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Grunberg VA, Bannon S, Popok P, Reichman M, Dickerson BC, Vranceanu AM. A race against time: couples' lived diagnostic journeys to young-onset dementia. Aging Ment Health 2022; 26:2223-2232. [PMID: 34435534 PMCID: PMC9377159 DOI: 10.1080/13607863.2021.1966748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/02/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE Young onset dementias (YOD) - typically defined by symptom onset before age 65 - are frequently overlooked in medical and community settings. Persons with YOD and their spouses face logistical and emotional challenges on their journey to a diagnosis (e.g. uncertainty about symptoms, lack of medical knowledge, emotional distress). An in-depth understanding of couples' experiences before and immediately following a YOD diagnosis is warranted to inform early psychosocial services for couples. METHODS We utilized dyadic qualitative semi-structured interviews (N = 23) to better understand the nuances of couples' pre-diagnostic and diagnostic experiences with YOD. We used a hybrid of deductive and inductive analytic strategies to identify couple-level themes. RESULTS Fifteen couple-level themes were extracted within four domains: (1) early indicators of symptoms, (2) obtaining a diagnosis, (3) experiences with health care providers, and (4) emotional reactions to the diagnosis. Couples expressed difficulties communicating about early symptoms, receiving accurate and timely diagnostic information, and managing multiple emotions. They described the value of working together to manage care, gain information, establish positive relationships with providers, and promote adjustment. CONCLUSION Findings highlight the shared experiences of couples during the early stages of YOD, including the importance of strong communication with each other and providers. Early and accessible psychosocial services that help couples cope with and communicate about individual and shared stressors are warranted.
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Affiliation(s)
- Victoria A. Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Paula Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Bradford C. Dickerson
- Harvard Medical School, Boston, MA
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Sasaki H, Jono T, Fukuhara R, Honda K, Ishikawa T, Boku S, Takebayashi M. Late-manifestation of attention-deficit/hyperactivity disorder in older adults: an observational study. BMC Psychiatry 2022; 22:354. [PMID: 35610630 PMCID: PMC9128193 DOI: 10.1186/s12888-022-03978-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The age of attention-deficit/hyperactivity disorder onset is usually during the first 12 years of life; however, there have been recent reports of late-onset attention-deficit/hyperactivity disorder. These reports have been limited to that of young adults, and details in older adults remain unknown. As such, we had previously presented the first case report of "very" late-onset attention-deficit/hyperactivity disorder, wherein the symptoms presented in senile age. In this observational study, we aimed to investigate the prevalence and clinical features of such attention-deficit/hyperactivity disorders in older adults visiting our dementia clinic. METHODS Four hundred forty-six consecutive patients visiting our specialty outpatient clinic for dementia during the 2-year period from April 1, 2015 to March 31, 2017 were included in this study. First, the patients were examined for the presence or absence of dementia in our specialty outpatient clinic for dementia. Those not diagnosed with dementia were examined for the presence or absence of attention-deficit/hyperactivity disorder in our specialty outpatient clinic for developmental disorders. Finally, these patients who were diagnosed with attention-deficit/hyperactivity disorder were investigated in detail to clarify their clinical characteristics. RESULTS Of 446 patients (246 women and 200 men), 7 patients were finally diagnosed with attention-deficit/hyperactivity disorder. Although these 7 patients were initially suspected to have Alzheimer's disease (considering their age, 6 of these 7 patients were suspected to have early onset Alzheimer's disease), it was found that these symptoms were due to attention-deficit/hyperactivity disorder. These patients had four characteristics in common: (1) they were significantly younger than the complete study population; (2) they predominantly showed inattention-related symptoms; (3) they showed latent manifestation; and (4) they experienced a stressful life event before manifestation. CONCLUSIONS Our previous case report suggested that very late-onset attention-deficit/hyperactivity disorder patients could be incorrectly diagnosed with dementia. In this observational study, 1.6% of patients who were initially suspected of having dementia were actually diagnosed with attention-deficit/hyperactivity disorder. This study also showed that the "late-onset" described in our previous report would be better described as "late-manifestation." A clinician should consider late-manifestation of attention-deficit/hyperactivity disorder in the differential diagnosis when encountering dementia patients, especially early onset Alzheimer's disease.
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Affiliation(s)
- Hiroyuki Sasaki
- grid.411152.20000 0004 0407 1295Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556 Japan ,grid.411152.20000 0004 0407 1295Medical Center for Developmental Disorders, Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Tadashi Jono
- grid.411152.20000 0004 0407 1295Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556 Japan ,grid.411152.20000 0004 0407 1295Medical Center for Developmental Disorders, Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryuji Fukuhara
- grid.411152.20000 0004 0407 1295Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556 Japan ,grid.411152.20000 0004 0407 1295Medical Center for Dementia-related Disease, Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Kazuki Honda
- grid.411152.20000 0004 0407 1295Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556 Japan ,grid.411152.20000 0004 0407 1295Medical Center for Dementia-related Disease, Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Tomohisa Ishikawa
- grid.411152.20000 0004 0407 1295Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556 Japan ,grid.411152.20000 0004 0407 1295Medical Center for Dementia-related Disease, Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Shuken Boku
- grid.411152.20000 0004 0407 1295Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556 Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan. .,Institute for Clinical Research, National Hospital Organization Kure Medical Center Chugoku Cancer Center, Hiroshima, Japan.
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Aiba Y, Sakakibara R, Ogata T, Iimura A, Terayama K, Suzuki K, Katsuragawa S, Kato Y, Tateno F, Terada H, Inaoka T, Nakatsuka T. Young-Onset Dementia with Lewy Bodies. Case Rep Neurol 2018; 10:363-368. [PMID: 30687068 PMCID: PMC6341340 DOI: 10.1159/000495748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 11/26/2018] [Indexed: 01/25/2023] Open
Abstract
Young-onset (< 65 years) dementia is a challenging clinical problem. A 61-year-old man visited our clinic because of a 2-year history of mild cognitive impairment of the executive disorder type. He was initially suspected of having young-onset Alzheimer's disease due to the lack of motor signs or hippocampal atrophy by conventional brain MRI. However, he proved to have anosmia, erectile dysfunction, hypersexuality, constipation, REM sleep behavior disorder, and emotional lability; imaging findings included positive brain perfusion SPECT, nigrosome MRI, DAT scan, and MIBG myocardial scintigraphy. All these clinical imaging features led to the correct diagnosis of young-onset dementia with Lewy bodies (YOD-DLB). It is hoped that this case report will help facilitate a future prospective study to diagnose and follow YOD-DLB patients with the aim of determining appropriate management and care.
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Affiliation(s)
- Yosuke Aiba
- Dementia Support Team, Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ryuji Sakakibara
- Dementia Support Team, Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tsuyoshi Ogata
- Dementia Support Team, Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ayako Iimura
- Dementia Support Team, Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Keiichiro Terayama
- Dementia Support Team, Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Keiko Suzuki
- Dementia Support Team, Psychiatry, Sakura Medical Center, Toho University, Sakura, Japan
| | - Shuichi Katsuragawa
- Dementia Support Team, Psychiatry, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yuuki Kato
- Dementia Support Team, Psychiatry, Sakura Medical Center, Toho University, Sakura, Japan
| | - Fuyuki Tateno
- Dementia Support Team, Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Hitoshi Terada
- Radiology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tsutomu Inaoka
- Radiology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tomoya Nakatsuka
- Radiology, Sakura Medical Center, Toho University, Sakura, Japan
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Abstract
A substantial number of adults suffer young-onset dementia (YOD). The diversity of types and syndromes makes recognition and diagnosis difficult. An algorithmic approach to interpreting clinical data, informed by clinical epidemiology, integrates data pertaining to defining syndromes and their chronology and tempo, family history, and other neuropsychiatric features and neurologic signs, is used to reach a preliminary diagnosis and direct diagnostic tests and their interpretation. Screening for YOD in the psychiatric context is a rational process in which vigilance is combined with careful searches for red flags that signal a neurodegenerative etiology.
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Affiliation(s)
- Bhargavi Devineni
- Geriatric Psychiatry Division, Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 279, Baltimore, MD 21287, USA.
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