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Carmel JF, Clerc D, Couture V, Reid I, Filali A, Villalpando JM. The Difference in Cognitive Profiles Between Patients With Alzheimer Dementia With and Without Psychosis: A Rapid Review. Alzheimer Dis Assoc Disord 2024:00002093-990000000-00129. [PMID: 39318171 DOI: 10.1097/wad.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/13/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Psychosis in Alzheimer disease (AD) is a major burden for patients and their family. Identifying the characteristics of delusions and hallucinations in the AD population is key to understanding the interconnection between the psychiatric and cognitive symptoms in neurocognitive disorders. The aim of this study is to compare the cognitive profiles of AD patients with and without psychosis. METHODS We conducted a rapid review to explore the relationship between psychotic symptoms and cognitive performances in patients with AD. We used MEDLINE, Embase, and PsychINFO literature databases between January 2015 and January 2023. This rapid review was guided by the Cochrane Rapid Reviews Methods Group. RESULTS We identified 2909 records from the initial searches. After reviewing the titles, abstracts, and full texts, we selected 8 cross-sectional and 5 cohort studies for the qualitative analysis. Among them, 6 studies were included in the final quantitative analysis. Most studies suggested a correlation between general cognitive decline and the risk of presenting psychotic symptoms. Three studies found an association between hallucinations and deficits in the visuocognitive domains (visuospatial, visuoperceptual, and visuoconstructive skills). Two studies found a relationship between psychotic symptoms and executive dysfunction. Two studies also found a correlation between psychotic symptoms and language. Our results are in line with previous data in the literature, especially regarding the outcome of psychosis on executive function and visuocognitive abilities. CONCLUSIONS There appears to be an association between cognitive deficits and psychotic symptoms in AD, but the direction of causality is still unclear, and further studies using longitudinal designs would give more insight into the pathophysiological process of psychosis in AD.
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Affiliation(s)
| | - Doris Clerc
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | | | - Isabelle Reid
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Ali Filali
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Juan Manuel Villalpando
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
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Kim SY, Lee SJ. The characteristics of cognitive and daily living functions of neurocognitive disorders with delusions in elderly Alzheimer's disease. PeerJ 2024; 12:e18026. [PMID: 39285920 PMCID: PMC11404475 DOI: 10.7717/peerj.18026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Background Delusions in neurocognitive disorder due to Alzheimer's disease (AD) worsen patients' cognitive functions and activities of daily living (ADL), increasing caregiver burden and the risk of mortality. AD patients with delusions tend to experience a more rapid decline in cognition and have demonstrated poorer performance on various cognitive function tests. Considering the prognosis of delusion in AD patients, it tends to be more favorable with appropriate treatment. However, there is a lack of neuropsychological research, specifically examining the impact of delusions in AD, characterized by progressive deterioration of cognitive function. This study investigates the impact of delusions on cognitive function and ADL under conditions controlling for disease severity. Methods We compared cognitive function and ADL in AD patients aged 65 years or older according to the presence of delusions. To assess longitudinal change, we analyzed data from patients monitored for an average of 15 to 16 months. We assessed cognitive function and ADL using the Seoul Neuropsychological Screening Battery-Second Edition (SNSB-II) and delusions using the Neuropsychiatric Inventory (NPI). We used IBM SPSS Statistics version 25.0 for all statistical analyses. The analysis was not adjusted for multiple comparisons. We investigated how delusions impact cognitive function and ADL, controlling for age, educational level, and disease severity. Results The delusions group exhibited poorer immediate recall of verbal memory than the non-delusions group. In the follow-up evaluation, patients who developed delusions had lower baseline cognitive function than those who did not, and their language fluency declined over time. In addition, we found the presence of delusions associated with worse functional impairment in ADL as the disease progressed. Conclusion While controlling for the severity of AD, we found no significant negative impacts of delusions on most cognitive functions. Nevertheless, it is noteworthy that the immediate recall of verbal memory and the Controlled Oral Word Association Test (COWAT)_animal sensitively detected the negative impact of delusions. Furthermore, since delusions are associated with worsening ADL, we understand that delusion treatment is important for improving the quality of life for patients and caregivers.
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Affiliation(s)
- Seo Yoo Kim
- Department of Psychology, Kyungpook National University, Daegu, Republic of South Korea
- Department of Neuropsychiatry, Good Samsun Hospital, Busan, Republic of South Korea
| | - Soo Jin Lee
- Department of Psychology, Kyungsung University, Busan, Republic of South Korea
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Berger A, Castilhos RM, Ismail Z, Camozzato A. Prevalence of psychotic symptoms in mild cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2024; 100:102431. [PMID: 39029803 DOI: 10.1016/j.arr.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Neuropsychiatric symptoms may impact prognosis in individuals with mild cognitive impairment (MCI); however, data on frequency of psychotic symptoms are sparse. METHODS We searched MEDLINE, EMBASE, PsychoINFO from inception to June 2023. We included studies reporting patients with MCI prevalence of (delusions and/or hallucinations. Random effects model were performed to estimate the prevalence, and subgroup and meta-regression analyses were performed to explore heterogeneity. RESULTS Of 3145 records identified, 36 studies were included, enrolling 20,426 patients. Overall prevalence of hallucinations was 1.78 % (95 % CI, 1.17 - 2.71) and delusions 3.84 % (95 % CI, 2.71 - 5.42), both with significant heterogeneity (/2 = 90 %). Prevalence of hallucinations and delusions were lower when measured by NPI scales and in population-based samples. DISCUSSION Delusions and hallucinations occur in MCI patients at low rates. Prevalence can be partially explained by the assessment method, sample source and study heterogeneity.
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Affiliation(s)
- Aline Berger
- Programa de Pós-Graduação em Ciências Médicas da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Zahinoor Ismail
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Analuiza Camozzato
- Programa de Pós-Graduação em Ciências Médicas da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
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Atchison K, Wu P, Watt JA, Seitz D, Ismail Z, Goodarzi Z. Psychosis detection in dementia: a systematic review of diagnostic test accuracy studies. FRONTIERS IN DEMENTIA 2024; 3:1377191. [PMID: 39081609 PMCID: PMC11285683 DOI: 10.3389/frdem.2024.1377191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/22/2024] [Indexed: 08/02/2024]
Abstract
Introduction Symptoms of psychosis, characterized by delusions and hallucinations, are commonly experienced by persons living with dementia. A systematic review was completed to identify tools to evaluate symptoms of psychosis compared to a reference standard in persons with dementia. Articles reporting correlation values between psychosis tools were also identified. Methods The search concepts psychosis, dementia, and diagnostic accuracy were used to search MEDLINE, PsycINFO, and Embase. Included articles meeting the primary objective described a tool to assess symptoms of psychosis, delusions, or hallucinations in persons with dementia, a reference standard form of diagnostic assessment for psychosis, and diagnostic accuracy outcomes for the psychosis tool. Secondary objective articles reported correlation values between two or more psychosis tools in persons with dementia. Results One study met the primary objective and described the sensitivity and specificity of the Neuropsychiatric Inventory (NPI) and Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD) in identifying symptoms of psychosis, hallucinations, and delusions. The sensitivity of the NPI and CUSPAD in identifying symptoms of psychosis was 83 and 90%, respectively. Nine studies meeting the secondary objective described eleven unique tools and examined the degree to which tools used to assess psychotic symptoms in persons with dementia were related. Discussion The NPI and CUSPAD were identified in a single study as psychosis tools that have been evaluated against a reference standard of psychosis assessment in persons with dementia. Various tools to assess the burden of psychotic symptoms in persons with dementia exist, but the diagnostic accuracy of existing tools remains understudied. Further research on the comparative utility and diagnostic accuracy is required for all psychosis tools used with persons with dementia.
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Affiliation(s)
- Kayla Atchison
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pauline Wu
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer A. Watt
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dallas Seitz
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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5
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Shippee TP, Parikh RR, Baker ZG, Bucy TI, Ng W, Jarosek S, Qin X, Woodhouse M, Nkimbeng M, McCarthy T. Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer's Disease and Related Dementias. J Aging Health 2024; 36:379-389. [PMID: 37493607 DOI: 10.1177/08982643231191164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ObjectivesAmong nursing home (NH) residents with Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012-2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0-100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.
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Affiliation(s)
- Tetyana Pylypiv Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Taylor I Bucy
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Weiwen Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Jarosek
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Xuanzi Qin
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA
| | - Mark Woodhouse
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Manka Nkimbeng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Teresa McCarthy
- Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Gkintoni E, Skokou M, Gourzis P. Integrating Clinical Neuropsychology and Psychotic Spectrum Disorders: A Systematic Analysis of Cognitive Dynamics, Interventions, and Underlying Mechanisms. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:645. [PMID: 38674291 PMCID: PMC11051923 DOI: 10.3390/medicina60040645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: The study aims to provide a comprehensive neuropsychological analysis of psychotic spectrum disorders, including schizophrenia, bipolar disorder, and depression. It focuses on the critical aspects of cognitive impairments, diagnostic tools, intervention efficacy, and the roles of genetic and environmental factors in these disorders. The paper emphasizes the diagnostic significance of neuropsychological tests in identifying cognitive deficiencies and their predictive value in the early management of psychosis. Materials and Methods: The study involved a systematic literature review following the PRISMA guidelines. The search was conducted in significant databases like Scopus, PsycINFO, PubMed, and Web of Science using keywords relevant to clinical neuropsychology and psychotic spectrum disorders. The inclusion criteria required articles to be in English, published between 2018 and 2023, and pertinent to clinical neuropsychology's application in these disorders. A total of 153 articles were identified, with 44 ultimately included for detailed analysis based on relevance and publication status after screening. Results: The review highlights several key findings, including the diagnostic and prognostic significance of mismatch negativity, neuroprogressive trajectories, cortical thinning in familial high-risk individuals, and distinct illness trajectories within psychosis subgroups. The studies evaluated underline the role of neuropsychological tests in diagnosing psychiatric disorders and emphasize early detection and the effectiveness of intervention strategies based on cognitive and neurobiological markers. Conclusions: The systematic review underscores the importance of investigating the neuropsychological components of psychotic spectrum disorders. It identifies significant cognitive impairments in attention, memory, and executive function, correlating with structural and functional brain abnormalities. The paper stresses the need for precise diagnoses and personalized treatment modalities, highlighting the complex interplay between genetic, environmental, and psychosocial factors. It calls for a deeper understanding of these neuropsychological processes to enhance diagnostic accuracy and therapeutic outcomes.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece; (M.S.); (P.G.)
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Evidente VGH, DeKarske D, Coate B, Abler V. The effects of treatment with pimavanserin on activities of daily living in patients with Parkinson's disease psychosis: a 16-week, single-arm, open-label study. Ther Adv Neurol Disord 2024; 17:17562864241228350. [PMID: 38476466 PMCID: PMC10929044 DOI: 10.1177/17562864241228350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/14/2023] [Indexed: 03/14/2024] Open
Abstract
Background More than half of patients with Parkinson's disease will experience psychosis symptoms in the form of hallucinations or delusions at some point over the course of their disease. These symptoms can significantly impact patients' health-related quality of life, cognitive abilities, and activities of daily living (ADLs) and function. Clinical assessment of how psychosis impacts these measures is crucial; however, few studies have assessed this sufficiently, in part due to a lack of appropriate scales for comprehensively assessing function. Objective The objective was to assess how symptoms of Parkinson's disease psychosis (PDP) impact ADLs and function, cognitive function, and health-related quality of life. Design To address this unmet need, we utilized a modified version of the Functional Status Questionnaire (mFSQ) to measure the impact of psychosis on ADLs and function in patients with PDP treated with pimavanserin, a US Food and Drug Administration-approved medication to treat hallucinations and delusions associated with PDP. Methods Eligible patients entered a 16-week, single-arm, open-label study of oral pimavanserin (34 mg) taken once daily. The primary endpoint was change from baseline to Week 16 on the mFSQ. Secondary endpoints included the Movement Disorders Society-modified Unified Parkinson's Disease Rating Scale (MDS-UPDRS) I and II; Schwab and England ADL; Clinical Global Impression-Severity of Illness (CGI-S), Clinical Global Impression-Improvement (CGI-I), and Patient Global Impression-Improvement (PGI-I), and were also measured as change from baseline to Week 16 using mixed-effects model for repeated measures (MMRM) and least-squares mean (LSM). Results Our results in a proof-of-concept, 16-week, open-label clinical study in 29 patients demonstrated that an improvement in psychosis symptoms following treatment with pimavanserin was associated with improvements in multiple measures of ADLs and function. Notably, a significant improvement was found on the primary endpoint, change from baseline to Week 16 in mFSQ score [LSM [SE] 14.0 [2.50], n = 17; 95% CI (8.8, 19.3); p < 0.0001]. Conclusion These findings highlight the potential for improvement in function with improvement of psychosis symptoms in patients with PDP and suggest that the mFSQ may be a measurement tool to evaluate the level of improvement in function. Trial registration ClinicalTrials.gov Identifier: NCT04292223.
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Affiliation(s)
- Virgilio G. H. Evidente
- Movement Disorders Center of Arizona, 9500 E. Ironwood Square Drive, Suite 118, Scottsdale, AZ 85258, USA
| | | | - Bruce Coate
- Acadia Pharmaceuticals Inc., San Diego, CA, USA
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Ducharme S, Pijnenburg Y, Rohrer JD, Huey E, Finger E, Tatton N. Identifying and Diagnosing TDP-43 Neurodegenerative Diseases in Psychiatry. Am J Geriatr Psychiatry 2024; 32:98-113. [PMID: 37741764 PMCID: PMC11270911 DOI: 10.1016/j.jagp.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/25/2023]
Abstract
Neuropsychiatric symptoms (NPS) are common manifestations of neurodegenerative disorders and are often early signs of those diseases. Among those neurodegenerative diseases, TDP-43 proteinopathies are an increasingly recognized cause of early neuropsychiatric manifestations. TDP-43-related diseases include frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS), and Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE). The majority of TDP-43-related diseases are sporadic, but a significant proportion is hereditary, with progranulin (GRN) mutations and C9orf72 repeat expansions as the most common genetic etiologies. Studies reveal that NPS can be the initial manifestation of those diseases or can complicate disease course, but there is a lack of awareness among clinicians about TDP-43-related diseases, which leads to common diagnostic mistakes or delays. There is also emerging evidence that TDP-43 accumulations could play a role in late-onset primary psychiatric disorders. In the absence of robust biomarkers for TDP-43, the diagnosis remains primarily based on clinical assessment and neuroimaging. Given the association with psychiatric symptoms, clinical psychiatrists have a key role in the early identification of patients with TDP-43-related diseases. This narrative review provides a comprehensive overview of the pathobiology of TDP-43, resulting clinical presentations, and associated neuropsychiatric manifestations to help guide clinical practice.
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Affiliation(s)
- Simon Ducharme
- Department of Psychiatry (SD), Douglas Mental Health University Institute, McGill University, Montreal, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada.
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience (YP), Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease (JDR), UCL Queen Square Institute of Neurology, London, UK
| | - Edward Huey
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Psychiatry (EH), Columbia University, New York, NY
| | - Elizabeth Finger
- London Health Sciences Centre Parkwood Institute (EF), London, ON, Canada
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Lanctôt KL, Boada M, Tariot PN, Dabbous F, Hahn‐Pedersen J, Udayachalerm S, Raket LL, Saiontz‐Martinez C, Michalak W, Weidner W, Cummings J. Association between clinical dementia rating and clinical outcomes in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12522. [PMID: 38239329 PMCID: PMC10794857 DOI: 10.1002/dad2.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION We examined associations between the Clinical Dementia Rating Scale (CDR) and function (Functional Assessment Scale [FAS]), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire [NPI-Q]), and cognitive impairment in Alzheimer's disease (AD). METHODS We used data from the National Alzheimer's Coordinating Center Uniform Data Set and defined cognitively unimpaired and AD stages using CDR-global. RESULTS Functional and neuropsychiatric symptoms occur as early as the mild cognitive impairment (MCI) phase. The adjusted lest square mean FAS (95% confidence interval [CI]) was lowest in cognitively unimpaired (3.88 [3.66, 4.11] to 5.01 [4.76, 5.26]) and higher with more advanced AD (MCI: 8.17 [6.92, 9.43] to 20.87 [19.53, 22.20]; mild: 18.54 [17.57, 19.50] to 28.13 [27.14, 29.12]; moderate: 26.01 [25.31, 26.70] to 29.42 [28.73, 30.10]). FAS and NPI-Q scores increased steeply with MCI (NPI-Q: 5.55 [4.89, 6.20] to 7.11 [6.43, 7.78]) and mild AD dementia (NPI-Q: 6.66 [5.72, 7.60] to 8.32 [7.32, 9.33]). DISCUSSION CDR-global staged AD by capturing differences in relevant outcomes along AD progression. Highlights There were strong associations among CDR and the various outcomes relevant to healthcare providers, patients, and their care givers, such as activities of daily living.Overall, activities of daily living, neuropsychiatric symptoms, and cognitive function outcomes deteriorated over time and can be observed in early stages of AD (MCI or mild dementia).Our findings directly inform the current understanding of AD progression and can aid in care planning and benefit assessments of early AD interventions to delay the progression of AD to more advanced stages.
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Affiliation(s)
- Krista L. Lanctôt
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Mercè Boada
- Ace Alzheimer Center Barcelona – Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | | | | | | | | | | | | | | | | | - Jeffrey Cummings
- Department of Brain Health, Chambers‐Grundy Center for Transformative NeuroscienceUNLVLas VegasNevadaUSA
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Liu S, Zheng Y, Li H, Pan M, Fang Z, Liu M, Qiao Y, Pan N, Jia W, Ge X. Improving Alzheimer Diagnoses With An Interpretable Deep Learning Framework: Including Neuropsychiatric Symptoms. Neuroscience 2023; 531:86-98. [PMID: 37709003 DOI: 10.1016/j.neuroscience.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
Alzheimer's disease (AD) is a prevalent neurodegenerative disorder characterized by the progressive cognitive decline. Among the various clinical symptoms, neuropsychiatric symptoms (NPS) commonly occur during the course of AD. Previous researches have demonstrated a strong association between NPS and severity of AD, while the research methods are not sufficiently intuitive. Here, we report a hybrid deep learning framework for AD diagnosis using multimodal inputs such as structural MRI, behavioral scores, age, and gender information. The framework uses a 3D convolutional neural network to automatically extract features from MRI. The imaging features are passed to the Principal Component Analysis for dimensionality reduction, which fuse with non-imaging information to improve the diagnosis of AD. According to the experimental results, our model achieves an accuracy of 0.91 and an area under the curve of 0.97 in the task of classifying AD and cognitively normal individuals. SHapley Additive exPlanations are used to visually exhibit the contribution of specific NPS in the proposed model. Among all behavioral symptoms, apathy plays a particularly important role in the diagnosis of AD, which can be considered a valuable factor in further studies, as well as clinical trials.
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Affiliation(s)
- Shujuan Liu
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Yuanjie Zheng
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Hongzhuang Li
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Minmin Pan
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Zhicong Fang
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Mengting Liu
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
| | - Yuchuan Qiao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Ningning Pan
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Weikuan Jia
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Xinting Ge
- School of Information Science and Engineering, Shandong Normal University, Shandong, China.
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Vincent B, Maitra S. BACE1-dependent metabolism of neuregulin 1: Bridging the gap in explaining the occurrence of schizophrenia-like symptoms in Alzheimer's disease with psychosis? Ageing Res Rev 2023; 89:101988. [PMID: 37331479 DOI: 10.1016/j.arr.2023.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
Alzheimer's disease is a neurodegenerative disease mainly characterized by cortico-neuronal atrophy, impaired memory and other cognitive declines. On the other hand, schizophrenia is a neuro-developmental disorder with an overtly active central nervous system pruning system resulting into abrupt connections with common symptoms including disorganised thoughts, hallucination and delusion. Nevertheless, the fronto-temporal anomaly presents itself as a common denominator for the two pathologies. There is even a strong presumption of increased risk of developing co-morbid dementia for schizophrenic individuals and psychosis for Alzheimer's disease patients, overall leading to a further deteriorated quality of life. However, convincing proofs of how these two disorders, although very distant from each other when considering their aetiology, develop coexisting symptoms is yet to be resolved. At the molecular level, the two primarily neuronal proteins β-amyloid precursor protein and neuregulin 1 have been considered in this relevant context, although the conclusions are for the moment only hypotheses. In order to propose a model for explaining the psychotic schizophrenia-like symptoms that sometimes accompany AD-associated dementia, this review projects out on the similar sensitivity shared by these two proteins regarding their metabolism by the β-site APP cleaving enzyme 1.
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Affiliation(s)
- Bruno Vincent
- Institute of Molecular and Cellular Pharmacology, Laboratory of Excellence DistALZ, Université Côte d'Azur, INSERM, CNRS, Sophia-Antipolis, 06560 Valbonne, France.
| | - Subhamita Maitra
- Department of Molecular Biology, Umeå University, Umeå 90736, Sweden
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Eikelboom WS, Koch J, Beattie E, Lautenschlager NT, Doyle C, van den Berg E, Papma JM, Anstey KJ, Mortby ME. Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records. Aging Ment Health 2023; 27:243-250. [PMID: 35100918 DOI: 10.1080/13607863.2022.2032597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. METHODS We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67-101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. RESULTS 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident's needs, removing identified triggers, or distracting. CONCLUSION Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597 .
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Affiliation(s)
- Willem S Eikelboom
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jana Koch
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Colleen Doyle
- National Aging Research Institute, Parkville, VIC, Australia
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Moyra E Mortby
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
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13
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Kociolek AJ, Fernandez KK, Hernandez M, Jin Z, Cosentino S, Zhu CW, Gu Y, Devanand DP, Stern Y. Neuropsychiatric Symptoms and Trajectories of Dependence and Cognition in a Sample of Community-dwelling Older Adults with Dementia. Curr Alzheimer Res 2023; 20:409-419. [PMID: 37694796 PMCID: PMC10726418 DOI: 10.2174/1567205020666230908163414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropsychiatric symptoms (NPS), including psychotic symptoms (hallucinations, illusions, delusions), agitation/aggression, and depressed mood, are common in individuals with Alzheimer's disease (AD) and predict poorer outcomes, including faster disease progression. We aimed to evaluate associations between NPS and cognition and dependence in a multi-ethnic sample of community-dwelling older adults with AD. METHODS Predictors 3 (P3) is a cohort study of AD disease courses recruiting older adults aged 65 and above residing in upper Manhattan. A total of 138 of 293 participants had probable AD at the study baseline. We fit linear mixed models to examine longitudinal associations of time-varying NPS (psychotic symptoms, agitation/aggression, and depressed mood) with dependence and cognition, adjusted for race-ethnicity, sex, education, age, clinical dementia rating score, APOE-ε4, and comorbidity burden; separate interaction models were fit for age, Hispanic ethnicity, and sex. RESULTS Psychotic symptoms were associated with faster rates of increasing dependence and declining cognition over time, agitation/aggression with faster rates of declining cognition, and depressed mood with faster rates of increasing dependence. Among psychotic symptoms, delusions, but not hallucinations or illusions, were associated with worse outcome trajectories. Depressed mood predicted an accelerated increase in dependence in males but not females. CONCLUSION Our results confirm and extend prior results in clinic-based samples. The presence of NPS was associated with worse trajectories of dependence and cognition in this muti-ethnic sample of older adults with AD. Importantly, sex modified the association between depressed mood and dependence. Our results on NPS as predictors of differential AD progression in a community-dwelling, ethnically diverse sample serve to better inform the clinical care of patients and the future development of AD therapies.
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Affiliation(s)
- Anton J. Kociolek
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michelle Hernandez
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Carolyn W. Zhu
- Brookdale Department of Geriatrics & Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Davangere P. Devanand
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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14
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Manca R, Pardiñas AF, Venneri A. The neural signatures of psychoses in Alzheimer's disease: a neuroimaging genetics approach. Eur Arch Psychiatry Clin Neurosci 2023; 273:253-267. [PMID: 35727357 PMCID: PMC9957843 DOI: 10.1007/s00406-022-01432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
Psychoses in Alzheimer's disease (AD) are associated with worse prognosis. Genetic vulnerability for schizophrenia (SCZ) may drive AD-related psychoses, yet its impact on brain constituents is still unknown. This study aimed to investigate the association between polygenic risk scores (PRSs) for SCZ and psychotic experiences (PE) and grey matter (GM) volume in patients with AD with (AD-PS) and without (AD-NP) psychosis. Clinical, genetic and T1-weighted MRI data for 800 participants were extracted from the ADNI database: 203 healthy controls, 121 AD-PS and 476 AD-NP. PRSs were calculated using a Bayesian approach and analysed at ten p-value thresholds. Standard voxel-based morphometry was used to process MRI data. Logistic regression models including both PRSs for SCZ and PE, and an AD-PRS were used to predict psychosis in AD. Associations between PRSs and GM volume were investigated in the whole sample and the three groups independently. Only the AD-PRS predicted psychosis in AD. Inconsistent associations between the SCZ-PRS and PE-PRS and GM volumes were found across groups. The SCZ-PRS was negatively associated with medio-temporal/subcortical volumes and positively with medial/orbitofrontal volumes in the AD-PS group. Only medio-temporal areas were more atrophic in the AD-PS group, while there was no significant correlation between psychosis severity and GM volume. Although not associated with psychoses, the SCZ-PRS was correlated with smaller medio-temporal and larger orbitofrontal volumes in AD-PS. Similar alterations have also been observed in SCZ patients. This finding suggest a possible disconnection between these regions associated with psychoses in more advanced AD.
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Affiliation(s)
- Riccardo Manca
- grid.7728.a0000 0001 0724 6933Department of Life Sciences, Brunel University London, Uxbridge, London, UK
| | - Antonio F. Pardiñas
- grid.5600.30000 0001 0807 5670MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge, London, UK. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
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15
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Accelerated atrophy in dopaminergic targets and medial temporo-parietal regions precedes the onset of delusions in patients with Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci 2023; 273:229-241. [PMID: 35554669 PMCID: PMC9958148 DOI: 10.1007/s00406-022-01417-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/11/2022] [Indexed: 12/21/2022]
Abstract
People with Alzheimer's disease (AD) and delusions have worse quality of life and prognosis. However, early markers of delusions have not been identified yet. The present study investigated whether there are any detectable differences in grey matter (GM) volume and cognitive changes in the year before symptom onset between patients with AD who did and did not develop delusions. Two matched samples of AD patients, 63 who did (PT-D) and 63 who did not develop delusions (PT-ND) over 1 year, were identified from the Alzheimer's Disease Neuroimaging Initiative database. The Neuropsychiatric Inventory (NPI) was used to assess the presence of delusions. Sixty-three additional matched healthy controls (HC) were selected. Repeated-measures ANCOVA models were used to investigate group-by-time effects on the volume of selected GM regions of interest and on cognitive performance. No neurocognitive differences were observed between patient groups prior to symptom onset. Greater episodic memory decline and GM loss in bilateral caudate nuclei, medio-temporal and midline cingulo-parietal regions were found in the PT-D compared with the PT-ND group. A pattern of faster GM loss in brain areas typically affected by AD and in cortical and subcortical targets of dopaminergic pathways, paralleled by worsening of episodic memory and behavioural symptoms, may explain the emergence of delusions in patients with AD.
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16
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Fischer CE, Namasivayam A, Crawford-Holland L, Hakobyan N, Schweizer TA, Munoz DG, Pollock BG. Psychotic Disorders in the Elderly: Diagnosis, Epidemiology, and Treatment. Psychiatr Clin North Am 2022; 45:691-705. [PMID: 36396273 DOI: 10.1016/j.psc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This review covers the latest advances in our understanding of psychosis in the elderly population with respect to diagnosis, epidemiology, and treatment. Major topics of discussion include late life psychiatric disorders such as schizophrenia, schizoaffective disorder, and delusional disorder as well as dementia-related psychosis. Clinical differences between early-onset and late-onset disorders are reviewed in terms of prevalence, symptomatology, and approach to treatment. Newly revised research and clinical criteria for dementia-related psychosis are referenced. The evidence base for emerging therapies including citalopram and pimavanserin in relation to conventional therapies such as atypical antipsychotics are discussed..
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Affiliation(s)
- Corinne E Fischer
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
| | - Andrew Namasivayam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lucas Crawford-Holland
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada
| | - Narek Hakobyan
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Department of Neurosurgery, University of Toronto, Toronto, Canada
| | - David G Munoz
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Bruce G Pollock
- Division of Geriatric Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
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17
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Connors MH, Teixeira-Pinto A, Ames D, Woodward M, Brodaty H. Distinguishing apathy and depression in dementia: A longitudinal study. Aust N Z J Psychiatry 2022; 57:884-894. [PMID: 35968798 DOI: 10.1177/00048674221114597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Apathy is a common symptom in dementia, though can be difficult to distinguish from depression due to shared features and frequent co-occurrence. As such, a significant limitation of much previous research on apathy is the failure to control for depression. The current study sought to address this by examining the trajectory and clinical correlates of apathy after controlling for depression. METHODS Seven hundred and seventy-nine patients with dementia were recruited from nine memory clinics around Australia. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden and medication use were completed at baseline and at regular intervals over a 3-year period. Driving and institutionalisation data were obtained throughout the study. Mortality data were obtained from state registries 8 years after baseline. RESULTS Of the 662 patients with completed measures of neuropsychiatric symptoms, 342 (51.7%) had apathy and 332 (50.2%) had depression at baseline, while 212 (32.0%) had both. Whereas apathy increased over time, depression remained relatively stable. Apathy, but not depression, was associated with greater dementia severity, poorer cognition and function, driving cessation and mortality. Both apathy and depression were associated with greater neuropsychiatric symptoms, psychosis, caregiver burden and institutionalisation. CONCLUSIONS Apathy increases over the course of dementia and is associated with worse clinical outcomes independent of depression. Distinguishing apathy and depression appears important given their different implications for prognosis and management.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia.,Academic Unit for Psychiatry of Old Age, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
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18
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Vuic B, Konjevod M, Tudor L, Milos T, Nikolac Perkovic M, Nedic Erjavec G, Pivac N, Uzun S, Mimica N, Svob Strac D. Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia. Expert Rev Neurother 2022; 22:707-720. [PMID: 35950234 DOI: 10.1080/14737175.2022.2112668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) are symptoms of non-cognitive nature, which frequently develop during the course and different stages of dementia. The diagnosis of BPSD is complex due to symptom variety, and relies on detailed clinical evaluation and medical history. Accurate assessment of BPSD is crucial in order to tailor therapeutic intervention (non-pharmacological and pharmacological) for each individual and monitor patient response to therapy. AREAS COVERED This review encompasses the epidemiology, classification, assessment and etiology of BPSD, as well as their impact on caregiver distress, and gives an overview of current and emerging non-pharmacological and pharmacological therapeutic options, as well as potential BPSD biomarkers, in order to provide a framework for improving BPSD diagnosis and developing novel, targeted and specific therapeutic strategies for BPSD. EXPERT OPINION Due to the large heterogeneity of BPSD and of the fact that drugs available only alleviate symptoms, finding an adequate treatment is very challenging and often involves a polytherapeutic approach. Non-pharmacologic interventions have shown promising results in improving BPSD, however further research is needed to confirm their beneficial effects. Thus, the modification of pre-existancing as well as the development of novel pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy.
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Affiliation(s)
- Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
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19
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Sutin AR, Luchetti M, Stephan Y, Terracciano A. Self-reported sense of purpose in life and proxy-reported behavioral and psychological symptoms of dementia in the last year of life. Aging Ment Health 2022; 26:1693-1698. [PMID: 34166597 PMCID: PMC8976232 DOI: 10.1080/13607863.2021.1937055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives:Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of dementia for individuals living with dementia and their caregivers. Identifying factors associated with resilience to BPSD may inform interventions to reduce them. The present research examines whether purpose in life is associated with BPSD in the last year of life.Method:Participants from the Health and Retirement Study were selected if they reported on their sense of purpose, had evidence of a memory impairment, died across the follow-up, and a proxy completed the End of Life survey that included BPSD (N = 2473). Self-reported sense of purpose was tested as a predictor of the sum of symptoms and each indivdual symptom in the last year of life.Results:Purpose in life was associated with fewer BPSD overall. Of the individual symptoms, purpose was associated with less risk of psychological symptoms, specfiically less depression, periodic confusion, uncontrolled temper, but not with motor or perceptual symptoms.Conclusion: These results are consistent with growing evidence that purpose is associated with better cognitive outcomes. Purpose may be a useful target of intervention to improve outcomes across the spectrum of dementia.
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20
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Agüera-Ortiz L, Babulal GM, Bruneau MA, Creese B, D'Antonio F, Fischer CE, Gatchel JR, Ismail Z, Kumar S, McGeown WJ, Mortby ME, Nuñez NA, de Oliveira FF, Pereiro AX, Ravona-Springer R, Rouse HJ, Wang H, Lanctôt KL. Psychosis as a Treatment Target in Dementia: A Roadmap for Designing Interventions. J Alzheimers Dis 2022; 88:1203-1228. [PMID: 35786651 PMCID: PMC9484097 DOI: 10.3233/jad-215483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Psychotic phenomena are among the most severe and disruptive symptoms of dementias and appear in 30% to 50% of patients. They are associated with a worse evolution and great suffering to patients and caregivers. Their current treatments obtain limited results and are not free of adverse effects, which are sometimes serious. It is therefore crucial to develop new treatments that can improve this situation. We review available data that could enlighten the future design of clinical trials with psychosis in dementia as main target. Along with an explanation of its prevalence in the common diseases that cause dementia, we present proposals aimed at improving the definition of symptoms and what should be included and excluded in clinical trials. A review of the available information regarding the neurobiological basis of symptoms, in terms of pathology, neuroimaging, and genomics, is provided as a guide towards new therapeutic targets. The correct evaluation of symptoms is transcendental in any therapeutic trial and these aspects are extensively addressed. Finally, a critical overview of existing pharmacological and non-pharmacological treatments is made, revealing the unmet needs, in terms of efficacy and safety. Our work emphasizes the need for better definition and measurement of psychotic symptoms in dementias in order to highlight their differences with symptoms that appear in non-dementing diseases such as schizophrenia. Advances in neurobiology should illuminate the development of new, more effective and safer molecules for which this review can serve as a roadmap in the design of future clinical trials.
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Affiliation(s)
- Luis Agüera-Ortiz
- Department of Psychiatry, Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, & Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Ganesh M Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
| | - Marie-Andrée Bruneau
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Quebec, Canada.,Geriatric Institute of Montreal Research Center, Montreal, Quebec, Canada
| | - Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, UK
| | | | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Jennifer R Gatchel
- Harvard Medical School; Massachusetts General Hospital, Boston MA, USA.,McLean Hospital, Belmont MA, USA
| | - Zahinoor Ismail
- Hotchkiss Brain Institute & O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sanjeev Kumar
- Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - William J McGeown
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Moyra E Mortby
- School of Psychology, University of New South Wales, Sydney, Australia & Neuroscience Research Australia, Sydney, Australia
| | - Nicolas A Nuñez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Fabricio F de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Arturo X Pereiro
- Facultade de Psicoloxía, Universidade de Santiago de Compostela, Spain
| | - Ramit Ravona-Springer
- Sheba Medical Center, Tel Hashomer, Israel & Sackler School of Medicine, Tel Aviv University, Israel
| | - Hillary J Rouse
- School of Aging Studies, University of South Florida, Tampa, FL, USA.,SiteRx, New York, NY, USA
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health; National & Clinical Research Center for Mental Disorders, Beijing, China
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
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21
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Ge X, Qiao Y, Choi J, Raman R, Ringman JM, Shiand Y. Enhanced Association of Tau Pathology and Cognitive Impairment in Mild Cognitive Impairment Subjects with Behavior Symptoms. J Alzheimers Dis 2022; 87:557-568. [PMID: 35342088 DOI: 10.3233/jad-215555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) individuals with neuropsychiatric symptoms (NPS) are more likely to develop dementia. OBJECTIVE We sought to understand the relationship between neuroimaging markers such as tau pathology and cognitive symptoms both with and without the presence of NPS during the prodromal period of Alzheimer's disease. METHODS A total of 151 MCI subjects with tau positron emission tomographic (PET) scanning with 18F AV-1451, amyloid-β (Aβ) PET scanning with florbetapir or florbetaben, magnetic resonance imaging, and cognitive and behavioral evaluations were selected from the Alzheimer's Disease Neuroimaging Initiative. A 4-group division approach was proposed using amyloid (A-/A+) and behavior (B-/B+) status: A-B-, A-B+, A+B-, and A+B+. Pearson's correlation test was conducted for each group to examine the association between tau deposition and cognitive performance. RESULTS No statistically significant association between tau deposition and cognitive impairment was found for subjects without behavior symptoms in either the A-B-or A+B-groups after correction for false discovery rate. In contrast, tau deposition was found to be significantly associated with cognitive impairment in entorhinal cortex and temporal pole for the A-B+ group and nearly the whole cerebrum for the A+B+ group. CONCLUSION Enhanced associations between tauopathy and cognitive impairment are present in MCI subjects with behavior symptoms, which is more prominent in the presence of elevated amyloid pathology. MCI individuals with NPS may thus be at greater risk for further cognitive decline with the increase of tau deposition in comparison to those without NPS.
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Affiliation(s)
- Xinting Ge
- Laboratory of Neuro Imaging (LONI), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,School of Information Science and Engineering, Shandong Normal University, Jinan, Shandong, China.,School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuchuan Qiao
- Laboratory of Neuro Imaging (LONI), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jiyoon Choi
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, CA, USA
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, CA, USA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yonggang Shiand
- Laboratory of Neuro Imaging (LONI), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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22
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Kumfor F, Liang CT, Hazelton JL, Leyton CE, Kaizik C, Devenney E, Connaughton E, Langdon R, Mioshi E, Kwok JB, Dobson‐Stone C, Halliday GM, Piguet O, Hodges JR, Landin‐Romero R. Examining the presence and nature of delusions in Alzheimer's disease and frontotemporal dementia syndromes. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5692. [PMID: 35178786 PMCID: PMC9546395 DOI: 10.1002/gps.5692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Abnormal beliefs and delusions have been reported in some people with dementia, however, the prevalence of delusions, and their neurocognitive basis has been underexplored. This study aimed to examine the presence, severity, content and neural correlates of delusions in a large, well-characterised cohort of dementia patients using a transdiagnostic, cross-sectional approach. METHODS Four-hundred and eighty-seven people with dementia were recruited: 102 Alzheimer's disease, 136 behavioural-variant frontotemporal dementia, 154 primary progressive aphasia, 29 motor neurone disease, 46 corticobasal syndrome, 20 progressive supranuclear palsy. All patients underwent neuropsychological assessment and brain magnetic resonance imaging, and the Neuropsychiatric Inventory was conducted with an informant, by an experienced clinician. RESULTS In our cohort, 48/487 patients (10.8%) had delusions. A diagnosis of behavioural-variant frontotemporal dementia (18.4%) and Alzheimer's disease (11.8%) were associated with increased risk of delusions. A positive gene mutation was observed in 11/27 people with delusions. Individuals with frequent delusions performed worse on the Addenbrooke's Cognitive Examination (p = 0.035), particularly on the orientation/attention (p = 0.022) and memory (p = 0.013) subtests. Voxel-based morphometry analyses found that increased delusional psychopathology was associated with reduced integrity of the right middle frontal gyrus, right planum temporale and left anterior temporal pole. CONCLUSION Our results demonstrate that delusions are relatively common in dementia and uncover a unique cognitive and neural profile associated with the manifestation of delusions. Clinically, delusions may lead to delayed or misdiagnosis. Our results shed light on how to identify individuals at risk of neuropsychiatric features of dementia, a crucial first step to enable targeted symptom management.
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Affiliation(s)
- Fiona Kumfor
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Cheng Tao Liang
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Jessica L. Hazelton
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - Cristian E. Leyton
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Faculty of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Cassandra Kaizik
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Memory and Cognition ClinicRPA HospitalSydneyLocal Health District, New South WalesAustralia
| | - Emma Devenney
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Emily Connaughton
- Department of Cognitive SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Robyn Langdon
- Department of Cognitive SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eneida Mioshi
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - John B. Kwok
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Carol Dobson‐Stone
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Glenda M. Halliday
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Olivier Piguet
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
| | - John R. Hodges
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Ramon Landin‐Romero
- School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Brain & Mind CentreThe University of SydneySydneyNew South WalesAustralia
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23
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Pearce D, Gould RL, Roughley M, Reynolds G, Ward EV, Bhome R, Reeves S. Paranoid and misidentification subtypes of psychosis in dementia. Neurosci Biobehav Rev 2022; 134:104529. [PMID: 35032536 DOI: 10.1016/j.neubiorev.2022.104529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/22/2021] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
This study aimed to review the neurobiological and neuropsychological correlates of paranoid (persecutory delusions) and misidentification (misidentification delusions and/or hallucinations) subtypes of psychosis in dementia, to establish if they represent distinct subphenotypes. Nine studies were eligible, all included patients with Alzheimer's disease. Greater global cognitive deficits and an accelerated global cognitive decline were observed in the misidentification subtype. Neuroimaging studies showed more marked volume loss in multiple regions in patients with the misidentification subtype, including those involved in object recognition and the processing of information on spatial and temporal context. A single study found greater impairment in visual sustained attention and object recognition in the misidentification subtype. The small number of studies and methodological heterogeneity limit interpretation of the findings. Nevertheless, these findings would tentatively suggest that there may be additional or accelerated pathological change in functional networks involved in visuoperceptual processing in the misidentification subtype. This should be further explored in prospective studies and the investigation extended to other forms of dementia, to gain a transdiagnostic perspective.
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Affiliation(s)
- Danielle Pearce
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, W1T 7NF, UK
| | | | - Gemma Reynolds
- Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Emma V Ward
- Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Rohan Bhome
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, W1T 7NF, UK.
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24
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Karcher NR, Paul SE, Johnson EC, Hatoum AS, Baranger DAA, Agrawal A, Thompson WK, Barch DM, Bogdan R. Psychotic-like Experiences and Polygenic Liability in the Adolescent Brain Cognitive Development Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:45-55. [PMID: 34271214 PMCID: PMC8786267 DOI: 10.1016/j.bpsc.2021.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Childhood psychotic-like experiences (PLEs) often precede the development of later severe psychopathology. This study examined whether childhood PLEs are associated with several psychopathology-related polygenic scores (PGSs) and additionally examined possible neural and behavioral mechanisms. METHODS Adolescent Brain Cognitive Development Study baseline data from children with European ancestry (n = 4650, ages 9-10 years, 46.8% female) were used to estimate associations between PLEs (i.e., both total and presence of significantly distressing) and PGSs for psychopathology (i.e., schizophrenia, psychiatric cross-disorder risk, PLEs) and related phenotypes (i.e., educational attainment [EDU], birth weight, inflammation). We also assessed whether variability in brain structure indices (i.e., volume, cortical thickness, surface area) and behaviors proximal to PGSs (e.g., cognition for EDU) indirectly linked PGSs to PLEs using mediational models. RESULTS Total and significantly distressing PLEs were associated with EDU and cross-disorder PGSs (all %ΔR2s = 0.202%-0.660%; false discovery rate-corrected ps < .006). Significantly distressing PLEs were also associated with higher schizophrenia and PLE PGSs (both %ΔR2 = 0.120%-0.216%; false discovery rate-corrected ps < .03). There was evidence that global brain volume metrics and cognitive performance indirectly linked EDU PGS to PLEs (estimated proportion mediated = 3.33%-32.22%). CONCLUSIONS Total and significantly distressing PLEs were associated with genomic risk indices of broad-spectrum psychopathology risk (i.e., EDU and cross-disorder PGSs). Significantly distressing PLEs were also associated with genomic risk for psychosis (i.e., schizophrenia, PLEs). Global brain volume metrics and PGS-proximal behaviors represent promising putative intermediary phenotypes that may indirectly link genomic risk to psychopathology. Broadly, polygenic scores derived from genome-wide association studies of adult samples generalize to indices of psychopathology risk among children.
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Affiliation(s)
- Nicole R Karcher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
| | - Sarah E Paul
- Department of Psychological and Brain Sciences, Washington University, St. Louis, Missouri
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Alexander S Hatoum
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - David A A Baranger
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Wesley K Thompson
- Population Neuroscience and Genetics Laboratory, University of California San Diego, San Diego, California
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Psychological and Brain Sciences, Washington University, St. Louis, Missouri
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University, St. Louis, Missouri
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25
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Chepke C, Shaughnessy LW, Brunton S, Farmer JG, Rosenzweig AS, Grossberg GT, Wright WL. Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease. Int J Gen Med 2021; 14:10271-10280. [PMID: 34992442 PMCID: PMC8711560 DOI: 10.2147/ijgm.s335739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson’s disease psychosis or dementia-related psychosis.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
- Atrium Health, Charlotte, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Correspondence: Craig Chepke Email
| | - Lynn W Shaughnessy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA
- Department of Family Medicine, Touro University, Vallejo, CA, USA
| | - Jill G Farmer
- Parkinson’s Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA
- Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA
| | | | - George T Grossberg
- Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Wendy L Wright
- Wright & Associates Family Health Care, Concord and Amherst, NH, USA
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26
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Xiao S, Wang Y, Duan S, Li B. Effects of aromatherapy on agitation and aggression in cognitive impairment: A meta-analysis. J Clin Nurs 2021. [PMID: 34355444 DOI: 10.1111/jocn.15984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of aromatherapy on agitation and aggression in patients with cognitive impairment. BACKGROUND The impact of aromatherapy on agitation and aggression has been evaluated in various studies, but there is uncertainty about their impact. DESIGN A meta-analysis of randomised controlled trials was undertaken. METHODS This meta-analysis was conducted under PRISMA guidelines. Following eight electronic literature databases were searched: Web of Science, PubMed, PsycINFO, Embase, Cochrane Library, Chinese Wanfang database, CNKI and VIP digital database from the inception of the databases up to 27 February 2021. Two reviewers assessed the risk of bias of the included studies independently using the Cochrane Collaboration tool. Overall, meta-analysis and three subgroup analyses regarding the type of aroma preparations, delivery mode and session length were performed using RevMan5.3 and stata14.0. Publication bias was assessed by visual inspection of the funnel plot asymmetry and Egger's regression test. RESULTS Fifteen studies comprising 693 participants were included. The meta-analysis indicated that aromatherapy could ameliorate agitation and aggression for cognitive impairment. The subgroup analysis based on the type of aroma preparations showed that lavender oil could significantly improve agitation and aggression. Most delivery modes of aromatherapy, including smearing and inhalation, were effective. Moreover, less length (≤4 weeks) aromatherapy showed a better effect on agitation behaviour than aromatherapy more than 4 weeks. CONCLUSIONS Despite the meta-analysis indicating that aromatherapy could alleviate agitation and aggression especially short-term (≤4 weeks) aromatherapy inhalation in different conditions, further researches are needed to investigate the appropriate dosage of essential oils and the side effects. More well-designed randomised controlled trials containing participants from more countries are needed to verify our findings before we can make strong recommendations. RELEVANCE TO CLINICAL PRACTICE This meta-analysis suggested that aromatherapy should be considered as a complementary programme for patients with cognitive impairment patients. Medical workers could apply aromatherapy into daily routine cares for cognitive impairment patients.
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Affiliation(s)
- Shudan Xiao
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Ying Wang
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Shumin Duan
- The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Bo Li
- School of Nursing and Health, Henan University, Kaifeng, China
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27
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Walker VG, Walker EK. Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice. J Holist Nurs 2021; 40:181-192. [PMID: 34106020 DOI: 10.1177/08980101211025372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.
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28
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Habiger TF, Achterberg WP, Flo-Groeneboom E, Mannseth J, Husebo BS. Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS). J Am Med Dir Assoc 2021; 22:1692-1698. [PMID: 34087225 DOI: 10.1016/j.jamda.2021.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In nursing homes (NHs), 30% to 60% of patients experience daily pain and >80% have dementia. This can lead to neuropsychiatric symptoms, including psychosis symptoms such as delusion. We investigated if there was a relationship between pain and psychosis symptoms over time. We also aimed to investigate the effect of a multicomponent intervention (COSMOS) on pain, psychosis symptoms, and analgesic prescription. DESIGN COSMOS is a cluster-randomized, single blinded, controlled trial. Each NH unit was defined as a cluster and randomized to either the COSMOS intervention or care as usual. The COSMOS intervention is a multicomponent intervention, consisting of staff training in communication, pain treatment, medication review, organization of activities, and safety. The intervention lasted for 4 months with a follow-up at month 9. SETTING AND PARTICIPANTS Sixty-seven units from 33 Norwegian NHs in 8 municipalities. The study included 723 patients aged ≥65 years, residing at the NH ≥2 weeks before inclusion. Patients with a life expectancy <6 months were excluded. MEASURES Pain was measured using the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale. Psychosis symptoms were measured using the Neuropsychiatric Inventory-NH version. Measurements were performed at baseline, and months 4 and 9. RESULTS Multilevel Mixed-Effect statistical analysis found that psychosis symptoms as a group (odds ratio [OR] 2.03, P = .009), and delusion (OR 2.12, P = .007) were associated with pain over time. No significant intervention effect on psychosis symptoms was observed. Compared with the control group, people with dementia in the intervention group experienced less musculoskeletal pain (β: -0.47, P = .047). Analgesic prescription was not affected by the intervention. CONCLUSION AND IMPLICATIONS Pain is associated with psychosis symptoms, and pain assessment should be done when making treatment decisions on psychosis symptoms in NH patients. The COSMOS intervention improved musculoskeletal pain in people with dementia, but not psychosis symptoms, and there is need for further studies on treatment of psychosis symptoms in NH patients.
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Affiliation(s)
- Torstein F Habiger
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
| | - Wilco P Achterberg
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Leiden University Medical Centre, Netherlands
| | - Elisabeth Flo-Groeneboom
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Janne Mannseth
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Municipality of Bergen, Bergen, Norway
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29
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Reeves S, Bertrand J, Uchida H, Yoshida K, Otani Y, Ozer M, Liu KY, Bramon E, Bies R, Pollock BG, Howard R. Towards safer risperidone prescribing in Alzheimer's disease. Br J Psychiatry 2021; 218:268-275. [PMID: 33176899 DOI: 10.1192/bjp.2020.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the treatment of psychosis, agitation and aggression in Alzheimer's disease, guidelines emphasise the need to 'use the lowest possible dose' of antipsychotic drugs, but provide no information on optimal dosing. AIMS This analysis investigated the pharmacokinetic profiles of risperidone and 9-hydroxy (OH)-risperidone, and how these related to treatment-emergent extrapyramidal side-effects (EPS), using data from The Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease study (Clinicaltrials.gov identifier: NCT00015548). METHOD A statistical model, which described the concentration-time course of risperidone and 9-OH-risperidone, was used to predict peak, trough and average concentrations of risperidone, 9-OH-risperidone and 'active moiety' (combined concentrations) (n = 108 participants). Logistic regression was used to investigate the associations of pharmacokinetic biomarkers with EPS. Model-based predictions were used to simulate the dose adjustments needed to avoid EPS. RESULTS The model showed an age-related reduction in risperidone clearance (P < 0.0001), reduced renal elimination of 9-OH-risperidone (elimination half-life 27 h), and slower active moiety clearance in 22% of patients, (concentration-to-dose ratio: 20.2 (s.d. = 7.2) v. 7.6 (s.d. = 4.9) ng/mL per mg/day, Mann-Whitney U-test, P < 0.0001). Higher trough 9-OH-risperidone and active moiety concentrations (P < 0.0001) and lower Mini-Mental State Examination (MMSE) scores (P < 0.0001), were associated with EPS. Model-based predictions suggest the optimum dose ranged from 0.25 mg/day (85 years, MMSE of 5), to 1 mg/day (75 years, MMSE of 15), with alternate day dosing required for those with slower drug clearance. CONCLUSIONS Our findings argue for age- and MMSE-related dose adjustments and suggest that a single measure of the concentration-to-dose ratio could be used to identify those with slower drug clearance.
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Affiliation(s)
| | - Julie Bertrand
- Institute of Genetics, University College London, UK; and UMR 1137 Infection, Antimicrobials, Modelling, Evolution (IAME) French Institute for Medical Research (INSERM), University Paris, France
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Japan; and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Canada
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Japan; and Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Canada
| | - Yohei Otani
- Department of Neuropsychiatry, Keio University School of Medicine, Japan
| | - Mikail Ozer
- St Ann's Hospital, Barnet Enfield and Haringey Mental Health NHS Trust, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, UK
| | - Elvira Bramon
- Division of Psychiatry, University College London, UK
| | - Robert Bies
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State, University of New York at Buffalo, USA
| | - Bruce G Pollock
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Faculty of Medicine, Canada
| | - Robert Howard
- Division of Psychiatry, University College London, UK
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30
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Chen YA, Chang CC, Wang WF, Lin YS, Jhang KM, Lo TY, Wu HH. Association Between Caregivers' Burden and Neuropsychiatric Symptoms in Female Patients with Alzheimer's Disease with Varying Dementia Severity. J Multidiscip Healthc 2021; 14:929-940. [PMID: 33953562 PMCID: PMC8090980 DOI: 10.2147/jmdh.s298196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/11/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose This study examined the attributes causing higher burdens for caregivers caring for female patients with Alzheimer’s disease by analyzing a combination of various variables, including demographic data, dementia severity, and neuropsychiatric symptoms. Patients and Methods This study included 99 female patients with Alzheimer’s disease who were cared for by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Neuropsychiatric symptoms used in this study included affections (9 types), behavior symptoms (9 symptoms), and psychological symptoms (3 symptoms). The Apriori algorithm was employed to identify association rules that reveal the relationships among demographic data, dementia severity, neuropsychiatric symptoms, and caregivers’ burden. Results A total of 185 rules were determined, including 51 rules with little or no burden, 108 rules with mild to moderate burden, and 26 rules with moderate to severe burden. The major findings are as follows. Neuropsychiatric symptoms were associated with varying degrees of caregivers’ burden among female patients aged 75 to 84 years with mild dementia. Crying spells and aggression were specifically associated with a moderate to severe burden. Delusion was associated with a mild to moderate and moderate to severe burden. Dysthymia and depression were associated with little or no burden to moderate to severe burden. Conclusion Clinicians can provide early interventions to reduce the burden of caregivers caring for female patients with Alzheimer’s disease and can refer caregivers for timely assistance to reduce their burden.
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Affiliation(s)
- Yu-An Chen
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan
| | - Ya-Sian Lin
- Department of Business Administration, National Changhua University of Education, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tzu-Ying Lo
- Department of Business Administration, National Changhua University of Education, Changhua, Taiwan
| | - Hsin-Hung Wu
- Department of Business Administration, National Changhua University of Education, Changhua, Taiwan.,Department of M-Commerce and Multimedia Applications, Asia University, Taichung City, Taiwan.,Faculty of Education, State University of Malang, Malang, East Java, Indonesia
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31
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Giil LM, Aarsland D, Vik‐Mo AO. Differentiating traits and states identifies the importance of chronic neuropsychiatric symptoms for cognitive prognosis in mild dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12152. [PMID: 33665342 PMCID: PMC7896634 DOI: 10.1002/dad2.12152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) in dementia are associated with poor cognitive outcomes in longitudinal studies. Whether this is due to differences in symptom burden between persons (BP) or changes within persons (WP) is unknown. METHODS Patients with mild Alzheimer's disease (AD, n = 111) and Lewy-body dementia (LBD, n = 85) were assessed annually for 8 years. We modelled the association between NPS assessed by the Neuropsychiatric Inventory (NPI) and Mini-Mental State Examinations (MMSE) using Tobit mixed-effects model with NPS as individual means over time (BP) and its deviance (WP). RESULTS The association between higher NPS and poorer cognitive outcomes was mostly due to BP differences for the NPI-total score, and in particular for delusions, hallucinations, agitation, aberrant motor behavior, and apathy scores. DISCUSSION The NPS trait (BP) effect on cognitive decline is considerably stronger than the state effect (WP). Clinically, long-term rather than episodic NPS better identifies patients with poor cognitive outcomes.
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Affiliation(s)
- Lasse M. Giil
- Department of Internal MedicineHaraldsplass Deaconess HospitalBergenNorway
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and NeuroscienceKings CollegeLondonUK
| | - Dag Aarsland
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and NeuroscienceKings CollegeLondonUK
- Centre for Age‐Related Diseases (SESAM)Stavanger University HospitalStavangerNorway
| | - Audun Osland Vik‐Mo
- Centre for Age‐Related Diseases (SESAM)Stavanger University HospitalStavangerNorway
- Department of Clinical MedicineUniversity of BergenNorway
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Gottesman RT, Kociolek A, Fernandez K, Cosentino S, Devanand D, Stern Y, Gu Y. Association Between Early Psychotic Symptoms and Alzheimer's Disease Prognosis in a Community-Based Cohort. J Alzheimers Dis 2021; 81:1131-1139. [PMID: 33896840 PMCID: PMC8785362 DOI: 10.3233/jad-200729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychotic symptoms are an important and increasingly recognized aspect of Alzheimer's disease (AD). They have been shown to contribute to faster disease progression in clinic-based, demographically homogenous samples with high educational attainment. OBJECTIVE We studied the association between baseline psychotic symptoms and disease progression among individuals with incident AD or 'at risk' of developing AD, from a demographically heterogenous, community-based cohort with minimal educational attainment. METHODS 212 participants received the Columbia University Scale of Psychopathology in Alzheimer's Disease scale. Participants had psychotic symptoms with any of: visual illusions, delusions, hallucinations, or agitation/aggression. Disease progression was measured yearly and defined by meeting cognitive (≤10 on the Folstein MMSE) or functional endpoints (≥10 on the Blessed Dementia Rating Scale or ≥4 on the Dependence Scale). RESULTS The mean age was 85 years old. The cohort was 78.3% female, 75.9% Hispanic, and had a mean 6.96 years of education. Within the follow-up period (mean: 3.69 years), 24 met the cognitive endpoint, 59 met the functional endpoint, and 132 met the cutoff for dependence. The presence of at least one psychotic symptom was initially associated with an increased risk of reaching the functional endpoint (HR 3.12, 95% CI 1.67-5.86, p < 0.001) and the endpoint of dependence (HR = 1.498, 95% CI 1.05-2.13, p = 0.03). However, these associations were attenuated and non-significant when adjusted for baseline functional status. Psychotic symptoms were not associated with the cognitive endpoint. CONCLUSION Psychotic symptoms may predict functional decline in patients of non-Caucasian ethnicity and with lower educational attainment.
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Affiliation(s)
- Reena T. Gottesman
- Department of Neurology, Columbia University Medical Center 622 W. 168 Street, PH19 New York, NY 10032
| | - Anton Kociolek
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center
| | - Kayri Fernandez
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Medical Center 622 W. 168 Street, PH19 New York, NY 10032
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center
- Gertrude H. Sergievsky Center, Columbia University Medical Center
| | - D.P. Devanand
- Department of Neurology, Columbia University Medical Center 622 W. 168 Street, PH19 New York, NY 10032
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center
- Department of Psychiatry, Columbia University Medical Center
| | - Yaakov Stern
- Department of Neurology, Columbia University Medical Center 622 W. 168 Street, PH19 New York, NY 10032
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center
- Gertrude H. Sergievsky Center, Columbia University Medical Center
- Department of Psychiatry, Columbia University Medical Center
| | - Yian Gu
- Department of Neurology, Columbia University Medical Center 622 W. 168 Street, PH19 New York, NY 10032
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center
- Gertrude H. Sergievsky Center, Columbia University Medical Center
- Department of Epidemiology, Columbia University Medical Center
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Kwon CY, Lee B. Prevalence of Behavioral and Psychological Symptoms of Dementia in Community-Dwelling Dementia Patients: A Systematic Review. Front Psychiatry 2021; 12:741059. [PMID: 34744832 PMCID: PMC8566725 DOI: 10.3389/fpsyt.2021.741059] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Identifying the characteristics of behavioral and psychological symptoms of dementia (BPSD) associated with different dementia types may be a promising strategy to effectively deal with BPSD. We aimed to synthesize the prevalence rates of BPSD characteristics in community-dwelling dementia patients. Methods: We searched Medline, EMBASE, and PsycARTICLES databases for original clinical studies published until December 2020 that enrolled at least 300 community-dwelling dementia patients. The methodological qualities of prevalence studies were assessed using the Joanna Briggs Institute's critical appraisal checklist. Results: Thirty studies were included. The prevalence of the BPSD characteristic ranged from 4 (elation and mania) to 32% (apathy) in the pooled samples. The prevalence of delusions, anxiety, apathy, irritability, elation and mania, and aberrant motor behavior in Alzheimer's disease patients was 1.72-2.88 times greater than that in vascular dementia (VD) patients, while the prevalence of disinhibition in VD patients was 1.38 times greater. The prevalence of anxiety, irritability, and agitation and aggression, delusion, hallucinations, apathy, disinhibition, and aberrant motor behavior tended to increase as the severity of dementia increased, while that of depression, eating disorder, sleep disorders, and elation and mania tended to stable. In community-dwelling patients with dementia, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was higher than 20%, while that of disinhibition and elation and mania was lower than 10%. Conclusion: Overall, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was generally high in patients with dementia. Also, the prevalence of some BPSD characteristics differed according to the type and the severity of dementia. The methodological quality of the included studies is not the best, and high heterogeneity may affect the certainty of the findings. However, the results of this review can deepen our understanding of the prevalence of BPSD. Systematic Review Registration: https://osf.io/dmj7k, identifier: 10.17605/OSF.IO/DMJ7K.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, South Korea
| | - Boram Lee
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, South Korea
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Sverdrup K, Bergh S, Selbæk G, Benth JŠ, Røen IM, Husebo B, Tangen GG. Trajectories of physical performance in nursing home residents with dementia. Aging Clin Exp Res 2020; 32:2603-2610. [PMID: 32060802 PMCID: PMC7680334 DOI: 10.1007/s40520-020-01499-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/22/2022]
Abstract
Background In nursing homes (NH) the prevalence of dementia ranges from 50 to 84% and most residents have extensive physical-performance impairments. However, from time of admission, development of physical performance in NH residents with dementia remains unexplored. Aims To explore the overall trend in physical performance, associated characteristics, and groups following distinct trajectories from time of admission, in NH residents with dementia. Methods We followed newly admitted NH residents diagnosed with dementia (N = 583) from 47 NHs across Norway for 3 years. Individual assessments were conducted biannually, and main outcome measure was the Short Physical Performance Battery (SPPB). Facility-level characteristics included unit size, staff-to-resident ratio, and quality of the physical environment (Special Care Unit Environmental Quality Scale, SCUEQS). Results From time of admission, NH residents with dementia showed a significant overall decline in physical performance. Further, we identified three distinct trajectory groups with significantly different baseline physical-performance status (“good,” “moderate,” and “poor”), differences between groups maintained and all declined across time. Younger age, good general medical health, less-severe dementia, and less musculoskeletal pain were associated with both an average higher overall trend and better baseline group-belonging. Additionally, less apathy and more psychosis were associated with a higher overall trend, and agitation was associated with poorer baseline group-belonging. Conclusions To prevent excessive decline in physical performance in this population, NH clinicians should focus efforts specifically on assessment of physical performance at admission and on identification and management of musculoskeletal pain and neuropsychiatric symptoms. Electronic supplementary material The online version of this article (10.1007/s40520-020-01499-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Irene M Røen
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Centre for Development of Institutional and Home Care Services, Hamar, Hedmark, Norway
| | - Bettina Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Gro G Tangen
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Gülcan HO, Orhan IE. The Main Targets Involved in Neuroprotection for the Treatment of Alzheimer’s Disease and Parkinson Disease. Curr Pharm Des 2020; 26:509-516. [DOI: 10.2174/1381612826666200131103524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/21/2019] [Indexed: 01/28/2023]
Abstract
With respect to the total cure failure of current drugs used in the treatment of neurodegenerative diseases,
alternative strategies are followed. Particularly, neuroprotection approaches are questioned. Metal chelation,
antioxidant towards oxidative stress, modulation of the amyloidogenic pathway, MAO-B inhibition, and
NMDA receptor antagonism is more or less typical examples. Some of the representative drug candidates with
promising neuroprotective features are assessed in clinical trials. Although initial attempts were found hopeful,
none of the candidates have been found successful in each required clinical trials, particularly depending on the
failures in terms of cognitive enhancement and slowing the progressive characteristics of neurodegenerative diseases.
Today, neuroprotection is evaluated using multi-target ligand-based drug design studies. Within this study,
the clinical outcomes of these studies, the rationale behind the design of the molecules are reviewed concomitant
to the representative drug candidates of each group.
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Affiliation(s)
- Hayrettin O. Gülcan
- Eastern Mediterranean University, Faculty of Pharmacy, Famagusta, TR. North Cyprus, via Mersin 10, Turkey
| | - Ilkay E. Orhan
- Gazi University, Faculty of Pharmacy, Department of Pharmacognosy, Etiler, Ankara, Turkey
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Fischer CE, Ismail Z, Youakim JM, Creese B, Kumar S, Nuñez N, Ryan Darby R, Di Vita A, D’Antonio F, de Lena C, McGeown WJ, Ramit R, Rasmussen J, Bell J, Wang H, Bruneau MA, Panegyres PK, Lanctôt KL, Agüera-Ortiz L, Lyketsos C, Cummings J, Jeste DV, Sano M, Devanand D, Sweet RA, Ballard C. Revisiting Criteria for Psychosis in Alzheimer’s Disease and Related Dementias: Toward Better Phenotypic Classification and Biomarker Research. J Alzheimers Dis 2020; 73:1143-1156. [DOI: 10.3233/jad-190828] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences; Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | | | - Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicolas Nuñez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - R. Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Antonella Di Vita
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabrizia D’Antonio
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carlo de Lena
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - William J. McGeown
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Ravona Ramit
- Memory and Geriatric Psychiatry Clinic, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, Beijing, China
| | - Marie-Andrée Bruneau
- Department of Psychiatry, University of Montreal, Centre de Recherche de l’Institut Universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - Peter K. Panegyres
- Director, Neurodegenerative Disorders Research Pty Ltd, West Perth, WA, Australia
| | - Krista L. Lanctôt
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Luis Agüera-Ortiz
- Department of Psychiatry Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, & Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jeffrey Cummings
- UNLV Department of Brain Health and the Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Dilip V. Jeste
- Departments of Psychiatry and Neurosciences, and Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - Mary Sano
- Mt Sinai School of Medicine, Manhattan, NY, USA
| | - D.P. Devanand
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Robert A. Sweet
- Departments of Psychiatry and Neurology, University of Pittsburgh, PA, USA
| | - Clive Ballard
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
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Psychosis-associated DNA methylomic variation in Alzheimer's disease cortex. Neurobiol Aging 2020; 89:83-88. [PMID: 32007278 DOI: 10.1016/j.neurobiolaging.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/16/2019] [Accepted: 01/01/2020] [Indexed: 11/22/2022]
Abstract
Psychotic symptoms are a common and debilitating feature of Alzheimer's disease (AD) and are associated with a more rapid course of decline. Current evidence from postmortem and neuroimaging studies implicates frontal, temporal, and parietal lobes, with reported disruptions in monoaminergic pathways. However, the molecular mechanisms underlying this remain unclear. In the present study, we investigated methylomic variation associated with AD psychosis in 3 key brain regions implicated in the etiology of psychosis (prefrontal cortex, entorhinal cortex, and superior temporal gyrus) in postmortem brain samples from 29 AD donors with psychosis and 18 matched AD donors without psychosis. We identified psychosis-associated methylomic changes in a number of loci, with these genes being enriched in known schizophrenia-associated genetic and epigenetic variants. One of these known loci resided in the AS3MT gene-previously implicated in schizophrenia in a large GWAS meta-analysis. We used bisulfite-pyrosequencing to confirm hypomethylation across 4 neighboring CpG sites in the ASM3T gene. Finally, our regional analysis nominated multiple CpG sites in TBX15 and WT1, which are genes that have been previously implicated in AD. Thus one potential implication from our study is whether psychosis-associated variation drives reported associations in AD case-control studies.
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38
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Connors MH, Teixeira-Pinto A, Loy CT. Psychosis and longitudinal outcomes in Huntington disease: the COHORT Study. J Neurol Neurosurg Psychiatry 2020; 91:15-20. [PMID: 31611263 DOI: 10.1136/jnnp-2019-320646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/13/2019] [Accepted: 08/14/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Huntington disease (HD) is an autosomal dominant neurodegenerative disease involving motor disturbances, cognitive decline and psychiatric symptoms. Psychotic symptoms occur in a significant proportion of patients. We sought to characterise the clinical outcomes of this group of patients. METHODS Data were drawn from the Cooperative Huntington Observational Research Trial, a prospective, multi-centre observational study. 1082 patients with HD were recruited. Measures of cognition, function, behavioural disturbance and motor function were completed annually over 5 years. RESULTS Overall, 190 patients (17.6%) displayed psychotic symptoms. These patients demonstrated worse cognition, function and behavioural disturbances than patients without psychosis over time. Patients with psychosis also demonstrated lower levels of chorea than patients without psychosis, despite adjusting for concurrent antipsychotic and tetrabenazine use. CONCLUSIONS Psychosis in HD is associated with poorer outcomes in cognition, function and behavioural symptoms. Patients with psychotic symptoms may also have less chorea. Altogether, the findings suggest patients with psychosis have a distinct clinical course.
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Affiliation(s)
- Michael H Connors
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, The University of New South Wales, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Clement T Loy
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia .,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
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Creese B, Vassos E, Bergh S, Athanasiu L, Johar I, Rongve A, Medbøen IT, Vasconcelos Da Silva M, Aakhus E, Andersen F, Bettella F, Braekhus A, Djurovic S, Paroni G, Proitsi P, Saltvedt I, Seripa D, Stordal E, Fladby T, Aarsland D, Andreassen OA, Ballard C, Selbaek G. Examining the association between genetic liability for schizophrenia and psychotic symptoms in Alzheimer's disease. Transl Psychiatry 2019; 9:273. [PMID: 31641104 PMCID: PMC6805870 DOI: 10.1038/s41398-019-0592-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
Psychosis (delusions or hallucinations) in Alzheimer's disease (AD + P) occurs in up to 50% of individuals and is associated with significantly worse clinical outcomes. Atypical antipsychotics, first developed for schizophrenia, are commonly used in AD + P, suggesting shared mechanisms. Despite this implication, little empirical research has been conducted to examine whether there are mechanistic similarities between AD + P and schizophrenia. In this study, we tested whether polygenic risk score (PRS) for schizophrenia was associated with AD + P. Schizophrenia PRS was calculated using Psychiatric Genomics Consortium data at ten GWAS p value thresholds (PT) in 3111 AD cases from 11 cohort studies characterized for psychosis using validated, standardized tools. Association between PRS and AD + P status was tested by logistic regression in each cohort individually and the results meta-analyzed. The schizophrenia PRS was associated with AD + P at an optimum PT of 0.01. The strongest association was for delusions where a one standard deviation increase in PRS was associated with a 1.18-fold increased risk (95% CI: 1.06-1.3; p = 0.001). These new findings point towards psychosis in AD-and particularly delusions-sharing some genetic liability with schizophrenia and support a transdiagnostic view of psychotic symptoms across the lifespan.
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Affiliation(s)
- Byron Creese
- University of Exeter Medical School, Exeter, UK.
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK.
| | - Evangelos Vassos
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sverre Bergh
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Research Centre of Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, 2312, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lavinia Athanasiu
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Iskandar Johar
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Arvid Rongve
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Research and Innovation, Helse Fonna, Haugesund, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingrid Tøndel Medbøen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Miguel Vasconcelos Da Silva
- University of Exeter Medical School, Exeter, UK
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eivind Aakhus
- Research Centre of Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, 2312, Ottestad, Norway
| | - Fred Andersen
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Francesco Bettella
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Braekhus
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Srdjan Djurovic
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Giulia Paroni
- Complex Structure of Geriatrics, Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Petroula Proitsi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ingvild Saltvedt
- Geriatric Department, St. Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Davide Seripa
- Complex Structure of Geriatrics, Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Eystein Stordal
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, Namsos Hospital, Namsos, Norway
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Dag Aarsland
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Clive Ballard
- University of Exeter Medical School, Exeter, UK
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
| | - Geir Selbaek
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Research Centre of Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, 2312, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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40
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Gottesman RT, Stern Y. Behavioral and Psychiatric Symptoms of Dementia and Rate of Decline in Alzheimer's Disease. Front Pharmacol 2019; 10:1062. [PMID: 31616296 PMCID: PMC6768941 DOI: 10.3389/fphar.2019.01062] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
Alzheimer’s disease causes both cognitive and non-cognitive symptoms. There is increasing evidence that the presentation and course of Alzheimer’s disease is highly heterogenous. This heterogeneity presents challenges to patients, their families, and clinicians due to the difficulty in prognosticating future symptoms and functional impairment. Behavioral and psychiatric symptoms are emerging as a significant contributor to this clinical heterogeneity. These symptoms have been linked to multiple areas of neurodegeneration, which may suggest that they are representative of network-wide dysfunction in the brain. However, current diagnostic criteria for Alzheimer’s disease focus exclusively on the cognitive aspects of disease. Behavioral and psychiatric symptoms have been found in multiple studies to be related to disease severity and to contribute to disease progression over time. A better understanding of how behavioral and psychiatric symptoms relate to cognitive aspects of Alzheimer’s disease would help to refine the models of disease and hopefully lead to improved ability to develop therapeutic options for this devastating disease.
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Affiliation(s)
- Reena T Gottesman
- Division of Aging and Dementia, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Yaakov Stern
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University Medical Center, New York, NY, United States
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Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1326-1334. [PMID: 30198597 DOI: 10.1002/gps.4965] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. METHODS We searched PubMed and Google Scholar for potential eligible articles. RESULTS Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. CONCLUSION Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.,Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
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Harris M, Devereaux Melillo K, Keilman LJ, Peraza-Smith GB, Duane S, Walmer M, Arms T, Bronner S, Nwogu CA, Lewitz AM, Cacchione PZ. Basic considerations for understanding, diagnosing and treating symptoms of primary non-dementia psychosis in older adults. Geriatr Nurs 2019. [DOI: 10.1016/j.gerinurse.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tan EJ, Fletcher K, Rossell SL. Exploring the relationship between fantasy proneness and delusional beliefs in psychosis and non-clinical individuals. Psychiatry Res 2019; 272:80-85. [PMID: 30579186 DOI: 10.1016/j.psychres.2018.12.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/19/2018] [Accepted: 12/16/2018] [Indexed: 12/15/2022]
Abstract
Delusions are a core feature of psychopathology while fantasy proneness (FP) is a trait that describes a predisposition towards fantastical thinking, vivid mental imagery and an overactive imagination. The relationship between FP and delusional experiences has not yet been examined in the literature. The current study hypothesised that FP would be significantly associated with and predict delusion severity as well as the associated delusional distress, preoccupation and conviction. Ninety-five patients with current psychosis (schizophrenia and bipolar I disorder) were assessed for overall delusional severity using the PANSS (clinician-rated) and the Peters Delusions Inventory (PDI; self-report). FP was assessed using the Creative Experiences Questionnaire (CEQ). Forty-six healthy control participants also completed the PDI and CEQ. Significant positive correlations were observed between FP and delusion severity in both groups; and distress, preoccupation and conviction in patients only. Linear regression analyses, controlling for manic and depressive symptoms, revealed that greater FP predicted higher levels of severity, distress, preoccupation, and conviction associated with delusions in patients, and higher severity only in healthy controls. The findings highlight the role of specific cognitive biases in delusional experiences, and empirically support models of unusual belief formation and maintenance.
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Affiliation(s)
- Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, VIC, Australia.
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, VIC, Australia
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Verdoux H, Pambrun E, Tournier M, Cortaredona S, Verger P. Trajectories of Antipsychotic Drug Use Over 10 Years in a French Community-Based Sample of Persons Aged 50 and Older. Am J Geriatr Psychiatry 2019; 27:73-83. [PMID: 30442530 DOI: 10.1016/j.jagp.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the temporal prescribing patterns of antipsychotics among persons aged 50 and older and to explore the demographic and clinical characteristics associated with each trajectory of antipsychotic drug use. METHODS This was a historical fixed cohort study on a community-based sample of persons affiliated with the French Insurance Healthcare system. Data from community drug reimbursement claims were collected by the French Insurance Healthcare system over the period 2006-2015. The study included 160,853 persons aged 50 and older. Trajectories of antipsychotic drug use were identified by examining the distribution of antipsychotic use within consecutive 3-month periods over the entire follow-up period. Latent class analyses were used to identify distinct trajectories. Multivariate polynomial logistic regression models were used to explore the characteristics independently associated with trajectories. RESULTS Five trajectories of antipsychotic use were identified: null or very low use (93.8%), occasional use (2%), decreasing use (1.6%), chronic use (1.5%), and increasing use (1.1%). Occasional users were older and had a lower use of other psychotropic drugs and a high use of health resources. Chronic users had the highest frequency of chronic psychiatric diseases and were less likely to present with dementia or Parkinson disease. Persons with increasing use of antipsychotics were more frequently males and had a high frequency of dementia; half of them died over the follow-up period compared with 20% in the total sample. CONCLUSION Further studies should explore whether the benefit-risk ratio of antipsychotic drugs in older adults differs according to trajectories of use.
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Affiliation(s)
- Hélène Verdoux
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Elodie Pambrun
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Marie Tournier
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Sébastien Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection (SC, PV), Aix-Marseille University, Marseille, France
| | - Pierre Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection (SC, PV), Aix-Marseille University, Marseille, France; ORS PACA (PV), Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, F-13006, Marseille, France.
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Zalomonson S, Freud T, Punchik B, Samson T, Lebedinsky S, Press Y. The Results of a Crossover Placebo-Controlled Study of the Effect of Lavender Oil on Behavioral and Psychological Symptoms of Dementia. Rejuvenation Res 2018; 22:246-253. [PMID: 30328781 DOI: 10.1089/rej.2018.2123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies of the effect of aromatherapy on patients with behavioral and psychological symptoms of dementia (BPSD) have yielded contradictory results. One possible explanation for this lack of consistent results is the site of application of the oil. The aim of the study was to evaluate the effect of lavender oil on the rate of BPSD when applied close to and away from the olfactory system. A crossover placebo-controlled study was conducted in the two psychogeriatric long term care departments. Patients in Department A received lavender oil on their face during the first month and on their foot in the second month, sunflower seed oil on their foot in the third month and on their face in the fourth month. Patients in Department B received sunflower seed oil on their face during the first month and on their foot in the second month, and lavender oil on their foot in the third month and on their face in the fourth month. Forty-two patients completed the study. Their mean age was 76.1 ± 11.2 years. After 4 months of treatment, the mean Neuropsychiatric Inventory score in Department A dropped from 13.1 ± 8.3 (median 12.0) to 3.5 ± 3.8 (median 2.0; p < 0.0001) and in Department B it dropped from 9.7 ± 9.6 (median 6.0) to 1.4 ± 2.5 (median 0; p < 0.0001). This reduction was not associated with the type of oil or the site of application. Based on these results, lavender oil has no advantage over sunflower seed oil in the reduction of BPSD, regardless of the place of application.
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Affiliation(s)
- Svetlana Zalomonson
- 1 Mental Health Center Beer-Sheva, Ministry of Health, Affiliated to the Faculty of Medical Science Ben-Gurion University of the Negev, Beer-Sheva, Israel.,2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- 3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- 2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tali Samson
- 2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Svetlana Lebedinsky
- 4 Clinical Pharmacy Services, Pharmacy Department, Clalit Health Services, Beer-Sheva, Israel
| | - Yan Press
- 2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,5 Department of Geriatrics, Soroka Medical Hospital, Beer-Sheva, Israel
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Ruiz M, Arias A, Sánchez-Llanos E, Gil MP, López-Ortega R, Dakterzada F, Purroy F, Piñol-Ripoll G. Minor Hallucinations in Alzheimer's Disease. J Alzheimers Dis 2018; 64:543-549. [PMID: 29889069 DOI: 10.3233/jad-180234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hallucinations may have a broad spectrum and include so-called minor hallucinations (MHs). MHs include passage hallucinations (PHs), visual illusions, and presence hallucinations (PrHs). OBJECTIVE To determine the prevalence and characteristics of MHs in Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI) patients, and to describe their potential relationship with cognition, behavioral symptoms, and use of psychoactive drugs. METHODS We have recruited prospectively and consecutively 268 subjects (90 AD mild-moderate drug-naïve patients, 78 aMCI, and 100 controls). All patients responded to a semi-structured questionnaire in order to rate psychotic phenomena. Clinical, neuropsychological, and demographic data of patients with and without MH were compared with those of age, sex, and education-matched controls. RESULTS The prevalence of MHs was 21.1% (19) in AD, 12.8% (10) in aMCI, and 3% (3) in controls (p < 0.01). The most frequent MH was PrH (9.3%), followed by PH (4.9%) and illusion (0.7%). Eight (27.8%) patients had more than one MH. After adjusting for age and gender, there was a negative correlation between the presence of MHs and MMSE score (r = -0.261; p < 0.01) and a positive correlation between MHs and Neuropsychiatric Inventory score (r = 0.237; p < 0.01). We did not observe a significant relationship between presence of MHs and the consumption of psychoactive drugs (p > 0.05). CONCLUSION We have shown that the presence of MHs in patients with newly diagnosed, untreated AD and aMCI is more than controls. MHs were correlated with other behavioral symptoms and a worse cognitive performance. We suggest the specific interrogation for MHs as a clinical feature for this population.
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Affiliation(s)
- Maria Ruiz
- Servicio de Neurología, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Spain
| | - Alfonso Arias
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
| | - Ernesto Sánchez-Llanos
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
| | - Maria Pilar Gil
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
| | | | - Faridé Dakterzada
- Clinical Neuroscience Research Group, IRBLleida-Department of Experimental Medicine, Lleida, Spain
| | - Francisco Purroy
- Servicio de Neurología, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
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Psychosis in Neurodegeneration: Relating Phenomenology to Pathology and Prognosis. Am J Geriatr Psychiatry 2018; 26:314-315. [PMID: 29398353 DOI: 10.1016/j.jagp.2017.11.008] [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: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022]
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