo
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA; Veterans Affairs Atlanta Health Care System, Decatur, GA, USA
| | - Robert A Sweet
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Panos Roussos
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Mental Illness Research, Education, and Clinical Center (VISN 2 South), James J. Peters VA Medical Center, Street, Bronx, NY, USA; Center for Precision Medicine and Translational Therapeutics, James J. Peters VA Medical Center, Street, Bronx, NY, USA.
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2
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Yan H, Wu H, Cai Z, Du S, Li L, Xu B, Chang C, Wang N. The neural correlates of apathy in the context of aging and brain disorders: a meta-analysis of neuroimaging studies. Front Aging Neurosci 2023; 15:1181558. [PMID: 37396666 PMCID: PMC10311641 DOI: 10.3389/fnagi.2023.1181558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Apathy is a prevalent mood disturbance that occurs in a wide range of populations, including those with normal cognitive aging, mental disorders, neurodegenerative disorders and traumatic brain injuries. Recently, neuroimaging technologies have been employed to elucidate the neural substrates underlying brain disorders accompanying apathy. However, the consistent neural correlates of apathy across normal aging and brain disorders are still unclear. Methods This paper first provides a brief review of the neural mechanism of apathy in healthy elderly individuals, those with mental disorders, neurodegenerative disorders, and traumatic brain injuries. Further, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, the structural and functional neuroimaging meta-analysis using activation likelihood estimation method is performed on the apathy group with brain disorders and the healthy elderly, aiming at exploring the neural correlates of apathy. Results The structural neuroimaging meta-analysis showed that gray matter atrophy is associated with apathy in the bilateral precentral gyrus (BA 13/6), bilateral insula (BA 47), bilateral medial frontal gyrus (BA 11), bilateral inferior frontal gyrus, left caudate (putamen) and right anterior cingulate, while the functional neuroimaging meta-analysis suggested that the functional connectivity in putamen and lateral globus pallidus is correlated with apathy. Discussion Through the neuroimaging meta-analysis, this study has identified the potential neural locations of apathy in terms of brain structure and function, which may offer valuable pathophysiological insights for developing more effective therapeutic interventions for affected patients.
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Affiliation(s)
- Hongjie Yan
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Huijun Wu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zenglin Cai
- Department of Neurology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
- Department of Neurology, Gusu School, Suzhou Science and Technology Town Hospital, Nanjing Medical University, Suzhou, China
| | - Shouyun Du
- Department of Neurology, Guanyun People’s Hospital, Guanyun, China
| | - Lejun Li
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Bingchao Xu
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Chunqi Chang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Pengcheng Laboratory, Shenzhen, China
| | - Nizhuan Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
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3
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Mehak SF, Shivakumar AB, Saraf V, Johansson M, Gangadharan G. Apathy in Alzheimer's disease: A neurocircuitry based perspective. Ageing Res Rev 2023; 87:101891. [PMID: 36871779 DOI: 10.1016/j.arr.2023.101891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In addition to memory deficits and other cognitive disturbances, patients with Alzheimer's disease (AD) experience neuropsychiatric symptoms, notably apathy, which is a state of impaired motivation observed by deficits in goal directed behavior. Apathy is a multifaceted neuropsychiatric condition and appears to be a prognostic indicator, correlating with the progression of AD. Strikingly, recent studies point out that the neurodegenerative pathology of AD may drive apathy independent of cognitive decline. These studies also highlight that neuropsychiatric symptoms, in particular apathy, might manifest early in AD. Here, we review the current understanding of the neurobiological underpinnings of apathy as a neuropsychiatric symptom of AD. Specifically, we highlight the neural circuits and brain regions recognized to be correlated with the apathetic symptomatology. We also discuss the current evidence that supports the notion that apathy and cognitive deficits may develop as independent but concurrent phenomena driven by AD pathology, suggesting its efficacy as an additional outcome measure in Alzheimer's disease clinical trials. The current and prospective therapeutic interventions for apathy in AD from a neurocircuitry based perspective are also reviewed.
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Affiliation(s)
- Sonam Fathima Mehak
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Apoorva Bettagere Shivakumar
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Vikyath Saraf
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, SUS, Sweden; Division of Clinical Sciences, Helsingborg, Department of Clinical Sciences Lund, Lund University, Sweden; Department of Psychiatry, Helsingborg Hospital, Sweden.
| | - Gireesh Gangadharan
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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4
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Mallick A, Biffi A. Diagnostic and Management Strategies for Common Neurobehavioral and Psychiatric Disturbances Among Patients with Cognitive Impairment and the Dementias. Clin Geriatr Med 2023; 39:161-175. [PMID: 36404029 DOI: 10.1016/j.cger.2022.08.004] [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: 11/03/2022]
Abstract
Neurobehavioral and neuropsychiatric symptoms are highly prevalent among individuals diagnosed with cognitive impairment or dementia and impact the quality of life for patients and caregivers alike. Diagnosis and management of these conditions (including primarily depression, anxiety, apathy, psychosis, agitation, and aggression) is crucial to optimal patient care outcomes in clinical practice. The present article provides a practical review of diagnostic approaches and management strategies for behavioral and neuropsychiatric disorders arising in patients with cognitive impairment, up to and including dementia.
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Affiliation(s)
- Akashleena Mallick
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Henry and Allison McCance Center for Brain Health, 100 Cambridge Street, Room 2054, Boston, MA 02144, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Henry and Allison McCance Center for Brain Health, 100 Cambridge Street, Room 2054, Boston, MA 02144, USA.
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5
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Bogdan A, Fabre R, Desmidt T, Golebiowski J, Topin J, Bethus I, Hanon O, Boutoleau-Bretonniere C, Wagemann N, Annweiler C, Ousset PJ, Godefroy O, Rouch I, Paccalin M, Sukhorukova M, Gabelle A, Robert G, David R. Different Trajectories of Apathy and Depression Among Subjective Cognitive Impairment Individuals with or without Conversion to Dementia: Results from the Memento Cohort in France. J Alzheimers Dis 2023; 95:415-426. [PMID: 37545236 DOI: 10.3233/jad-230162] [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: 08/08/2023]
Abstract
BACKGROUND Apathy and depression are two early behavioral symptoms in Alzheimer's disease (AD) and related disorders that often occur prior to the onset of cognitive decline and memory disturbances. Both have been associated with an increased risk of conversion to dementia, with a distinct neuropathology. OBJECTIVE The assessment of the trajectories of apathy and depression and their independent impact on dementia conversion. METHODS Apathy and Depression were measured using the Neuropsychiatric Inventory for caregiver (NPI) and clinician (NPI-C), among the nondemented individuals reporting subjective cognitive decline (SCD) at baseline. They were followed up over a 60-month period. Some converted to dementia, according to the methodology carried out by the French Memento Cohort. RESULTS Among individuals with SCD (n = 2,323), the levels of apathy and depression were low and did not evolve significantly over the 60-month period, despite a trend in apathy increasing as of month 24. Regarding SCD individuals who converted to dementia within the 60-month period (n = 27), the prevalence of depression remained globally steady, while the levels of apathy increased over time. CONCLUSION Apathy and depression have different trajectories among individuals with SCD and apathy alone is more likely-compared to depression-to be associated with conversion to dementia.
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Affiliation(s)
- Anamaria Bogdan
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
| | - Roxane Fabre
- Nice University Hospital, Department of Public Health, Nice, France
| | | | | | - Jérémie Topin
- Côte D'Azur University, Chemistry Institute of Nice, France
| | - Ingrid Bethus
- Côte d'Azur University, IPMC (Institut de Pharmacologie Moléculaire et cellulaire), Sophia Antipolis, France
| | - Olivier Hanon
- Université Paris Cité - EA4468 APHP-Hôpitaux Universitaires Paris Centre - Service de Gériatrie- hôpital Broca, Paris, France
| | | | | | | | - Pierre-Jean Ousset
- Toulouse Clinical Research Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Isabelle Rouch
- Memory Clinic (CMRR) Saint Etienne, INSERM U1219, Bordeaux, France
| | - Marc Paccalin
- Department of Geriatry, Memory Clinic (CMRR), CIC U1402, Poitiers University Hospital, Poitiers, France
| | | | - Audrey Gabelle
- Memory Clinic (CMRR), Montpellier University Hospital, Montpellier, France
| | | | - Renaud David
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
- NICE BRAIN non-profitorganization for research on brain, Nice, France
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6
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Apathy in Parkinson’s Disease: Defining the Park Apathy Subtype. Brain Sci 2022; 12:brainsci12070923. [PMID: 35884730 PMCID: PMC9313138 DOI: 10.3390/brainsci12070923] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023] Open
Abstract
Apathy is a neurobehavioural symptom affecting Parkinson’s disease patients of all disease stages. Apathy seems to be associated with a specific underlying non-motor disease subtype and reflects dysfunction of separate neural networks with distinct neurotransmitter systems. Due to the complicated neuropsychiatric aetiology of apathy, clinical assessment of this invalidating non-motor symptom remains challenging. We aim to summarize the current findings on apathy in Parkinson’s disease and highlight knowledge gaps. We will discuss the prevalence rates across the different disease stages and suggest screening tools for clinically relevant apathetic symptoms. We will approach the fundamental knowledge on the neural networks implicated in apathy in a practical manner and formulate recommendations on patient-tailored treatment. We will discuss the Park apathy phenotype in detail, shedding light on different clinical manifestations and implications for prognosis. With this review, we strive to distil the vast available theoretical knowledge into a clinical and patient-oriented perspective.
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7
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Apathy as a Treatment Target in Alzheimer's Disease: Implications for Clinical Trials. Am J Geriatr Psychiatry 2022; 30:119-147. [PMID: 34315645 DOI: 10.1016/j.jagp.2021.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
Apathy is one of the most prevalent, stable and persistent neuropsychiatric symptom across the neurocognitive disorders spectrum. Recent advances in understanding of phenomenology, neurobiology and intervention trials highlight apathy as an important target for clinical intervention. We conducted a comprehensive review and critical evaluation of recent advances to determine the evidence-based suggestions for future trial designs. This review focused on 4 key areas: 1) pre-dementia states; 2) assessment; 3) mechanisms/biomarkers and 4) treatment/intervention efficacy. Considerable progress has been made in understanding apathy as a treatment target and appreciating pharmacological and non-pharmacological apathy treatment interventions. Areas requiring greater investigation include: diagnostic procedures, symptom measurement, understanding the biological mechanisms/biomarkers of apathy, and a well-formed approach to the development of treatment strategies. A better understanding of the subdomains and biological mechanisms of apathy will advance apathy as a treatment target for clinical trials.
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8
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Chaudhary S, Zhornitsky S, Chao HH, van Dyck CH, Li CSR. Hypothalamic Functional Connectivity and Apathy in People with Alzheimer's Disease and Cognitively Normal Healthy Controls. J Alzheimers Dis 2022; 90:1615-1628. [PMID: 36314209 PMCID: PMC10064487 DOI: 10.3233/jad-220708] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Earlier studies have described the neural markers of apathy in Alzheimer's disease (AD) and mild cognitive impairment (MCI), but few focused on the motivation circuits. Here, we targeted hypothalamus, a hub of the motivation circuit. OBJECTIVE To examine hypothalamic resting state functional connectivity (rsFC) in relation to apathy. METHODS We performed whole-brain regression of hypothalamic rsFC against Apathy Evaluation Scale (AES) total score and behavioral, cognitive, and emotional subscores in 29 patients with AD/MCI and 28 healthy controls (HC), controlling for age, sex, education, cognitive status, and depression. We evaluated the results at a corrected threshold and employed path analyses to assess possible interaction between hypothalamic rsFCs, apathy and depression/memory. Finally, we re-examined the findings in a subsample of amyloid-β-verified AD. RESULTS AES total score correlated negatively with hypothalamic precuneus (PCu)/posterior cingulate cortex (PCC) and positively with left middle temporal gyrus (MTG) and supramarginal gyrus rsFCs. Behavioral subscore correlated negatively with hypothalamic PCu/PCC and positively with middle frontal gyrus rsFC. Cognitive subscore correlated positively with hypothalamic MTG rsFC. Emotional subscore correlated negatively with hypothalamic calcarine cortex rsFC. In path analyses, hypothalamic-PCu/PCC rsFC negatively modulated apathy and, in turn, depression. The model where hypothalamic MTG rsFC and memory independently modulated apathy also showed a good fit. The findings of diminished hypothalamic-PCu/PCC rsFC in relation to apathy and, in turn, depression were confirmed in amyloid-verified AD. CONCLUSION The findings together support a role of altered hypothalamic connectivity in relation to apathy and depression, and modulation of apathy by memory dysfunction.
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Affiliation(s)
- Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Herta H Chao
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Medicine & Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher H van Dyck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA.,Wu Tsai Institute, Yale University, New Haven, CT, USA
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9
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Chaudhary S, Zhornitsky S, Chao HH, van Dyck CH, Li CSR. Cerebral Volumetric Correlates of Apathy in Alzheimer's Disease and Cognitively Normal Older Adults: Meta-Analysis, Label-Based Review, and Study of an Independent Cohort. J Alzheimers Dis 2022; 85:1251-1265. [PMID: 34924392 PMCID: PMC9215906 DOI: 10.3233/jad-215316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Affecting nearly half of the patients with Alzheimer's disease (AD), apathy is associated with higher morbidity and reduced quality of life. Basal ganglia and cortical atrophy have been implicated in apathy. However, the findings have varied across studies and left unclear whether subdomains of apathy may involve distinct neuroanatomical correlates. OBJECTIVE To identify neuroanatomical correlates of AD-associated apathy. METHODS We performed a meta-analysis and label-based review of the literature. Further, following published routines of voxel-based morphometry, we aimed to confirm the findings in an independent cohort of 19 patients with AD/mild cognitive impairment and 25 healthy controls assessed with the Apathy Evaluation Scale. RESULTS Meta-analysis of 167 AD and 56 healthy controls showed convergence toward smaller basal ganglia gray matter volume (GMV) in apathy. Label-based review showed anterior cingulate, putamen, insula, inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) atrophy in AD apathy. In the independent cohort, with small-volume-correction, right putamen and MTG showed GMVs in negative correlation with Apathy Evaluation Scale total, behavioral, and emotional scores, and right IFG with emotional score (p < 0.05 family-wise error (FWE)-corrected), controlling for age, education, intracranial volume, and depression. With the Mini-Mental State Examination scores included as an additional covariate, the correlation of right putamen GMV with behavioral and emotional score, right MTG GMV with total and emotional score, and right IFG GMV with emotional score were significant. CONCLUSION The findings implicate putamen, MTG and IFG atrophy in AD associated apathy, potentially independent of cognitive impairment and depression, and suggest potentially distinct volumetric correlates of apathy.
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Affiliation(s)
- Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519
| | - Herta H. Chao
- Comprehensive Cancer Center, Department of Medicine, Yale University School of Medicine, New Haven, CT 06519
| | - Christopher H. van Dyck
- Disease Research Center, Department of Psychiatry; Department of Neuroscience; Interdepartmental Neuroscience, Program, Yale University School of Medicine, New Haven, CT 06520
| | - Chiang-Shan R. Li
- Department of Psychiatry; Department of Neuroscience; Interdepartmental Neuroscience, Program, Wu Tsai Institute, Yale University, Yale University School of Medicine, New Haven, CT 06520
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10
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Chaudhary S, Zhornitsky S, Chao HH, van Dyck CH, Li CSR. Emotion Processing Dysfunction in Alzheimer's Disease: An Overview of Behavioral Findings, Systems Neural Correlates, and Underlying Neural Biology. Am J Alzheimers Dis Other Demen 2022; 37:15333175221082834. [PMID: 35357236 PMCID: PMC9212074 DOI: 10.1177/15333175221082834] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We described behavioral studies to highlight emotional processing deficits in Alzheimer's disease (AD). The findings suggest prominent deficit in recognizing negative emotions, pronounced effect of positive emotion on enhancing memory, and a critical role of cognitive deficits in manifesting emotional processing dysfunction in AD. We reviewed imaging studies to highlight morphometric and functional markers of hippocampal circuit dysfunction in emotional processing deficits. Despite amygdala reactivity to emotional stimuli, hippocampal dysfunction conduces to deficits in emotional memory. Finally, the reviewed studies implicating major neurotransmitter systems in anxiety and depression in AD supported altered cholinergic and noradrenergic signaling in AD emotional disorders. Overall, the studies showed altered emotions early in the course of illness and suggest the need of multimodal imaging for further investigations. Particularly, longitudinal studies with multiple behavioral paradigms translatable between preclinical and clinical models would provide data to elucidate the time course and underlying neurobiology of emotion processing dysfunction in AD.
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Affiliation(s)
- Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Herta H. Chao
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher H. van Dyck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA,Wu Tsai Institute, Yale University, New Haven, CT, USA
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11
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Olivieri P, Lebouvier T, Hardouin JB, Courtemanche H, Le Dily S, Barbin L, Pallardy A, Derkinderen P, Boutoleau-Bretonnière C. LeSCoD: a new clinical scale for the detection of Lewy body disease in neurocognitive disorders. J Neurol 2021; 268:3886-3896. [PMID: 33830336 DOI: 10.1007/s00415-021-10539-0] [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: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dementia with Lewy bodies remains underdiagnosed in clinical practice mainly because of the low sensitivity of existing diagnostic criteria and a strong overlap with Alzheimer's pathology that can mask the Lewy phenotype. OBJECTIVE The objective of this study was therefore to develop and validate a new clinical scale designed to detect signs of Lewy body disease, called LeSCoD for Lewy body Screening scale in Cognitive Disorders. METHODS 128 patients who fulfilled the clinical criteria of dementia with Lewy bodies (DLB; n = 32), Alzheimer's disease (AD; n = 77) or both (n = 19) was prospectively enrolled. 18F-DOPA PET imaging and/or CSF biomarkers were available in some patients. LeSCoD scale was systematically administered and the potential correlation with 18F-DOPA PET imaging was evaluated in a subgroup of patients. RESULTS LeSCoD scale showed robust internal and external validity. We determined a cut-off of 10 above which the sensitivity and specificity for Lewy body disease diagnosis were 86% and 95%, respectively. The LeSCoD scale correlated with striatal dopamine uptake in 18F-DOPA PET. CONCLUSION LeSCoD scale is a simple and reliable tool for the evaluation of Lewy body disease in routine clinical practice, with a higher sensitivity and specificity than the existing criteria. It might be an alternative to the use of dopamine-specific imaging.
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Affiliation(s)
- Pauline Olivieri
- Department of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Thibaud Lebouvier
- University of Lille, Inserm U1172, CHU Lille, DISTALZ, Lille, France
| | - Jean-Benoît Hardouin
- UMR INSERM 1246-SPHERE "Methods in Patient-Centered Outcomes and Health Research", Université de Nantes, Université de Tours, Tours, France.,Unit of Methodology and Biostatistics, Université de Nantes, Nantes, France
| | - Hélène Courtemanche
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France.,INSERM CIC 04, Nantes, France
| | | | | | | | | | - Claire Boutoleau-Bretonnière
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France. .,INSERM CIC 04, Nantes, France. .,Claire Boutoleau-Bretonnière, Centre Mémoire Ressource et Recherche (CMRR), Centre Hospitalier Universitaire de Nantes Hôpital Laennec, Boulevard Jacques Monod, 44000, Nantes, France.
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12
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Cognitive and Neuropsychiatric Profiles in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease. J Pers Med 2021; 11:jpm11010051. [PMID: 33467021 PMCID: PMC7830588 DOI: 10.3390/jpm11010051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for developing Parkinson’s disease (PD) and may represent its prodromal state. We compared neuropsychological and neuropsychiatric phenotypes of idiopathic (i) RBD, PD and healthy comparators (HC) in order to identify iRBD specific characteristics. Thirty-eight patients with iRBD, 38 PD patients with RBD (PD + RBD), 38 PD patients without RBD (PD-RBD) and 38 HC underwent a comprehensive neurological, neuropsychological and neuropsychiatric evaluation. iRBD, PD + RBD and PD-RBD performed worse than HC in short-term verbal memory, praxia, language and executive functions. iRBD had higher levels of anxiety, depression, apathy and alexithymia than HC. iRBD had higher levels of apathy than PD + RBD. Both PD groups had higher levels of anxiety and depression than HC. Surprisingly, iRBD performed better than all groups in long-term verbal memory. Patients diagnosed with iRBD are characterized by poor global cognitive performance, but better long-term memory and higher levels of depression, anxiety, alexithymia and apathy. Alexithymia and apathy in patients diagnosed with iRBD may be the expression of precocious derangement of emotional regulation, subsequently observed also in PD. Cognitive and neuropsychiatric symptoms of iRBD are early clinical manifestations of widespread neurodegeneration.
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Udo N, Hashimoto N, Toyonaga T, Isoyama T, Oyanagi Y, Narita H, Shiga T, Nakagawa S, Kusumi I. Apathy in Alzheimer's Disease Correlates with the Dopamine Transporter Level in the Caudate Nuclei. Dement Geriatr Cogn Dis Extra 2020; 10:86-93. [PMID: 33082772 PMCID: PMC7548940 DOI: 10.1159/000509278] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Apathy is a common neuropsychiatric symptom in patients with Alzheimer's disease (AD). The striatal binding potential (BP) of 123I-FP-CIT (N-δ-fluoropropyl-2β-carbomethoxy-3β-[4-iodophenyl]tropane) single-photon emission computed tomography (SPECT) is correlated with the degree of apathy in patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). This study aimed to determine if dopaminergic activity in the basal ganglia is associated with the development of apathy in AD. Methods Nineteen subjects with AD were included and underwent 123I-FP-CIT-SPECT. Patients with other types of dementia as a comorbidity, those taking antidepressants, and those with overt parkinsonism were excluded. Apathy was assessed using the Apathy Evaluation Scale Informant-Japanese version (AES-I-J). SPECT images were overlaid with images in striatal regions of interest (ROIs), and the SPECT values in these regions were counted. The relationship between BP values and AES-I-J scores was investigated using Spearman's rank correlation coefficient. Results Significant inverse correlations were observed between BP values and AES-I-J scores in the left caudate nucleus and there was a marginally significant inverse correlation in the right caudate nucleus. Conclusion The pathological basis of apathy might be the impairment of the dopaminergic nervous system. Further studies on more subjects with AD, healthy controls, and patients with PD and DLB are needed.
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Affiliation(s)
- Niki Udo
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takuya Toyonaga
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tomoyuki Isoyama
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuka Oyanagi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisashi Narita
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tohru Shiga
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Pimontel MA, Kanellopoulos D, Gunning FM. Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review. J Geriatr Psychiatry Neurol 2020; 33:289-303. [PMID: 31635522 DOI: 10.1177/0891988719882100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. METHOD Systematic literature review. RESULTS The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. CONCLUSIONS Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.
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Affiliation(s)
- Monique A Pimontel
- Graduate Center, City University of New York, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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Bogdan A, Manera V, Koenig A, David R. Pharmacologic Approaches for the Management of Apathy in Neurodegenerative Disorders. Front Pharmacol 2020; 10:1581. [PMID: 32038253 PMCID: PMC6989486 DOI: 10.3389/fphar.2019.01581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/05/2019] [Indexed: 01/10/2023] Open
Abstract
Apathy is one of the most frequent behavioral disturbances in many neurodegenerative disorders and is known to have a negative impact on the disease progression, particularly in Alzheimer’s disease. Therapeutic options are currently limited and non-pharmacological approaches should constitute first line treatments. Pharmacological agents likely to reduce apathy levels are lacking. The objective of the present article is to review recent pharmacological treatments for apathy in neurodegenerative disorders. The Pubmed database was searched with a particular focus on articles published as of January 2017. Current main levels of evidence have been reported so far with cholinergic, glutamatergic and dopaminergic agents to reduce levels of apathy, despite several conflicting results. Treatment duration and samples sizes may have however decreased the validity of previous results. Ongoing studies involving more participants/treatment duration or distinct neural pathways may provide new insights in the treatment of apathy in neurodegenerative disorders.
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Affiliation(s)
- Anamaria Bogdan
- Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Valeria Manera
- CoBTeK Lab "Cognition Behaviour Technology", University of Nice Sophia Antipolis, Nice, France
| | - Alexandra Koenig
- CoBTeK Lab "Cognition Behaviour Technology", University of Nice Sophia Antipolis, Nice, France
| | - Renaud David
- Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France
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Hamaguchi T, Tsutsui-Kimura I, Mimura M, Saito T, Saido TC, Tanaka KF. App mice overall do not show impaired motivation, but cored amyloid plaques in the striatum are inversely correlated with motivation. Neurochem Int 2019; 129:104470. [DOI: 10.1016/j.neuint.2019.104470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
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Leach J. ‘Give-up-itis’ revisited: Neuropathology of extremis. Med Hypotheses 2018; 120:14-21. [DOI: 10.1016/j.mehy.2018.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To explore the most recent developments in the effective diagnosis and treatment of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD). RECENT FINDINGS The clinical diagnosis of NPS in AD is facilitated by the use of the Neuropsychiatric Inventory (NPI). CT and MRI scans can be useful for detecting structural changes indicating AD. Other promising diagnostic methodologies that are less frequently used in the clinical setting include positron emission tomography (PET) scans for detecting amyloid and blood tests for detecting serum biomarkers. Numerous pharmaceutical agents have been studied for their use in managing NPS, with antipsychotics being popular for managing agitation but also having significant side effects. Non-pharmacological interventions, such as reminiscence therapy and the Describe, Investigate, Create, Evaluate (DICE) approach may be able to provide treatment without such adverse effects. Diagnosing AD and the comorbid NPS remains primarily a clinical endeavor with CT and MRI scans sometimes used, but evidence is amassing for the use of other imaging modalities and different lab tests for convenient and empiric diagnosis of AD to distinguish it from other psychiatric illnesses. The number of pharmacologic treatments for NPS that are safe as well as efficacious remains limited, yet non-pharmacologic interventions have clear clinical utility. In addition to searching for more successful pharmacological treatments, further research should focus on novel diagnostic tests and non-pharmacologic therapies.
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Affiliation(s)
- David Wolinsky
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Karina Drake
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Jolene Bostwick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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20
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Brain Perfusion Correlates of Apathy in Alzheimer's Disease. Dement Neurocogn Disord 2018; 17:50-56. [PMID: 30906392 PMCID: PMC6427971 DOI: 10.12779/dnd.2018.17.2.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Apathy is one of the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). It may have adverse impacts on the progression of AD. However, its neurobiological underpinnings remain unclear. The objective of this study was to investigate differences in regional cerebral blood flow (rCBF) between AD patients with apathy and those without apathy. Methods Sixty-six apathetic AD patients and 66 AD patients without apathy completed Neuropsychiatric Inventory (NPI) and underwent technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) scans. Voxel-wise differences in rCBF between the 2 groups were examined. Association between rCBF and levels of apathy in the apathetic group was also assessed. Results AD patients with apathy showed lower rCBF in the bilateral orbitofrontal cortex, left putamen, left nucleus accumbens, left thalamus, and bilateral insula than those without (all p<0.005). Mean perfusion across all significant clusters showed a negative linear correlation with NPI apathy score in AD patients with apathy (β=-0.25; p=0.04). Conclusions Hypoperfusion in the prefrontal, striatal, and insular areas may be neural correlates of apathy in AD patients.
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Ruthirakuhan MT, Herrmann N, Abraham EH, Chan S, Lanctôt KL. Pharmacological interventions for apathy in Alzheimer's disease. Cochrane Database Syst Rev 2018; 5:CD012197. [PMID: 29727467 PMCID: PMC6494556 DOI: 10.1002/14651858.cd012197.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite the high prevalence of apathy in Alzheimer's disease (AD), and its harmful effects, there are currently no therapies proven to treat this symptom. Recently, a number of pharmacological therapies have been investigated as potential treatments for apathy in AD. OBJECTIVES Objective 1: To assess the safety and efficacy of pharmacotherapies for the treatment of apathy in Alzheimer's disease (AD).Objective 2: To assess the effect on apathy of pharmacotherapies investigated for other primary outcomes in the treatment of AD. SEARCH METHODS We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, ClinicalTrials.gov and the World Health Organization (WHO) portal, ICTRP on 17 May 2017. SELECTION CRITERIA Eligible studies were double-blind, randomized, placebo-controlled trials (RCTs) investigating apathy as a primary or secondary outcome in people with AD. DATA COLLECTION AND ANALYSIS Three review authors extracted data. We assessed the risks of bias of included studies using Cochrane methods, and the overall quality of evidence for each outcome using GRADE methods. We calculated mean difference (MD), standardized mean difference (SMD) or risk ratio (RR) with 95% confidence intervals on an intention-to-treat basis for all relevant outcome measures. MAIN RESULTS We included 21 studies involving a total of 6384 participants in the quantitative analyses. Risk of bias is very low to moderate. All studies reported appropriate methods of randomization and blinding. Most studies reported appropriate methods of allocation concealment. Four studies, three with methylphenidate and one with modafinil, had a primary aim of improving apathy. In these studies, all participants had clinically significant apathy at baseline. Methylphenidate may improve apathy compared to placebo. This finding was present when apathy was assessed using the apathy evaluation scale (AES), which was used by all three studies investigating methylphenidate: MD -4.99, 95% CI -9.55 to -0.43, n = 145, 3 studies, low quality of evidence, but not when assessed with the neuropsychiatric inventory (NPI)-apathy subscale, which was used by two of the three studies investigating methylphenidate: MD -0.08, 95% CI -3.85 to 3.69, n = 85, 2 studies, low quality of evidence. As well as having potential benefits for apathy, methylphenidate probably also slightly improves cognition (MD 1.98, 95% CI 1.06 to 2.91, n = 145, 3 studies, moderate quality of evidence), and probably improves instrumental activities of daily living (MD 2.30, 95% CI 0.74 to 3.86, P = 0.004, n = 60, 1 study, moderate quality of evidence), compared to placebo. There may be no difference between methylphenidate and placebo in the risk of developing an adverse event: RR 1.28, 95% CI 0.67 to 2.42, n = 145, 3 studies, low quality of evidence. There was insufficient evidence from one very small study of modafinil to determine the effect of modafinil on apathy assessed with the FrSBe-apathy subscale: MD 0.27, 95% CI -3.51 to 4.05, n = 22, 1 study, low quality of evidence. In all other included studies, apathy was a secondary outcome and participants were not selected on the basis of clinically significant apathy at baseline. We considered the evidence on apathy from these studies to be indirect and associated with publication bias. There was low or very low quality of evidence on cholinesterase inhibitors (ChEIs) (six studies), ChEI discontinuation (one study), antipsychotics (two studies), antipsychotic discontinuation (one study), antidepressants (two studies), mibampator (one study), valproate (three studies) and semagacestat (one study). AUTHORS' CONCLUSIONS Methylphenidate may demonstrate a benefit for apathy and may have slight benefits for cognition and functional performance in people with AD, but this finding is associated with low-quality evidence. Our meta-analysis is limited by the small number of studies within each drug class, risk of bias, publication bias, imprecision and inconsistency between studies. Additional studies should be encouraged targeting people with AD with clinically significant apathy which investigate apathy as a primary outcome measure, and which have a longer duration and a larger sample size. This could increase the quality of evidence for methylphenidate, and may confirm whether or not it is an effective pharmacotherapy for apathy in AD.
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Affiliation(s)
- Myuri T Ruthirakuhan
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueTorontoONCanadaM4N 3M5
- University of TorontoDepartment of Pharmacology and Toxicology2075 Bayview AvenueTorontoCanada
| | - Nathan Herrmann
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueTorontoONCanadaM4N 3M5
- University of TorontoDepartment of Psychiatry2075 Bayview Avenue, Room H‐185TorontoONCanada
- Sunnybrook Health Sciences CentreGeriatric PsychiatryTorontoCanada
| | - Eleenor H Abraham
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueTorontoONCanadaM4N 3M5
| | - Sarah Chan
- Sunnybrook Health Sciences CentreNeuropsychopharmacology Research Group2075 Bayview AvenueTorontoCanadaM4N 3M5
| | - Krista L Lanctôt
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueTorontoONCanadaM4N 3M5
- University of TorontoDepartment of Pharmacology and Toxicology2075 Bayview AvenueTorontoCanada
- University of TorontoDepartment of Psychiatry2075 Bayview Avenue, Room H‐185TorontoONCanada
- Sunnybrook Health Sciences CentreGeriatric PsychiatryTorontoCanada
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Barber TR, Muhammed K, Drew D, Lawton M, Crabbe M, Rolinski M, Quinnell T, Zaiwalla Z, Ben‐Shlomo Y, Husain M, Hu MTM. Apathy in rapid eye movement sleep behaviour disorder is common and under-recognized. Eur J Neurol 2018; 25:469-e32. [PMID: 29114969 PMCID: PMC5838543 DOI: 10.1111/ene.13515] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/02/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Apathy is an important neuropsychiatric feature of Parkinson's disease (PD), which often emerges before the onset of motor symptoms. Patients with rapid eye movement sleep behaviour disorder (RBD) have a high probability of developing PD in future. Neuropsychiatric problems are common in RBD, but apathy has not previously been detailed in this key prodromal population. METHODS Eighty-eight patients with polysomnographically proven RBD, 65 patients with PD and 33 controls were assessed for apathy using the Lille Apathy Rating Scale. Cognition and depression were also quantified. The sensitivity of the Unified Parkinson's Disease Rating Scale screening questions for apathy and depression was calculated. RESULTS A total of 46% of patients with RBD were apathetic, compared with 31% of patients with PD in our sample. Most patients with RBD with depression were apathetic but more than half of apathetic patients were not depressed. The sensitivity of the single Unified Parkinson's Disease Rating Scale screening question was only 33% for mild apathy and 50% for severe apathy. CONCLUSIONS Apathy is common in RBD and is underestimated by a single self-report question. Recognition of apathy as a distinct neuropsychiatric feature in RBD could aid targeted treatment interventions and might contribute to the understanding of prodromal PD.
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Affiliation(s)
- T. R. Barber
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - K. Muhammed
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - D. Drew
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - M. Lawton
- Population Health SciencesUniversity of BristolBristolUK
| | - M. Crabbe
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - M. Rolinski
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Institute of Clinical NeurosciencesUniversity of BristolBristolUK
| | - T. Quinnell
- Respiratory Support and Sleep CentrePapworth HospitalCambridgeUK
| | - Z. Zaiwalla
- Department of Clinical NeurophysiologyJohn Radcliffe HospitalOxfordUK
| | - Y. Ben‐Shlomo
- Population Health SciencesUniversity of BristolBristolUK
| | - M. Husain
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - M. T. M. Hu
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
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Chagraoui A, Boukhzar L, Thibaut F, Anouar Y, Maltête D. The pathophysiological mechanisms of motivational deficits in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:138-152. [PMID: 29097256 DOI: 10.1016/j.pnpbp.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/21/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder that leads to disabling motor symptoms and a wide variety of neuropsychiatric symptoms. Apathy is the most common psychiatric disorder in the early stages of untreated PD and can be defined as a hypodopaminergic syndrome, which also includes anxiety and depression. Apathy is also considered the core feature of the parkinsonian triad (apathy, anxiety and depression) of behavioural non-motor signs, including a motivational deficit. Moreover, apathy is recognised as a distinct chronic neuropsychiatric behavioural disorder based on specific diagnostic criteria. Given the prevalence of apathy in approximately 40% of the general Parkinson's disease population, this appears to be a contributing factor to dementia in PD; also, apathy symptoms are factors that potentially contribute to morbidity, leading to a major impairment of health-related quality of life, thus stressing the importance of understanding the pathophysiology of this disease. Several studies have clearly established a prominent role for DA-mediated signals in PD apathy. However, synergistic interaction between dopaminergic impairment resulting from the neurodegenerative process and deep brain stimulation of the subthalamic nucleus may cause or exacerbate apathy. Furthermore, serotoninergic mechanism signalling is also likely to be of importance in this pathophysiology.
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Affiliation(s)
- A Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France.; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - L Boukhzar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - Y Anouar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, Rouen, France
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Abstract
BACKGROUND Apathy, characterized by diminished motivation, is a highly prevalent neuropsychiatric symptom in dementia. However, there is a substantial knowledge gap with regard to prevalence rates, neurobiological underpinnings, and effective treatments for apathy in pre-dementia states, including mild cognitive impairment (MCI) and mild behavioral impairment (MBI). METHODS We conducted a comprehensive literature search using MEDLINE, Embase, and PsycINFO databases to identify available research on apathy in prodromal dementia. RESULTS Apathy has consistently been detected in individuals with MCI with varying prevalence rates, and only recently has literature discussed the prevalence of apathy in MBI. Few pharmacological treatments have been utilized for apathy, with galantamine and risperidone showing mild reductions in apathetic behaviors. Non-pharmacological interventions in prodromal dementia are beginning to be explored and show promise, but few studies have replicated those results. DISCUSSION More comprehensive guidelines for diagnosing apathy and further research investigating neurobiological mechanisms of apathy in MCI and MBI are required in order to effectively treat apathetic patients in prodromal dementia.
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Onishi H, Sakai T, Shiromoto O, Amijima H. Validation of Optimum ROI Size for 123I-FP-CIT SPECT Imaging Using a 3D Mathematical Cylinder Phantom. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2018; 6:139-148. [PMID: 29998147 PMCID: PMC6038969 DOI: 10.22038/aojnmb.2018.10638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/30/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The partial volume effect (PVE) of single-photon emission computed tomography (SPECT) on corpus striatum imaging is caused by the underestimation of specific binding ratio (SBR). A large ROI (region of interest) set using the Southampton method is independent of PVE for SBR. The present study aimed to determine the optimal ROI size with contrast and SBR for striatum images and validate the Southampton method using a three-dimensional mathematical cylinder (3D-MAC) phantom. METHODS We used ROIs sizes of 27, 36, 44, 51, 61, 68, and 76 mm for targets with diameters 40, 20, and 10 mm on reference and processed images reconstructed using the 3D-MAC phantom. Contrast values and SBR were compared with the theoretical values to obtain the optimal ROI size. RESULTS The contrast values in the ROI with diameters of 51 (target: 40 mm in diameter) and 44 (target: 20 mm in diameter) mm matched the theoretical values. However, this value did not correspond with the 10-mm-diameter target. The SBR matched the theoretical value with an ROI of > 44 mm in the 20-mm-diameter target; but, it was under- and overestimated under any other conditions. CONCLUSION These results suggested that an ROI should be 2-4 folds larger than the target size without PVE, and that the Southampton method was remarkably accurate.
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Affiliation(s)
- Hideo Onishi
- Program in Health and Welfare, Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Takayuki Sakai
- Department of Radiology, Kyushu Rosai Hospital, Japan Labor Health and Welfare Organization, Fukuoka, Japan
| | - Osamu Shiromoto
- Program in Health and Welfare, Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Hizuru Amijima
- Graduate School of Nursing, Hyogo University of Health Sciences, Hyougo, Japan
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Gaskill PJ, Miller DR, Gamble-George J, Yano H, Khoshbouei H. HIV, Tat and dopamine transmission. Neurobiol Dis 2017; 105:51-73. [PMID: 28457951 PMCID: PMC5541386 DOI: 10.1016/j.nbd.2017.04.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 01/02/2023] Open
Abstract
Human Immunodeficiency Virus (HIV) is a progressive infection that targets the immune system, affecting more than 37 million people around the world. While combinatorial antiretroviral therapy (cART) has lowered mortality rates and improved quality of life in infected individuals, the prevalence of HIV associated neurocognitive disorders is increasing and HIV associated cognitive decline remains prevalent. Recent research has suggested that HIV accessory proteins may be involved in this decline, and several studies have indicated that the HIV protein transactivator of transcription (Tat) can disrupt normal neuronal and glial function. Specifically, data indicate that Tat may directly impact dopaminergic neurotransmission, by modulating the function of the dopamine transporter and specifically damaging dopamine-rich regions of the CNS. HIV infection of the CNS has long been associated with dopaminergic dysfunction, but the mechanisms remain undefined. The specific effect(s) of Tat on dopaminergic neurotransmission may be, at least partially, a mechanism by which HIV infection directly or indirectly induces dopaminergic dysfunction. Therefore, precisely defining the specific effects of Tat on the dopaminergic system will help to elucidate the mechanisms by which HIV infection of the CNS induces neuropsychiatric, neurocognitive and neurological disorders that involve dopaminergic neurotransmission. Further, this will provide a discussion of the experiments needed to further these investigations, and may help to identify or develop new therapeutic approaches for the prevention or treatment of these disorders in HIV-infected individuals.
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Affiliation(s)
- Peter J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, United States.
| | - Douglas R Miller
- Department of Neuroscience, University of Florida, Gainesville, FL 32611, United States
| | - Joyonna Gamble-George
- Department of Neuroscience, University of Florida, Gainesville, FL 32611, United States
| | - Hideaki Yano
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| | - Habibeh Khoshbouei
- Department of Neuroscience, University of Florida, Gainesville, FL 32611, United States.
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Tible OP, Riese F, Savaskan E, von Gunten A. Best practice in the management of behavioural and psychological symptoms of dementia. Ther Adv Neurol Disord 2017; 10:297-309. [PMID: 28781611 PMCID: PMC5518961 DOI: 10.1177/1756285617712979] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/24/2017] [Indexed: 12/12/2022] Open
Abstract
Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The causes and risk factors for BPSD are multiple and include biological, psychological and environmental variables. Frequently, their combination, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Thus, a sound etiopathogenetic investigation including the patient and the family or care team is essential. The aim is to develop an individualized treatment plan using a therapeutic decision tree modified by the individual and environmental risk profile. Still, treatment may be difficult and challenging. Clinical empiricism often steps in where evidence from controlled studies is lacking. Psychosocial treatment approaches are pivotal for successful treatment of BPSD. Often a combination of different non-pharmacological approaches precedes drug treatment (most of which is off-label). Regular assessments of the treatment plan and any prescriptions must be carried out to detect signs of relapse and to stop any medicines that may have become inappropriate. Even with optimal management, BPSD will not disappear completely in some cases and will remain challenging for all involved parties. This article is a narrative review based closely on the interprofessional Swiss recommendations for the treatment of BPSD. To establish the recommendations, a thorough research of the literature has been carried out. Evidence-based data were provided through searches of Medline, Embase, ISI and Cochrane-Database research. Evidence categories of the World Federation of Biological Societies were used. Additionally, the clinical experience of Swiss medical experts was considered.
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Affiliation(s)
- Olivier Pierre Tible
- Department of Psychiatry, Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Lausanne University Hospital, CH-1008 Prilly, Switzerland
| | - Florian Riese
- Department of Geriatric Psychiatry, University Hospital of Psychiatry, Zurich, Switzerland University Research Priority Programme 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Egemen Savaskan
- Department of Geriatric Psychiatry, University Hospital of Psychiatry, Zurich, Switzerland
| | - Armin von Gunten
- Department of Psychiatry, Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Lausanne University Hospital, Prilly, Switzerland
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Moretti R, Caruso P, Dal Ben M. Rivastigmine as a Symptomatic Treatment for Apathy in Parkinson's Dementia Complex: New Aspects for This Riddle. PARKINSON'S DISEASE 2017; 2017:6219851. [PMID: 28409049 PMCID: PMC5376458 DOI: 10.1155/2017/6219851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/17/2017] [Accepted: 03/02/2017] [Indexed: 12/26/2022]
Abstract
Over 90% of PDD patients show at least one neuropsychiatric symptom (NPS); in the 60-70% two or more NPS are present. Their incidence is important in terms of prognosis and severity of pathology. However, among all NPS, apathy is often the most disturbing, associated with greater caregiver's burden. Similar to other NPS, apathy may be due to a dysfunction of the nigrostriatal pathway, even though, not all the PD patients become apathetic, indicating that apathy should not entirely be considered a dopamine-dependent syndrome, and in fact it might also be related to acetylcholine defects. Apathy has been treated in many ways, without sure benefits; among these, Rivastigmine may present benefic properties. We present a series of 48 patients, suffering from PDD, treated with Rivastigmine, and followed-up for one year; they have been devotedly studied for apathy, even though all the other NPS disorders have been registered. Rivastigmine did not have a prolonged benefic effect on apathy, in our work, on the contrary of what had been observed in the literature, probably due to the longer follow-up of our patients.
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Affiliation(s)
- Rita Moretti
- Clinica Neurologica, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Paola Caruso
- Clinica Neurologica, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Matteo Dal Ben
- FIF Science Park, University of Trieste, Trieste, Italy
- Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
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Pharmacological Therapy for Apathy in Alzheimer’s Disease: A Systematic Review and Meta-Analysis. Can J Neurol Sci 2017; 44:267-275. [DOI: 10.1017/cjn.2016.426] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractIntroduction:Apathy is highly prevalent in Alzheimer’s disease (AD), but whether pharmacotherapy is effective in managing apathy is unclear.Methods:To assess the efficacy of pharmacotherapy for apathy in AD we searched for randomized controlled trials (RCT) and aggregate data reporting on apathy in several search engines, reference lists of articles, and reviews. Demographic characteristics and relevant data were extracted to assess apathy.Results:Fifteen RCTs’ were examined, and 11 were used in aggregate meta-analytic statistics. Drugs included were cholinesterase inhibitors, memantine, and psycho-stimulants. We found no significant treatment effect in favour of any of the drugs, and the effect-size estimates under a random effect model were heterogeneous. Most RCTs had a high attrition rate and used the NPI apathy subscale to measure apathy.Conclusion:The lack of an effect could be explained by methodological limitations, publication bias, and heterogeneity.
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Qamar MA, Sauerbier A, Politis M, Carr H, Loehrer PA, Chaudhuri KR. Presynaptic dopaminergic terminal imaging and non-motor symptoms assessment of Parkinson's disease: evidence for dopaminergic basis? NPJ Parkinsons Dis 2017; 3:5. [PMID: 28649605 PMCID: PMC5445592 DOI: 10.1038/s41531-016-0006-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/04/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is now considered to be a multisystemic disorder consequent on multineuropeptide dysfunction including dopaminergic, serotonergic, cholinergic, and noradrenergic systems. This multipeptide dysfunction leads to expression of a range of non-motor symptoms now known to be integral to the concept of PD and preceding the diagnosis of motor PD. Some non-motor symptoms in PD may have a dopaminergic basis and in this review, we investigate the evidence for this based on imaging techniques using dopamine-based radioligands. To discuss non-motor symptoms we follow the classification as outlined by the validated PD non-motor symptoms scale.
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Affiliation(s)
- MA Qamar
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - A Sauerbier
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - M Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - H Carr
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - P A Loehrer
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - K Ray Chaudhuri
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
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Moretti R, Signori R. Neural Correlates for Apathy: Frontal-Prefrontal and Parietal Cortical- Subcortical Circuits. Front Aging Neurosci 2016; 8:289. [PMID: 28018207 PMCID: PMC5145860 DOI: 10.3389/fnagi.2016.00289] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
Apathy is an uncertain nosographical entity, which includes reduced motivation, abulia, decreased empathy, and lack of emotional involvement; it is an important and heavy-burden clinical condition which strongly impacts in everyday life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; “emotional affective” apathy may be related to the orbitomedial PFC and ventral striatum; “cognitive apathy” may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of “autoactivation” may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to gray matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. These neural networks are linked to projects, judjing and planning, execution and selection common actions, and through the basolateral amygdala and nucleus accumbens projects to the frontostriatal and to the dorsolateral prefrontal cortex. Therefore, an alteration of these circuitry caused a lack of insight, a reduction of decision-making strategies, and a reduced speedness in action decision, major responsible for apathy. Emergent role concerns also the parietal cortex, with its direct action motivation control. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
| | - Riccardo Signori
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
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Borgonovo J, Allende-Castro C, Laliena A, Guerrero N, Silva H, Concha ML. Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease. Parkinsonism Relat Disord 2016; 35:17-24. [PMID: 27889469 DOI: 10.1016/j.parkreldis.2016.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD.
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Affiliation(s)
- Janina Borgonovo
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Camilo Allende-Castro
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Almudena Laliena
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Néstor Guerrero
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Miguel L Concha
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile.
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Abstract
Increasing recognition that apathy is one of the most prevalent behavioral and psychological symptoms of dementia and causes substantial caregiver distress has led to trials evaluating psychosocial and pharmacological treatments of apathy in dementia. We evaluated evidence of the efficacy of pharmacotherapies for apathy in dementia from studies since 2013. Previously reported benefits of acetylcholinesterase inhibitors and memantine were not replicated in recent studies. Antidepressants had mixed results with positive effects for apathy shown only for agomelatine, while stimulants, analgesics, and oxytocin study results were inconclusive. For some approaches, such as antipsychotic review, positive effects were found only in combination with nonpharmacological approaches. Relatively few studies assessed apathy outcomes specifically, complicating interpretation of potentially positive treatment effects; none dissected outcomes for emotional, motivational and behavioral components of apathy. Better trial design and more detailed analysis are needed in order to evaluate outcomes of pharmacological treatments for apathy.
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34
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Neural correlates of apathy in patients with neurodegenerative disorders, acquired brain injury, and psychiatric disorders. Neurosci Biobehav Rev 2016; 69:381-401. [DOI: 10.1016/j.neubiorev.2016.08.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/11/2016] [Accepted: 08/06/2016] [Indexed: 11/21/2022]
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Apathy associated with neurocognitive disorders: Recent progress and future directions. Alzheimers Dement 2016; 13:84-100. [PMID: 27362291 DOI: 10.1016/j.jalz.2016.05.008] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Apathy is common in neurocognitive disorders (NCDs) such as Alzheimer's disease and mild cognitive impairment. Although the definition of apathy is inconsistent in the literature, apathy is primarily defined as a loss of motivation and decreased interest in daily activities. METHODS The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Neuropsychiatric Syndromes Professional Interest Area (NPS-PIA) Apathy workgroup reviewed the latest research regarding apathy in NCDs. RESULTS Progress has recently been made in three areas relevant to apathy: (1) phenomenology, including the use of diagnostic criteria and novel instruments for measurement, (2) neurobiology, including neuroimaging, neuropathological and biomarker correlates, and (3) interventions, including pharmacologic, nonpharmacologic, and noninvasive neuromodulatory approaches. DISCUSSION Recent progress confirms that apathy has a significant impact on those with major NCD and those with mild NCDs. As such, it is an important target for research and intervention.
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Ruthirakuhan MT, Herrmann N, Abraham EH, Lanctôt KL. Pharmacological interventions for apathy in Alzheimer's disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Myuri T Ruthirakuhan
- Sunnybrook Research Institute; Hurvitz Brain Sciences Research Program; 2075 Bayview Avenue Toronto ON Canada M4N 3M5
- University of Toronto; Department of Pharmacology and Toxicology; 2075 Bayview Avenue Toronto Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute; Hurvitz Brain Sciences Research Program; 2075 Bayview Avenue Toronto ON Canada M4N 3M5
- University of Toronto; Department of Psychiatry; 2075 Bayview Avenue, Room H-185 Toronto ON Canada
- Sunnybrook Health Sciences Centre; Geriatric Psychiatry; Toronto Canada
| | - Eleenor H Abraham
- Sunnybrook Research Institute; Hurvitz Brain Sciences Research Program; 2075 Bayview Avenue Toronto ON Canada M4N 3M5
| | - Krista L Lanctôt
- Sunnybrook Research Institute; Hurvitz Brain Sciences Research Program; 2075 Bayview Avenue Toronto ON Canada M4N 3M5
- University of Toronto; Department of Pharmacology and Toxicology; 2075 Bayview Avenue Toronto Canada
- University of Toronto; Department of Psychiatry; 2075 Bayview Avenue, Room H-185 Toronto ON Canada
- Sunnybrook Health Sciences Centre; Geriatric Psychiatry; Toronto Canada
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Chau SA, Chung J, Herrmann N, Eizenman M, Lanctôt KL. Apathy and Attentional Biases in Alzheimer’s Disease. J Alzheimers Dis 2016; 51:837-46. [DOI: 10.3233/jad-151026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sarah A. Chau
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Jonathan Chung
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, ON, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Moshe Eizenman
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Krista L. Lanctôt
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Magnard R, Vachez Y, Carcenac C, Krack P, David O, Savasta M, Boulet S, Carnicella S. What can rodent models tell us about apathy and associated neuropsychiatric symptoms in Parkinson's disease? Transl Psychiatry 2016; 6:e753. [PMID: 26954980 PMCID: PMC4872443 DOI: 10.1038/tp.2016.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022] Open
Abstract
In addition to classical motor symptoms, Parkinson's disease (PD) patients display incapacitating neuropsychiatric manifestations, such as apathy, anhedonia, depression and anxiety. These hitherto generally neglected non-motor symptoms, have gained increasing interest in medical and scientific communities over the last decade because of the extent of their negative impact on PD patients' quality of life. Although recent clinical and functional imaging studies have provided useful information, the pathophysiology of apathy and associated affective impairments remains elusive. Our aim in this review is to summarize and discuss recent advances in the development of rodent models of PD-related neuropsychiatric symptoms using neurotoxin lesion-based approaches. The data collected suggest that bilateral and partial lesions of the nigrostriatal system aimed at inducing reliable neuropsychiatric-like deficits while avoiding severe motor impairments that may interfere with behavioral evaluation, is a more selective and efficient strategy than medial forebrain bundle lesions. Moreover, of all the different classes of pharmacological agents, D2/D3 receptor agonists such as pramipexole appear to be the most efficient treatment for the wide range of behavioral deficits induced by dopaminergic lesions. Lesion-based rodent models, therefore, appear to be relevant tools for studying the pathophysiology of the non-motor symptoms of PD. Data accumulated so far confirm the causative role of dopaminergic depletion, especially in the nigrostriatal system, in the development of behavioral impairments related to apathy, depression and anxiety. They also put forward D2/D3 receptors as potential targets for the treatment of such neuropsychiatric symptoms in PD.
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Affiliation(s)
- R Magnard
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Y Vachez
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - C Carcenac
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - P Krack
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Grenoble, France
| | - O David
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - M Savasta
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Boulet
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Carnicella
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Inserm U1216, Grenoble Institute of Neuroscience, Site Santé La Tronche - BP 170, 38042 Grenoble, France. E-mail:
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Pardini M, Cordano C, Guida S, Grafman J, Krueger F, Sassos D, Massucco D, Abate L, Yaldizli Ö, Serrati C, Amore M, Mattei C, Cocito L, Emberti Gialloreti L. Prevalence and cognitive underpinnings of isolated apathy in young healthy subjects. J Affect Disord 2016; 189:272-5. [PMID: 26454331 DOI: 10.1016/j.jad.2015.09.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Apathy is well described in neurodegenerative conditions, however to date there is no evidence of significant isolated apathy in subjects free from other neurological and psychiatric co-morbidites. Identifying isolated apathy in subjects free from neuropsychiatric conditions could contribute to refining current concepts of apathy and reevaluate its nosological classification as an independent clinical syndrome. METHODS We assessed apathy and perceived quality of life in a group of 2751 adults (age 19-40 years) free from neuropsychiatric or medical conditions. Subjects with and without elevated apathy were compared on measures of depression, self-efficacy, behavioral inhibition, and behavioral activation. RESULTS Observed prevalence of isolated elevated apathy was 1.45%. Subjects with apathy presented with reduced quality of life and lower behavioral activation compared to apathy-free subjects, while there was no difference between the two groups on measures of depression, self-efficacy, and perceived social skills. LIMITATIONS The main limitation of this study is the use of self-report questionnaires. CONCLUSIONS Isolated, ecologically-relevant apathy can be found in adults independently from the presence of subclinical depression or of concurrent medical conditions. Apathy screening should be considered in the evaluation of young non-depressed subjects with reduced perceived quality of life.
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Affiliation(s)
- Matteo Pardini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy; Neuropsychiatric Unit, Centre for Communication and Neurorehabilitation Research-CNAPP, Rome, Italy.
| | - Christian Cordano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy
| | - Silvia Guida
- Adult Residential Facilities for Persons with Intellectual and Developmental Disabilities of the Social Cooperative A.N.F.F.A.S., Genoa, Italy
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA
| | - Frank Krueger
- Department of Molecular Neuroscience, George Mason University, Fairfax, VA, USA
| | - Davide Sassos
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy
| | - Davide Massucco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy
| | - Lucia Abate
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy; Neurology Unit, Valtellina, Val Chiavenna Hospital, Sondrio, Italy
| | - Özgür Yaldizli
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Carlo Serrati
- Department of Neurology, IRCCS San Martino Hospital - IST, Genoa, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy
| | - Chiara Mattei
- Territorial Psychiatry Unit, Local Health Service, Ancona, Italy
| | - Leonardo Cocito
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3-16132, Genoa, Italy
| | - Leonardo Emberti Gialloreti
- Neuropsychiatric Unit, Centre for Communication and Neurorehabilitation Research-CNAPP, Rome, Italy; Department of Biomedicine and Prevention, Rome Tor Vergata University, Rome, Italy
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López-Dóriga Bonnardeaux P, Andrino Díaz N. [Post-stroke apathy]. Rev Esp Geriatr Gerontol 2015; 51:164-9. [PMID: 26522489 DOI: 10.1016/j.regg.2015.09.002] [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: 06/27/2015] [Revised: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 10/22/2022]
Abstract
Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy.
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Affiliation(s)
| | - Nuria Andrino Díaz
- Servicio de Rehabilitación, Hospital Universitario de Getafe, Getafe, Madrid, España
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Siepel FJ, Dalen I, Grüner R, Booij J, Brønnick KS, Buter TC, Aarsland D. Loss of Dopamine Transporter Binding and Clinical Symptoms in Dementia With Lewy Bodies. Mov Disord 2015. [DOI: 10.1002/mds.26327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Françoise J. Siepel
- Center for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
| | - Ingvild Dalen
- Department of Research; Stavanger University Hospital; Stavanger Norway
| | - Renate Grüner
- Department of Radiology; Haukeland University Hospital; Bergen Norway
- Department of Physics and Technology; University of Bergen; Bergen Norway
| | - Jan Booij
- Department of Nuclear Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Kolbjørn S. Brønnick
- TIPS-Regional Center for Clinical Research in Psychosis; Stavanger University Hospital; Stavanger Norway
- Faculty of Social Sciences; University of Stavanger; Stavanger Norway
| | - Tirza C. Buter
- Department of Nuclear Medicine; Stavanger University Hospital; Stavanger Norway
| | - Dag Aarsland
- Center for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
- Department of Neurobiology; Care Sciences and Society (NVS); Center for Alzheimer Research; Division of Neurogeriatrics; Karolinska Institute; Stockholm Sweden
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Rosenberg PB, Nowrangi MA, Lyketsos CG. Neuropsychiatric symptoms in Alzheimer's disease: What might be associated brain circuits? Mol Aspects Med 2015; 43-44:25-37. [PMID: 26049034 DOI: 10.1016/j.mam.2015.05.005] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 12/15/2022]
Abstract
Neuropsychiatric symptoms (NPS) are very common in Alzheimer's disease (AD), particularly agitation, apathy, depression, and delusions. Brain networks or circuits underlying these symptoms are just starting to be understood, and there is a growing imaging and neurochemical evidence base for understanding potential mechanisms for NPS. We offer a synthetic review of the recent literature and offer hypotheses for potential networks/circuits underlying these NPS, particularly agitation, apathy, and delusions. Agitation in AD appears to be associated with deficits in structure and function of frontal cortex, anterior cingulate cortex, posterior cingulate cortex, amygdala, and hippocampus, and may be associated with mechanisms underlying misinterpretation of threats and affective regulation. Apathy in AD is associated with frontal cortex, anterior cingulate cortex, posterior cingulate cortex, as well as orbitofrontal cortex, and inferior temporal cortex, and may be associated with mechanisms underlying avoidance behaviors.
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Affiliation(s)
- Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA.
| | - Milap A Nowrangi
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA
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Peterson KA, Housden CR, Killikelly C, DeVito EE, Keong NC, Savulich G, Czosnyka Z, Pickard JD, Sahakian BJ. Apathy, ventriculomegaly and neurocognitive improvement following shunt surgery in normal pressure hydrocephalus. Br J Neurosurg 2015; 30:38-42. [PMID: 25968325 DOI: 10.3109/02688697.2015.1029429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Apathy - impaired motivation and goal-directed behaviour - is a common yet often overlooked symptom in normal pressure hydrocephalus (NPH). Caudate atrophy often yields apathetic symptoms; however, this structural and functional relationship has not yet been explored in NPH. Additionally, little is known about the relationship between apathy and post-shunt cognitive recovery. METHODS This audit investigated whether apathetic symptoms improve following shunt surgery in NPH, and whether this relates to cognitive response. In addition, we assessed the relationship between ventriculomegaly and apathy using the bicaudate ratio. Twenty-two patients with NPH completed the Mini-Mental State Examination (MMSE), the Apathy Evaluation Scale (AES) and the Geriatric Depression Scale (GDS) before and 3-9 months after shunt surgery. Pre-operative ventriculomegaly was correlated with pre-operative AES and GDS scores. Difference scores (post-shunt minus baseline values) for AES and GDS were correlated with cognitive outcome. RESULTS Greater pre-operative ventriculomegaly was associated with increased level of apathy and depression. A reduction in apathetic symptoms following shunt surgery was associated with improved performance on the MMSE. CONCLUSIONS Apathy may be indicative of a greater degree of subcortical atrophy in NPH and may relate to functional outcome.
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Affiliation(s)
- Katie A Peterson
- a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - Charlotte R Housden
- a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.,c Cambridge Cognition Ltd , Cambridge , UK
| | - Clare Killikelly
- a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - Elise E DeVito
- a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.,b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.,d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA
| | - Nicole C Keong
- b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - George Savulich
- a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - Zofia Czosnyka
- b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - John D Pickard
- b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - Barbara J Sahakian
- a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.,e MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge , Cambridge , UK
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Neuropathological sequelae of Human Immunodeficiency Virus and apathy: A review of neuropsychological and neuroimaging studies. Neurosci Biobehav Rev 2015; 55:147-64. [PMID: 25944459 DOI: 10.1016/j.neubiorev.2015.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 02/07/2023]
Abstract
Apathy remains a common neuropsychiatric disturbance in the Human Immunodeficiency Virus (HIV-1) despite advances in anti-retroviral treatment (ART). The goal of the current review is to recapitulate findings relating apathy to the deleterious biobehavioral effects of HIV-1 in the post-ART era. Available literatures demonstrate that the emergence of apathy with other neurocognitive and neuropsychiatric symptoms may be attributed to neurotoxic effects of viral proliferation, e.g., aggregative effect of Tat and gp120 on apoptosis, transport and other enzymatic reactions amongst dopaminergic neurons and neuroglia. An assortment of neuroimaging modalities converge on the severity of apathy symptoms associated with the propensity of the virus to replicate within frontal-striatal brain circuits that facilitate emotional processing. Burgeoning research into functional brain connectivity also supports the effects of microvascular and neuro-inflammatory injury linked to aging with HIV-1 on the presentation of neuropsychiatric symptoms. Summarizing these findings, we review domains of HIV-associated neurocognitive and neuropsychiatric impairment linked to apathy in HIV. Taken together, these lines of research suggest that loss of affective, cognitive and behavioral inertia is commensurate with the neuropathology of HIV-1.
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Santangelo G, Vitale C, Picillo M, Cuoco S, Moccia M, Pezzella D, Erro R, Longo K, Vicidomini C, Pellecchia MT, Amboni M, Brunetti A, Salvatore M, Barone P, Pappatà S. Apathy and striatal dopamine transporter levels in de-novo, untreated Parkinson's disease patients. Parkinsonism Relat Disord 2015; 21:489-93. [DOI: 10.1016/j.parkreldis.2015.02.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/06/2015] [Accepted: 02/17/2015] [Indexed: 01/26/2023]
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Abstract
BACKGROUND Dementia with Lewy body (DLB) is considered to be the second most common form of neurodegenerative disorders after Alzheimer's disease (AD), affecting as many as 100,000 people in the UK and up to 1.3 million in the USA. However, nearly half of patients with DLB remain undiagnosed thus depriving many of them from an early and adequate treatment of their distressing symptoms. Accurate and early diagnosis of DLB is important for both patients and their caregivers, since the neuropsychiatric symptoms require specific management. METHODS In the current study, we review the most recent developments in the field of molecular nuclear imaging to diagnose DLB. RESULTS The review addresses, the neurotransmitter based (dopaminergic, cholinergic, and glutamatergic) nuclear imaging techniques, role of the autonomic dysfunction and its visualization in DLB with myocardial sympathetic imaging and vesicular catecholamine uptake, as well as the use of amyloid polypeptides and glial markers as molecular imaging probes in the clinical diagnosis of DLB. CONCLUSIONS Most of the above nuclear imaging methods are restricted to highly specialized clinical centers, and thus not applicable to a large number of patients requiring dementia (e.g. DLB) diagnosis in routine clinical setting. Validating them against more readily accessible peripheral biomarkers, e.g. CSF and blood biomarkers linked to the DLB process, may facilitate their use in wider clinical settings.
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Zaaijer ER, de Bruin K, la Fleur SE, Goudriaan AE, van den Brink W, Booij J. Subchronic administration of short-acting naltrexone has no effect on striatal dopamine transporter availability, food intake or body weight gain in rats. J Psychopharmacol 2015; 29:344-8. [PMID: 25586403 DOI: 10.1177/0269881114565380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The opioid receptor antagonist naltrexone is successfully used in the treatment of opioid and alcohol dependence. However, questions have been raised about possible anhedonic side effects, because the opioid system is directly involved in hedonic responses to natural rewarding activities, possibly due to its indirect effects on the striatal dopamine transporter (DAT). In order to test this hypothesis, 30 rats were randomized to either a 10-day treatment with 3 mg/kg short-acting naltrexone or vehicle. No significant differences between the groups were found in striatal DAT availability, cumulative food intake (for 48 or 72 h), body weight gain and abdominal fatpad weight. Thus, the results of this study suggest that (sub)chronic treatment with short-acting naltrexone does not induce possible anhedonic effects. However, it cannot be ruled out the anhedonic effect of naltrexone is only short-lived and thus not detected in the current study. Therefore, future studies are needed to study possible acute anhedonic effects at several time points shortly after short-acting naltrexone administration and to directly compare the possible anhedonic effects of long-acting with those of short-acting opioid antagonists.
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Affiliation(s)
- Eline R Zaaijer
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kora de Bruin
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne E la Fleur
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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The monoaminergic footprint of depression and psychosis in dementia with Lewy bodies compared to Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2015; 7:7. [PMID: 25717350 PMCID: PMC4339739 DOI: 10.1186/s13195-014-0090-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
Abstract
Introduction Depression and psychosis are two of the most severe neuropsychiatric symptoms (NPS) in dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD). Both NPS have negative effects on cognitive performance and life expectancy. The current study aimed to investigate and compare monoaminergic etiologies between both neurodegenerative conditions, given the lack of an efficient pharmacological treatment until present. Methods Eleven behaviorally relevant brain regions of the left frozen hemisphere of 10 neuropathologically confirmed AD patients with/without depression (AD + D/-D; 5 were psychotic within AD + D), 10 confirmed DLB patients, all of whom were depressed (DLB + D; 5 psychotic patients), and, finally, 10 confirmed control subjects were regionally dissected. All patients were retrospectively assessed before death using the Behavioral Pathology in Alzheimer’s Disease Rating Scale (Behave-AD) and Cornell Scale for Depression in Dementia amongst others. The concentrations of dopamine (DA), serotonin (5-HT), (nor)adrenaline and respective metabolites, i.e. 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), 5-hydroxy-3-indoleacetic acid (5-HIAA), and, 3-methoxy-4-hydroxyphenylglycol (MHPG), were determined using reversed-phase high-performance liquid chromatography with electrochemical detection. Results DLB subjects had the overall lowest monoamine and metabolite concentrations regarding 33 out of 41 significant monoaminergic group alterations. Moreover, MHPG levels were significantly decreased in almost 8 out of 11 brain regions of DLB- compared to AD patients. We also observed the lowest 5-HT and 5-HIAA levels, and 5-HIAA/5-HT turnover ratios in DLB + D compared to AD + D subjects. Additionally, a 4- and 7-fold increase of DOPAC/DA and HVA/DA turnover ratios, and, a 10-fold decrease of thalamic DA levels in DLB + D compared to AD + D patients and control subjects was noticed. Regarding psychosis, hippocampal DA levels in the overall DLB group significantly correlated with Behave-AD AB scores. In the total AD group, DA levels and HVA/DA ratios in the amygdala significantly correlated with Behave-AD AB scores instead. Conclusions Monoaminergic neurotransmitter alterations contribute differently to the pathophysiology of depression and psychosis in DLB as opposed to AD, with a severely decreased serotonergic neurotransmission as the main monoaminergic etiology of depression in DLB. Similarly, psychosis in DLB might, in part, be etiologically explained by dopaminergic alterations in the hippocampus, whereas in AD, the amygdala might be involved.
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Hirao K, Pontone GM, Smith GS. Molecular imaging of neuropsychiatric symptoms in Alzheimer's and Parkinson's disease. Neurosci Biobehav Rev 2015; 49:157-70. [PMID: 25446948 PMCID: PMC4806385 DOI: 10.1016/j.neubiorev.2014.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 01/14/2023]
Abstract
Neuropsychiatric symptoms (NPS) are very common in neurodegenerative diseases and are a major contributor to disability and caregiver burden. There is accumulating evidence that NPS may be a prodrome and/or a "risk factor" of neurodegenerative diseases. The medications used to treat these symptoms in younger patients are not very effective in patients with neurodegenerative disease and may have serious side effects. An understanding of the neurobiology of NPS is critical for the development of more effective intervention strategies. Targeting these symptoms may also have implications for prevention of cognitive or motor decline. Molecular brain imaging represents a bridge between basic and clinical observations and provides many opportunities for translation from animal models and human post-mortem studies to in vivo human studies. Molecular brain imaging studies in Alzheimer's disease (AD) and Parkinson's disease (PD) are reviewed with a primary focus on positron emission tomography studies of NPS. Future directions for the field of molecular imaging in AD and PD to understand the neurobiology of NPS will be discussed.
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Affiliation(s)
- Kentaro Hirao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
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Nowrangi MA, Lyketsos CG, Rosenberg PB. Principles and management of neuropsychiatric symptoms in Alzheimer's dementia. Alzheimers Res Ther 2015; 7:12. [PMID: 27391771 PMCID: PMC4571139 DOI: 10.1186/s13195-015-0096-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neuropsychiatric symptoms of Alzheimer's disease (NPS-AD) are highly prevalent and lead to poor medical and functional outcomes. In spite of the burdensome nature of NPS-AD, we are continuing to refine the nosology and only beginning to understand the underlying pathophysiology. Cluster analyses have frequently identified three to five subsyndromes of NPS-AD: behavioral dysfunction (for example, agitation/aggressiveness), psychosis (for example, delusions and hallucinations), and mood disturbance (for example, depression or apathy). Recent neurobiological studies have used new neuroimaging techniques to elucidate behaviorally relevant circuits and networks associated with these subsyndromes. Several fronto-subcortical circuits, cortico-cortical networks, and neurotransmitter systems have been proposed as regions and mechanisms underlying NPS-AD. Common to most of these subsyndromes is the broad overlap of regions associated with the salience network (anterior cingulate and insula), mood regulation (amygdala), and motivated behavior (frontal cortex). Treatment strategies for dysregulated mood syndromes (depression and apathy) have primarily targeted serotonergic mechanisms with antidepressants or dopaminergic mechanisms with psychostimulants. Psychotic symptoms have largely been targeted with anti-psychotic medications despite controversial risk/benefit tradeoffs. Management of behavioral dyscontrol, including agitation and aggression in AD, has encompassed a wide range of psychoactive medications as well as non-pharmacological approaches. Developing rational therapeutic approaches for NPS-AD will require a firmer understanding of the underlying etiology in order to improve nosology as well as provide the empirical evidence necessary to overcome regulatory and funding challenges to further study these debilitating symptoms.
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Affiliation(s)
- Milap A Nowrangi
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Dr, 4th Floor, Baltimore, MD 21225 USA
| | - Constantine G Lyketsos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Dr, 4th Floor, Baltimore, MD 21225 USA
| | - Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Dr, 4th Floor, Baltimore, MD 21225 USA
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