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Holmgren S, Andersson T, Berglund A, Aarsland D, Cummings J, Freund-Levi Y. Neuropsychiatric Symptoms in Dementia: Considering a Clinical Role for Electroencephalography. J Neuropsychiatry Clin Neurosci 2022; 34:214-223. [PMID: 35306829 PMCID: PMC9357098 DOI: 10.1176/appi.neuropsych.21050135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Degenerative dementia is characterized by progressive cognitive decline and neuropsychiatric symptoms. People with Alzheimer's disease (AD), the most common cause of dementia, show synaptic loss and disruption of functional brain networks along with neuritic plaques and neurofibrillary tangles. Electroencephalography (EEG) directly reflects synaptic activity, and among patients with AD it is associated with slowing of background activity. The purpose of this study was to identify associations between neuropsychiatric symptoms and EEG in patients with dementia and to determine whether EEG parameters could be used for clinical assessment of pharmacological treatment of neuropsychiatric symptoms in dementia (NPSD) with galantamine or risperidone. METHODS Seventy-two patients with EEG recordings and a score ≥10 on the Neuropsychiatric Inventory (NPI) were included. Clinical assessments included administration of the NPI, the Mini-Mental State Examination (MMSE), and the Cohen-Mansfield Agitation Inventory (CMAI). Patients underwent EEG examinations at baseline and after 12 weeks of treatment with galantamine or risperidone. EEG frequency analysis was performed. Correlations between EEG and assessment scale scores were statistically examined, as were EEG changes from baseline to the week 12 visit and the relationship with NPI, CMAI, and MMSE scores. RESULTS Significant correlations were found between NPI agitation and delta EEG frequencies at baseline and week 12. No other consistent and significant relationships were observed between NPSD and EEG at baseline, after NPSD treatment, or in the change in EEG from baseline to follow-up. CONCLUSIONS The limited informative findings in this study suggest that there exists a complex relationship between NPSD and EEG; hence, it is difficult to evaluate and use EEG for clinical assessment of pharmacological NPSD treatment.
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Affiliation(s)
- Simon Holmgren
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm (Holmgren, Aarsland, Freund-Levi); Department of Neurophysiology, Karolinska University Hospital, Huddinge, Sweden (Andersson); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Berglund); Institute of Psychiatry, Psychology and Neuroscience, Division of Old Age Psychiatry, Kings College London (Aarsland, Freund-Levi); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland); Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Science, University of Nevada, Las Vegas (Cummings); Department of Psychiatry and Geriatrics, University Hospital Örebro, Sweden (Freund-Levi); and School of Medical Sciences, Örebro University, Sweden (Freund-Levi)
| | - Thomas Andersson
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm (Holmgren, Aarsland, Freund-Levi); Department of Neurophysiology, Karolinska University Hospital, Huddinge, Sweden (Andersson); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Berglund); Institute of Psychiatry, Psychology and Neuroscience, Division of Old Age Psychiatry, Kings College London (Aarsland, Freund-Levi); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland); Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Science, University of Nevada, Las Vegas (Cummings); Department of Psychiatry and Geriatrics, University Hospital Örebro, Sweden (Freund-Levi); and School of Medical Sciences, Örebro University, Sweden (Freund-Levi)
| | - Anders Berglund
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm (Holmgren, Aarsland, Freund-Levi); Department of Neurophysiology, Karolinska University Hospital, Huddinge, Sweden (Andersson); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Berglund); Institute of Psychiatry, Psychology and Neuroscience, Division of Old Age Psychiatry, Kings College London (Aarsland, Freund-Levi); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland); Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Science, University of Nevada, Las Vegas (Cummings); Department of Psychiatry and Geriatrics, University Hospital Örebro, Sweden (Freund-Levi); and School of Medical Sciences, Örebro University, Sweden (Freund-Levi)
| | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm (Holmgren, Aarsland, Freund-Levi); Department of Neurophysiology, Karolinska University Hospital, Huddinge, Sweden (Andersson); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Berglund); Institute of Psychiatry, Psychology and Neuroscience, Division of Old Age Psychiatry, Kings College London (Aarsland, Freund-Levi); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland); Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Science, University of Nevada, Las Vegas (Cummings); Department of Psychiatry and Geriatrics, University Hospital Örebro, Sweden (Freund-Levi); and School of Medical Sciences, Örebro University, Sweden (Freund-Levi)
| | - Jeffrey Cummings
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm (Holmgren, Aarsland, Freund-Levi); Department of Neurophysiology, Karolinska University Hospital, Huddinge, Sweden (Andersson); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Berglund); Institute of Psychiatry, Psychology and Neuroscience, Division of Old Age Psychiatry, Kings College London (Aarsland, Freund-Levi); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland); Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Science, University of Nevada, Las Vegas (Cummings); Department of Psychiatry and Geriatrics, University Hospital Örebro, Sweden (Freund-Levi); and School of Medical Sciences, Örebro University, Sweden (Freund-Levi)
| | - Yvonne Freund-Levi
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm (Holmgren, Aarsland, Freund-Levi); Department of Neurophysiology, Karolinska University Hospital, Huddinge, Sweden (Andersson); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Berglund); Institute of Psychiatry, Psychology and Neuroscience, Division of Old Age Psychiatry, Kings College London (Aarsland, Freund-Levi); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland); Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Science, University of Nevada, Las Vegas (Cummings); Department of Psychiatry and Geriatrics, University Hospital Örebro, Sweden (Freund-Levi); and School of Medical Sciences, Örebro University, Sweden (Freund-Levi)
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2
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Wong TKS, Yunhua Y, Jinghan C, Lee CKM, Ying Z, Liping J, Qiubi T, Chung JWY. Development of an integrative learning program for community dwelling old people with dementia. Rev Lat Am Enfermagem 2021; 29:e3486. [PMID: 34816868 PMCID: PMC8616300 DOI: 10.1590/1518-8345.4794.3486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: to develop an integrative learning program for people with dementia. Method: a methodological study was conducted using Delphi technique to develop the
learning program, followed by a feasibility test. An expert panel was
invited to develop the integrative learning program based on the
neuroplasticity and learning framework. A feasibility test was conducted to
evaluate the implementation of the program in two centers after the training
of personnel who run the program. Verbatim transcripts of case conferences
were coded, analyzed, and collapsed into themes and sub-themes by
consensus. Results: there was no indication for content modification during the period of program
implementation. Qualitatively, the participating older adults showed
improvement in communications, emotions, connectedness with self and others,
and well-being. Conclusion: the integrative learning program was uneventfully implemented with promising
results. The program is ready for full-scale research on its efficacy in
multiple centers to obtain more robust evidence.
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Affiliation(s)
- Thomas Kwok Shing Wong
- Guangzhou Medical University, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Hong Kong Nang Yan College of Higher Education University, Hong Kong, China
| | - Yang Yunhua
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | | | | | - Zhou Ying
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiang Liping
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Tang Qiubi
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Joanne Wai Yee Chung
- Guangzhou Medical University, Guangzhou, Guangdong, China.,The Education University of Hong Kong, Hong Kong, China
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3
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Walczak-Nowicka ŁJ, Herbet M. Acetylcholinesterase Inhibitors in the Treatment of Neurodegenerative Diseases and the Role of Acetylcholinesterase in their Pathogenesis. Int J Mol Sci 2021; 22:9290. [PMID: 34502198 PMCID: PMC8430571 DOI: 10.3390/ijms22179290] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022] Open
Abstract
Acetylcholinesterase (AChE) plays an important role in the pathogenesis of neurodegenerative diseases by influencing the inflammatory response, apoptosis, oxidative stress and aggregation of pathological proteins. There is a search for new compounds that can prevent the occurrence of neurodegenerative diseases and slow down their course. The aim of this review is to present the role of AChE in the pathomechanism of neurodegenerative diseases. In addition, this review aims to reveal the benefits of using AChE inhibitors to treat these diseases. The selected new AChE inhibitors were also assessed in terms of their potential use in the described disease entities. Designing and searching for new drugs targeting AChE may in the future allow the discovery of therapies that will be effective in the treatment of neurodegenerative diseases.
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Affiliation(s)
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8bStreet, 20-090 Lublin, Poland;
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4
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Bloniecki V, Zetterberg H, Aarsland D, Vannini P, Kvartsberg H, Winblad B, Blennow K, Freund-Levi Y. Are neuropsychiatric symptoms in dementia linked to CSF biomarkers of synaptic and axonal degeneration? ALZHEIMERS RESEARCH & THERAPY 2020; 12:153. [PMID: 33203439 PMCID: PMC7670701 DOI: 10.1186/s13195-020-00718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/29/2020] [Indexed: 01/12/2023]
Abstract
Background The underlying disease mechanism of neuropsychiatric symptoms (NPS) in dementia remains unclear. Cerebrospinal fluid (CSF) biomarkers for synaptic and axonal degeneration may provide novel neuropathological information for their occurrence. The aim was to investigate the relationship between NPS and CSF biomarkers for synaptic (neurogranin [Ng], growth-associated protein 43 [GAP-43]) and axonal (neurofilament light [NFL]) injury in patients with dementia. Methods A total of 151 patients (mean age ± SD, 73.5 ± 11.0, females n = 92 [61%]) were included, of which 64 had Alzheimer’s disease (AD) (34 with high NPS, i.e., Neuropsychiatric Inventory (NPI) score > 10 and 30 with low levels of NPS) and 18 were diagnosed with vascular dementia (VaD), 27 with mixed dementia (MIX), 12 with mild cognitive impairment (MCI), and 30 with subjective cognitive impairment (SCI). NPS were primarily assessed using the NPI. CSF samples were analyzed using enzyme-linked immunosorbent assays (ELISAs) for T-tau, P-tau, Aβ1–42, Ng, NFL, and GAP-43. Results No significant differences were seen in the CSF levels of Ng, GAP-43, and NFL between AD patients with high vs low levels of NPS (but almost significantly decreased for Ng in AD patients < 70 years with high NPS, p = 0.06). No significant associations between NPS and CSF biomarkers were seen in AD patients. In VaD (n = 17), negative correlations were found between GAP-43, Ng, NFL, and NPS. Conclusion Our results could suggest that low levels of Ng may be associated with higher severity of NPS early in the AD continuum (age < 70). Furthermore, our data may indicate a potential relationship between the presence of NPS and synaptic as well as axonal degeneration in the setting of VaD pathology.
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Affiliation(s)
- Victor Bloniecki
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden. .,Department of Dermatology, Karolinska University Hospital, Solna, Sweden.
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, UK.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Center for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Patrizia Vannini
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hlin Kvartsberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry in Region Örebro County and School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Old Age Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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5
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Tan ECK, Johnell K, Bell JS, Garcia-Ptacek S, Fastbom J, Nordström P, Eriksdotter M. Do Acetylcholinesterase Inhibitors Prevent or Delay Psychotropic Prescribing in People With Dementia? Analyses of the Swedish Dementia Registry. Am J Geriatr Psychiatry 2020; 28:108-117. [PMID: 31331724 DOI: 10.1016/j.jagp.2019.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate whether acetylcholinesterase inhibitor (AChEI) use prevents or delays subsequent initiation of psychotropic medications in people with Alzheimer's disease (AD) and Lewy body dementia (LBD). METHODS Cohort study of 17,763 people with AD and LBD, without prior psychotropic use at time of dementia diagnosis, registered in the Swedish Dementia Registry from 2007 to 2015. Propensity score-matched regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent AChEI use and risk of psychotropic initiation. RESULTS Compared with matched comparators, AChEI users had a lower risk of antipsychotic (HR: 0.85, 95%CI: 0.75-0.95) and anxiolytic (HR: 0.76, 95%CI: 0.72-0.80) initiation. In subanalyses, this association remained significant at higher AChEI doses, and in AD but not LBD. There were no associations between AChEI use and initiation of antidepressants or hypnotics. CONCLUSION AChEI use may be associated with lower risk of antipsychotic and anxiolytic initiation in AD, particularly at higher doses. Further investigation into aceytylcholinesterase inhibitors in behavioral and psychological symptoms of dementia management in LBD is warranted.
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Affiliation(s)
- Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences (ECKT, JSB), Monash University, Parkville, Australia; The University of Sydney, Faculty of Medicine and Health, School of Pharmacy (ECKT), NSW, Australia; Aging Research Centre, Department of Neurobiology, Care Sciences and Society (ECKT, JF), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics (KJ), Karolinska Institutet, Stockholm, Sweden
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences (ECKT, JSB), Monash University, Parkville, Australia
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (SGP, ME), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Internal Medicine, Section for Neurology (SGP), Södersjukhuset, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society (ECKT, JF), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation (PN), Umeå University, Umeå, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (SGP, ME), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Aging (ME), Karolinska University Hospital, Huddinge, Sweden
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6
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Bartley MM, Suarez L, Shafi RMA, Baruth JM, Benarroch AJM, Lapid MI. Dementia Care at End of Life: Current Approaches. Curr Psychiatry Rep 2018; 20:50. [PMID: 29936639 DOI: 10.1007/s11920-018-0915-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia. RECENT FINDINGS Survival times may vary across dementia subtypes. Yet, the overall trajectory is characterized by progressive decline until death. Ideally, as people with dementia approach the end of life, care should focus on comfort, dignity, and quality of life. However, barriers prevent optimal end-of-life care in the final stages of dementia. Improved and earlier advanced care planning for persons with dementia and their caregivers can help delineate goals of care and prepare for the inevitable complications of end-stage dementia. This allows for timely access to palliative and hospice care, which ultimately improves dementia end-of-life care.
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Affiliation(s)
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Reem M A Shafi
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Joshua M Baruth
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amanda J M Benarroch
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Maria I Lapid
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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7
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Ruan Q, Yu Z, Zhang W, Ruan J, Liu C, Zhang R. Cholinergic Hypofunction in Presbycusis-Related Tinnitus With Cognitive Function Impairment: Emerging Hypotheses. Front Aging Neurosci 2018; 10:98. [PMID: 29681847 PMCID: PMC5897739 DOI: 10.3389/fnagi.2018.00098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/22/2018] [Indexed: 01/21/2023] Open
Abstract
Presbycusis (age-related hearing loss) is a potential risk factor for tinnitus and cognitive deterioration, which result in poor life quality. Presbycusis-related tinnitus with cognitive impairment is a common phenotype in the elderly population. In these individuals, the central auditory system shows similar pathophysiological alterations as those observed in Alzheimer's disease (AD), including cholinergic hypofunction, epileptiform-like network synchronization, chronic inflammation, and reduced GABAergic inhibition and neural plasticity. Observations from experimental rodent models indicate that recovery of cholinergic function can improve memory and other cognitive functions via acetylcholine-mediated GABAergic inhibition enhancement, nicotinic acetylcholine receptor (nAChR)-mediated anti-inflammation, glial activation inhibition and neurovascular protection. The loss of cholinergic innervation of various brain structures may provide a common link between tinnitus seen in presbycusis-related tinnitus and age-related cognitive impairment. We hypothesize a key component of the condition is the withdrawal of cholinergic input to a subtype of GABAergic inhibitory interneuron, neuropeptide Y (NPY) neurogliaform cells. Cholinergic denervation might not only cause the degeneration of NPY neurogliaform cells, but may also result in decreased AChR activation in GABAergic inhibitory interneurons. This, in turn, would lead to reduced GABA release and inhibitory regulation of neural networks. Reduced nAChR-mediated anti-inflammation due to the loss of nicotinic innervation might lead to the transformation of glial cells and release of inflammatory mediators, lowering the buffering of extracellular potassium and glutamate metabolism. Further research will provide evidence for the recovery of cholinergic function with the use of cholinergic input enhancement alone or in combination with other rehabilitative interventions to reestablish inhibitory regulation mechanisms of involved neural networks for presbycusis-related tinnitus with cognitive impairment.
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Affiliation(s)
- Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weibin Zhang
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Ruan
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunhui Liu
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruxin Zhang
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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8
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Bloniecki V, Aarsland D, Blennow K, Cummings J, Falahati F, Winblad B, Freund-Levi Y. Effects of Risperidone and Galantamine Treatment on Alzheimer's Disease Biomarker Levels in Cerebrospinal Fluid. J Alzheimers Dis 2018; 57:387-393. [PMID: 28269767 DOI: 10.3233/jad-160758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment for neuropsychiatric symptoms (NPS) in dementia is insufficient. Antipsychotics and acetylcholinesterase inhibitors are used generating symptomatic improvements in behavior and cognition, but few studies have investigated their effect on Alzheimer's disease (AD) biomarkers in cerebrospinal fluid (CSF). OBJECTIVE This is a secondary analysis based on an earlier clinical trial comparing the treatment effects on NPS. The aim of this study was to examine whether treatment with risperidone and galantamine affect levels of the biomarkers T-Tau, P-Tau, Aβ1-42, and Aβ42/40-ratio in CSF. The secondary aim was to test if baseline levels of these biomarkers are associated with the clinical course of NPS. METHODS 83 patients (mean + SD 77.9.6±7.7 years) with dementia and NPS were randomized to galantamine (n = 44) or risperidone (n = 39) treatment. CSF samples were collected at baseline and after 12 weeks. RESULTS Changes in levels of biomarkers between the two treatment groups did not differ significantly. Low baseline levels of Aβ1 - 42 was significantly associated with reduction of irritability at follow up. Low baseline levels of Aβ1-42, Aβ42/40, and P-Tau were significant correlates of reduction in appetite and eating disorders. CSF Aβ1-42 levels in patients treated with risperidone were significantly decreased at follow up, showing an 8% (40 pg/mL) reduction as compared with baseline (p = 0.03). CONCLUSIONS Our results suggest that risperidone may affect the CSF profile of AD biomarkers indicating more amyloid pathology. Treatment with galantamine did not affect the CSF biomarkers in any direction. The AD CSF biomarkers displayed correlations with specific NPS suggesting potential research questions to be pursued.
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Affiliation(s)
- Victor Bloniecki
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
| | - Dag Aarsland
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Farshad Falahati
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Karolinska Institute, Caring Sciences and Society (NVS), Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | - Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
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9
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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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10
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Shinohara K, Aoki T, So R, Tsujimoto Y, Suganuma AM, Kise M, Furukawa TA. Influence of overstated abstract conclusions on clinicians: a web-based randomised controlled trial. BMJ Open 2017; 7:e018355. [PMID: 29247102 PMCID: PMC5736039 DOI: 10.1136/bmjopen-2017-018355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To investigate whether overstatements in abstract conclusions influence primary care physicians' evaluations when they read reports of randomised controlled trials (RCTs) DESIGN: RCT setting: This study was a parallel-group randomised controlled survey, conducted online while masking the study hypothesis. PARTICIPANTS Volunteers were recruited from members of the Japan Primary Care Association in January 2017. We sent email invitations to 7040 primary care physicians. Among the 787 individuals who accessed the website, 622 were eligible and automatically randomised into 'without overstatement' (n=307) and 'with overstatement' (n=315) groups. INTERVENTIONS We selected five abstracts from published RCTs with at least one non-significant primary outcome and overstatement in the abstract conclusion. To construct a version without overstatement, we rewrote the conclusion sections. The methods and results sections were standardised to provide the necessary information of primary outcome information when it was missing in the original abstract. Participants were randomly assigned to read an abstract either with or without overstatements and asked to evaluate the benefit of the intervention. OUTCOME MEASURES The primary outcome was the participants' evaluation of the benefit of the intervention discussed in the abstract, on a scale from 0 to 10. A secondary outcome was the validity of the conclusion. RESULTS There was no significant difference between the groups with respect to their evaluation of the benefit of the intervention (mean difference: 0.07, 95% CI -0.28 to 0.42, p=0.69). Participants in the 'without' group considered the study conclusion to be more valid than those in the 'with' group (mean difference: 0.97, 95% CI 0.59 to 1.36, P<0.001). CONCLUSION The overstatements in abstract conclusions did not significantly influence the primary care physicians' evaluations of the intervention effect when necessary information about the primary outcomes was distinctly reported. TRIAL REGISTRATION NUMBER UMIN000025317; Pre-results.
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Affiliation(s)
- Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Takuya Aoki
- Department of Health care Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ryuhei So
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Okayama Psychiatric Medical Center, Okayama, Okayama, Japan
| | - Yasushi Tsujimoto
- Department of Health care Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Aya M Suganuma
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Morito Kise
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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11
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Rios S, Perlman CM, Costa A, Heckman G, Hirdes JP, Mitchell L. Antipsychotics and dementia in Canada: a retrospective cross-sectional study of four health sectors. BMC Geriatr 2017; 17:244. [PMID: 29061129 PMCID: PMC5651600 DOI: 10.1186/s12877-017-0636-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Antipsychotic medications are not recommended for the management of symptoms of dementia, particularly among persons with no behavioral or psychological symptoms. We examine patterns of antipsychotic medication use among persons with dementia across health sectors in Canada, with a focus on factors related to use among those without behavioral or psychotic symptoms. Methods Using a retrospective cross-sectional design, this study examines antipsychotic use among adults aged 65 or older with dementia in home care (HC), complex continuing care (CCC), long-term care (LTC), and among alternate level care patients in acute hospitals (ALC). Using clinical data from January 1, 2009 to December 31, 2014, the prevalence of antipsychotic medication use was estimated by the presence of behavioral and psychotic symptoms. Logistic regression was used to identify sector specific factors associated with antipsychotic use in the absence of behavioral and psychotic symptoms. Results The total prevalence of antipsychotic use among older adults with dementia was 26% in HC, 54% in ALC, 41% in CCC, and 48% in LTC. This prevalence ranged from 38% (HC) to 73% (ALC) for those with both behavioral and psychotic symptoms and from 15% (HC) to 31% (ALC) among those with no symptoms. The regression models identified a number of variables were related to antipsychotic use in the absence of behavior or psychotic symptoms, such as bipolar disorder (OR = 6.63 in CCC; OR = 5.52 in LTC), anxious complaints (OR = 1.54 in LTC to 2.01 in CCC), and wandering (OR = 1.83 in ALC). Conclusions Potentially inappropriate use of antipsychotic medications is prevalent among older adults with dementia across health sectors. The variations in prevalence observed from community to facility based care suggests that system issues may exist in appropriately managing persons with dementia. Electronic supplementary material The online version of this article (10.1186/s12877-017-0636-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian Rios
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Andrew Costa
- Schlegel Research Institute for Aging, Waterloo, ON, Canada.,Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lori Mitchell
- Winnipeg Regional Health Authority (WRHA) Home Care Program, Winnipeg, MB, Canada
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12
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Shinohara K, Suganuma AM, Imai H, Takeshima N, Hayasaka Y, Furukawa TA. Overstatements in abstract conclusions claiming effectiveness of interventions in psychiatry: A meta-epidemiological investigation. PLoS One 2017; 12:e0184786. [PMID: 28902885 PMCID: PMC5597227 DOI: 10.1371/journal.pone.0184786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 08/30/2017] [Indexed: 12/25/2022] Open
Abstract
Objective Abstracts of scientific reports are sometimes criticized for exaggerating significant results when compared to the corresponding full texts. Such abstracts can mislead the readers. We aimed to conduct a systematic review of overstatements in abstract conclusions in psychiatry trials. Methods We searched for randomized controlled trials published in 2014 that explicitly claimed effectiveness of any intervention for mental disorders in their abstract conclusion, using the Cochrane Register of Controlled Trials. Claims of effectiveness in abstract conclusion were categorized into three types: superiority (stating superiority of intervention to control), limited superiority (intervention has limited superiority), and equal efficactiveness (claiming equal effectiveness of intervention with standard treatment control), and full text results into three types: significant (all primary outcomes were statistically significant in favor of the intervention), mixed (primary outcomes included both significant and non-significant results), or all results non-significant. By comparing these classifications, we assessed whether each abstract was overstated. Our primary outcome was the proportion of overstated abstract conclusions. Results We identified and included 60 relevant trials. 20 out of 60 studies (33.3%) showed overstatements. Nine reports reported only significant results although none of their primary outcomes were significant. Large sample size (>300) and publication in high impact factor (IF>10) journals were associated with low occurrence of overstatements. Conclusions We found that one in three psychiatry studies claiming effectiveness in their abstract conclusion, either superior to control or equal to standard treatment, for any mental disorders were overstated in comparison with the full text results. Readers of the psychiatry literature are advised to scrutinize the full text results regardless of the claims in the abstract. Trial registration University hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000018668)
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Affiliation(s)
- Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Konoe-cho, Sakyo-ku, Kyoto, Japan
- * E-mail:
| | - Aya M. Suganuma
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Konoe-cho, Sakyo-ku, Kyoto, Japan
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13
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Chen CT, Chang CC, Chang WN, Tsai NW, Huang CC, Chang YT, Wang HC, Kung CT, Su YJ, Lin WC, Cheng BC, Su CM, Hsiao SY, Hsu CW, Lu CH. Neuropsychiatric symptoms in Alzheimer's disease: associations with caregiver burden and treatment outcomes. QJM 2017; 110:565-570. [PMID: 28383687 DOI: 10.1093/qjmed/hcx077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Caregivers play a major role in providing care for patients with Alzheimer's disease (AD) and are themselves at higher risk of health comorbidities. AIM To address the impact of neuropsychiatric symptoms of patients in different stages of AD on their caregivers' burden. DESIGN This prospective study enrolled 260 AD patients with clinical dementia rating (CDR) of 0.5, 1 and 2 at a tertiary medical center. METHODS All patients were tested using the mini-mental state examination (MMSE), the cognitive abilities screening instrument (CASI), the neuropsychiatric inventory (NPI) and the CDR scale. Data regarding therapeutic outcomes of anti-Alzheimer's drugs were also collected. Caregivers were tested using NPI. RESULTS The mean follow-up interval was 25.0 ± 12.2 months, and two patients died during follow-up. NPI-burden was positively correlated with NPI-sum ( r = 0.822, P < 0.001) but negatively correlated with years of education ( r = -0.140, P = 0.024), CASI score ( r = -0.259, P < 0.001) and MMSE score ( r = -0.262, P <0.001). Multiple linear regression analysis showed that only NPI-sum was independently associated with mean NPI-burden. Both higher mean CASI and MMSE scores had better therapeutic outcome of anti-Alzheimer's drugs ( P = 0.001 and P = 0.005, respectively). CONCLUSIONS The severity of neuropsychiatric symptoms in patients with AD was positively associated with caregiver's stress, and patients with better cognitive functions, under treatment with anti-Alzheimer's drugs, had better therapeutic outcomes. To reduce the impact of neuropsychiatric symptoms, it is crucial to detect dementia in its early phases and provide early intervention with anti-Alzheimer's drugs, which might help decrease the caregiver burden, thereby improving their quality of life.
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Affiliation(s)
| | | | | | | | | | | | | | - C-T Kung
- Department of Emergency Medicine
| | - Y-J Su
- Department of Internal Medicine
| | - W-C Lin
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - B-C Cheng
- Department of Internal Medicine
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
| | - C-M Su
- Department of Emergency Medicine
| | - S-Y Hsiao
- Department of Emergency Medicine
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
| | - C-W Hsu
- Department of Neurology
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
| | - C-H Lu
- Department of Neurology
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China
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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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15
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Panza F, Solfrizzi V, Seripa D, Imbimbo BP, Santamato A, Lozupone M, Prete C, Greco A, Pilotto A, Logroscino G. Progresses in treating agitation: a major clinical challenge in Alzheimer's disease. Expert Opin Pharmacother 2015; 16:2581-8. [PMID: 26389682 DOI: 10.1517/14656566.2015.1092520] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Treatment of neuropsychiatric symptoms (NPS) represents a major clinical challenge in Alzheimer's disease (AD). Agitation and aggression are frequently seen during institutionalization and increase patient morbidity and mortality and caregiver burden. Off-label use of atypical antipsychotics for treating agitation in AD showed only modest clinical benefits, with high side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred first-line option. When such treatment fails, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for efficiently treating agitation and aggression in AD and dementia. AREAS COVERED Emerging evidence on the neurobiological substrates of agitation in AD has led to several recent clinical trials of repositioned and novel therapeutics for these NPS in dementia as an alternative to antipsychotics. We operated a comprehensive literature search for published articles evaluating pharmacological interventions for agitation in AD, with a review of recent clinical trials on mibampator, dextromethorphan/quinidine, cannabinoids, and citalopram. EXPERT OPINION Notwithstanding the renewed interest for the pharmacological treatment of agitation in AD, progresses have been limited. A small number and, sometimes methodologically questionable, randomized controlled trials (RCTs) have produced disappointing results. However, recently completed RCTs on novel or repositioned drugs (mibampator, dextromethorphan/quinidine, cannabinoids, and citalopram) showed some promise in treating agitation in AD, but still with safety concerns. Further evidence will come from ongoing Phase II and III trials on promising novel drugs for treating these distressing symptoms in patients with AD and dementia.
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Affiliation(s)
- Francesco Panza
- a 1 University of Bari Aldo Moro, Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , Bari, Italy , .,b 2 University of Bari Aldo Moro, Department of Clinical Research in Neurology, "Pia Fondazione Cardinale G. Panico" , Tricase, Lecce, Italy.,c 3 Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- d 4 University of Bari Aldo Moro, Geriatric Medicine-Memory Unit and Rare Disease Centre , Bari, Italy
| | - Davide Seripa
- c 3 Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia, Italy
| | - Bruno P Imbimbo
- e 5 Research & Development Department, Chiesi Farmaceutici , Parma, Italy
| | - Andrea Santamato
- f 6 University of Foggia, Physical Medicine and Rehabilitation Section, "OORR" Hospital , Foggia, Italy
| | - Madia Lozupone
- a 1 University of Bari Aldo Moro, Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , Bari, Italy ,
| | - Camilla Prete
- g 7 Geriatrics Unit, Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, Galliera Hospital NR-HS , Genova, Italy
| | - Antonio Greco
- c 3 Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- g 7 Geriatrics Unit, Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, Galliera Hospital NR-HS , Genova, Italy
| | - Giancarlo Logroscino
- a 1 University of Bari Aldo Moro, Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , Bari, Italy , .,b 2 University of Bari Aldo Moro, Department of Clinical Research in Neurology, "Pia Fondazione Cardinale G. Panico" , Tricase, Lecce, Italy
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Defrancesco M, Marksteiner J, Fleischhacker WW, Blasko I. Use of Benzodiazepines in Alzheimer's Disease: A Systematic Review of Literature. Int J Neuropsychopharmacol 2015; 18:pyv055. [PMID: 25991652 PMCID: PMC4648159 DOI: 10.1093/ijnp/pyv055] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/12/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Benzodiazepines are frequently prescribed in patients with Alzheimer's disease. Unfortunately, studies evaluating their benefits and risks in these patients are limited. METHODS Clinical trials focusing on the effect of benzodiazepines on cognitive functions, disease progression, behavioral symptoms, sleep disturbances, and the general frequency of benzodiazepine use were included in this review. Published articles from January 1983 to January 2015 were identified using specific search terms in MEDLINE and PubMed Library according to the recommendations of The Strengthening the Reporting of Observational Studies in Epidemiology initiative. RESULTS Of the 657 articles found, 18 articles met predefined selection criteria and were included in this review (8 on frequency, 5 on cognitive functions, 5 on behavioral and sleep disturbances). The frequency of benzodiazepine use ranged from 8.5% to 20%. Five studies reported accelerated cognitive deterioration in association with benzodiazepine use. Two studies reported clinical efficacy for lorazepam and alprazolam to reduce agitation in Alzheimer's disease patients. No evidence was found for an improvement of sleep quality using benzodiazepines. CONCLUSION This systematic review shows a relatively high prevalence of benzodiazepine use but limited evidence for clinical efficacy in Alzheimer's disease patients. However, there is a paucity of methodologically high quality controlled clinical trials. Our results underscore a need for randomized controlled trials in this area.
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Affiliation(s)
- Michaela Defrancesco
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Josef Marksteiner
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - W Wolfgang Fleischhacker
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Imrich Blasko
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
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Freund-Levi Y, Bloniecki V, Auestad B, Tysen Bäckström AC, Lärksäter M, Aarsland D. Galantamine versus risperidone for agitation in people with dementia: a randomized, twelve-week, single-center study. Dement Geriatr Cogn Disord 2015; 38:234-44. [PMID: 24969380 DOI: 10.1159/000362204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS To examine the effects of galantamine and risperidone on agitation in patients with dementia. METHODS A total of 100 patients with dementia and neuropsychiatric symptoms (mean age ± SD: 78.6 ± 7.5 years; 67% female) were included in this 12-week, randomized, parallel-group, controlled, single-center trial. The participants received galantamine (n = 50; target dose: 24 mg) or risperidone (n = 50; target dose: 1.5 mg) for 12 weeks. RESULTS Both galantamine and risperidone treatment resulted in reduced agitation. However, risperidone showed a significant advantage over galantamine both at week 3 (mean difference in total Cohen-Mansfield Agitation Inventory score: 3.7 points; p = 0.03) and at week 12 (4.3 points; p = 0.01). CONCLUSIONS Agitation improved in both groups, even if the treatment effects were more pronounced in the risperidone group; however, the effects on cognition and other aspects of tolerability were stronger with galantamine.
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Affiliation(s)
- Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
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An unsubstantiated conclusion. Am J Geriatr Psychiatry 2015; 23:220. [PMID: 25575935 DOI: 10.1016/j.jagp.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 11/23/2022]
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Fereshtehnejad SM, Johnell K, Eriksdotter M. Anti-dementia drugs and co-medication among patients with Alzheimer's disease : investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem). Drugs Aging 2014; 31:215-24. [PMID: 24497071 DOI: 10.1007/s40266-014-0154-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is a substantial risk of drug-interactions, adverse events, and inappropriate drug use (IDU) among frail Alzheimer's disease (AD) patients; however, there are few studies about co-medication and IDU in clinical settings. OBJECTIVES To investigate anti-dementia drugs, associated characteristics of cholinesterase inhibitors (ChEIs) and NMDA antagonists, co-medication, and IDU in a large population of outpatients with mild AD. METHODS In this cross-sectional analysis of medication characteristics, we analyzed data from the Swedish Dementia Quality Registry (SveDem) on 5,907 newly diagnosed AD patients who were registered in memory clinics. SveDem is a national quality registry in Sweden, which was established in 2007 to evaluate and improve dementia healthcare. Comparisons were performed concerning co-medications, use of ≥3 psychotropic drugs (IDU) and polypharmacy (≥5 drugs) based on anti-dementia treatment (ChEIs or NMDA antagonists). Information on baseline characteristics such as age, sex, living conditions, cognitive evaluation based on the Mini-Mental State Examination (MMSE) score, and diagnostic work-up was also evaluated. RESULTS The majority of the AD patients were in the mild stage of the disease. Overall, 4,342 (75.4 %) patients received any ChEI, 438 (7.6 %) used an NMDA antagonist and 74 (1.3 %) patients were treated with both. However, 907 (15.7 %) patients were not treated with any anti-dementia drug. While polypharmacy was seen in 33.5 % of patients, only 2.6 % concurrently used ≥3 psychotropic medications. Patients on ChEIs were significantly younger, had a higher MMSE score and were treated with a smaller number of medications (a proxy for overall co-morbidity). Co-medication with antipsychotics [3.3 vs. 7.6 %; adjusted odds ratio (OR) 0.55 (95 % CI 0.38-0.79)] and anxiolytics [5.8 vs. 10.9 %; adjusted OR 0.62 (95 % CI 0.46-0.84)] was significantly lower in the ChEI+ group than in those with no anti-dementia treatment. CONCLUSION Patients taking ChEIs were treated with less antipsychotics and anxiolytics than those not taking ChEIs. More research is warranted to elucidate whether use of ChEIs in clinical practice can reduce the need for psychotropic drugs in AD patients.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Novum 5th floor, 14186, Stockholm, Sweden,
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Galantamine versus risperidone treatment of neuropsychiatric symptoms in patients with probable dementia: an open randomized trial. Am J Geriatr Psychiatry 2014; 22:951. [PMID: 25109421 DOI: 10.1016/j.jagp.2014.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022]
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Bloniecki V, Aarsland D, Cummings J, Blennow K, Freund-Levi Y. Agitation in dementia: relation to core cerebrospinal fluid biomarker levels. Dement Geriatr Cogn Dis Extra 2014; 4:335-43. [PMID: 25298777 PMCID: PMC4176467 DOI: 10.1159/000363500] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to examine the associations of agitation with the cerebrospinal fluid dementia biomarkers total-tau (T-tau), phosphorylated-tau (P-tau) and Aβ1-42. Methods One hundred patients (mean age ± SD, 78.6 ± 7.5 years) with dementia and neuropsychiatric symptoms, of whom 67% were female, were included. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI; 46.5 ± 11.8 points). Results Total CMAI correlated with T-tau [rs (31) = 0.36, p = 0.04] and P-tau [rs (31) = 0.35, p = 0.05] in patients with Alzheimer's disease (AD; n = 33) but not in the total dementia population (n = 95). Conclusions Our results suggest that tau-mediated pathology including neurofibrillary tangles and the intensity of the disease process might be associated with agitation in AD.
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Affiliation(s)
- Victor Bloniecki
- Division of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden
| | - Dag Aarsland
- Center for Alzheimer Research, Division for Neurogeriatrics, Department of Neurobiology, Caring Sciences and Society (NVS), Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden ; Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Yvonne Freund-Levi
- Division of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden
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Mulsant BH. Challenges of the treatment of neuropsychiatric symptoms associated with dementia. Am J Geriatr Psychiatry 2014; 22:317-20. [PMID: 24635993 DOI: 10.1016/j.jagp.2014.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Benoit H Mulsant
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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