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Elefante C, Brancati GE, Torrigiani S, Amadori S, Ricciardulli S, Pistolesi G, Lattanzi L, Perugi G. Bipolar Disorder and Manic-Like Symptoms in Alzheimer's, Vascular and Frontotemporal Dementia: A Systematic Review. Curr Neuropharmacol 2023; 21:2516-2542. [PMID: 35794767 PMCID: PMC10616925 DOI: 10.2174/1570159x20666220706110157] [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: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated. OBJECTIVES The main aim of this study is to systematically review clinical and therapeutic evidence about manic syndromes in patients with Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). Since manic-mixed episodes have been associated to negative outcomes in patients with dementia and often require medical intervention, we also critically summarized selected studies with relevance for the treatment of mania in patients with cognitive decline. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched up to February 2022. Sixty-one articles on patients with AD, VaD, or FTD and BD or (hypo) mania have been included. RESULTS Manic symptoms seem to be associated to disease progression in AD, have a greatly variable temporal relationship with cognitive decline in VaD, and frequently coincide with or precede cognitive impairment in FTD. Overall, mood stabilizers, and electroconvulsive therapy may be the most effective treatments, while the benefits of short-term treatment with antipsychotic agents must be balanced with the associated risks. Importantly, low-dose lithium salts may exert neuroprotective activity in patients with AD. CONCLUSION Prevalence, course, and characteristics of manic syndromes in patients with dementia may be differentially affected by the nature of the underlying neurodegenerative conditions.
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Affiliation(s)
- Camilla Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Samuele Torrigiani
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Salvatore Amadori
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Sara Ricciardulli
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Gabriele Pistolesi
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Lorenzo Lattanzi
- Psychiatry Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
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Cherkasov NS, Kolykhalov IV. [Non-cognitive psychopathological symptoms in mild cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:41-51. [PMID: 34870913 DOI: 10.17116/jnevro202112110241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Noncognitive psychopathological symptoms (NPS) in elderly patients are increasingly attracting the attention of researchers in the field of neurodegenerative diseases. The question is raised whether these symptoms are risk factors or initial manifestations of the neurodegeneration process. This article provides information on the prevalence of late-onset NPS together with mild cognitive impairment (MCI), combination of which reflects the risk of developing dementia. The characteristic of mild behavioral impairment syndrome, which is currently used along with the concept of MCI, is given. The authors summarized data of the studies published over the past 10 years on the effect of NPS on the progression of cognitive impairment. Topics related to the differential diagnosis of these disorders, as well as existing approaches to treatment, are considered.
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Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis. Int J Mol Sci 2021; 22:ijms22094440. [PMID: 33922780 PMCID: PMC8123079 DOI: 10.3390/ijms22094440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer’s disease, fronto-temporal dementia, Parkinson’s disease, Huntington’s disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.
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Matsuoka T, Ismail Z, Narumoto J. Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic. J Alzheimers Dis 2020; 70:505-513. [PMID: 31177229 PMCID: PMC6700628 DOI: 10.3233/jad-190278] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and for some, an early manifestation of dementia. Objective: We examined the prevalence of MBI in the psychiatric outpatient clinic, and compared the incidence of dementia in MBI with that in other psychiatric diseases. Methods: Retrospective chart review was conducted in 2,853 consecutive outpatients over the age of 50. MBI was diagnosed according to the International Society to Advance Alzheimer’s Research and Treatment research diagnostic criteria. The incidence rate of dementia was examined in the patients who were followed up for at least 1 month. Kaplan-Meier survival analyses and Cox proportional hazards regression models were performed to compare the time to onset of dementia between MBI and other psychiatric diseases. Results: The prevalence of MBI was 3.5% and the incidence of dementia was 30.7 cases per 1000 person-years. The hazard ratio (HR) for dementia was higher for MBI than other psychiatric diseases (HR: 8.07, 95% confidence interval: 4.34–15.03, p < 0.001). In MCI patients, the cumulative survival in MCI with affective dysregulation tended to be lower than that in MCI without (p = 0.090). Conclusions: Psychiatric outpatients often meet MBI criteria. MBI, especially the affective dysregulation domain, increases the risk of dementia in this psychiatric outpatient population. Since late-onset psychiatric and behavioral symptoms may be prodromal symptoms of dementia in some, careful observation is needed, and psychiatric clinicians should keep prodromal dementia on their differential diagnosis when assessing those with new onset psychiatric symptomatology in older adults.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - 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
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Wise EA, Rosenberg PB, Lyketsos CG, Leoutsakos JM. Time course of neuropsychiatric symptoms and cognitive diagnosis in National Alzheimer's Coordinating Centers volunteers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:333-339. [PMID: 31024987 PMCID: PMC6476801 DOI: 10.1016/j.dadm.2019.02.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPSs) are nearly universal in cognitive disorders. The mild behavioral impairment construct postulates that NPS may be the first symptom of impending dementia. METHODS Participants were cognitively normal volunteers followed up approximately annually at Alzheimer's Disease Centers, who were assessed on the Neuropsychiatric Inventory and had at least one follow-up visit during which they were diagnosed with mild cognitive impairment (MCI) or dementia. Descriptive statistics were used to determine sequencing of NPS presence with cognitive diagnoses. RESULTS Data were available for 1998 participants who progressed to MCI or dementia. Over 59% developed NPS before the diagnosis of any cognitive disorder. Depression and irritability were the most common NPSs to precede cognitive diagnoses (24 and 21%, respectively). DISCUSSION NPSs precede a cognitive diagnosis in most people who develop cognitive decline, both MCI and dementia. These individuals are an important group to focus clinical and research efforts.
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Affiliation(s)
| | | | | | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, Md
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Mallo SC, Ismail Z, Pereiro AX, Facal D, Lojo-Seoane C, Campos-Magdaleno M, Juncos-Rabadán O. Assessing Mild Behavioral Impairment with the Mild Behavioral Impairment-Checklist in People with Mild Cognitive Impairment. J Alzheimers Dis 2018; 66:83-95. [DOI: 10.3233/jad-180131] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Sabela C. Mallo
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, de Compostela, Galicia, Spain
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Arturo X. Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, de Compostela, Galicia, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, de Compostela, Galicia, Spain
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, de Compostela, Galicia, Spain
| | - María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, de Compostela, Galicia, Spain
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, de Compostela, Galicia, Spain
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Ismail Z, Agüera-Ortiz L, Brodaty H, Cieslak A, Cummings J, Fischer CE, Gauthier S, Geda YE, Herrmann N, Kanji J, Lanctôt KL, Miller DS, Mortby ME, Onyike CU, Rosenberg PB, Smith EE, Smith GS, Sultzer DL, Lyketsos C. The Mild Behavioral Impairment Checklist (MBI-C): A Rating Scale for Neuropsychiatric Symptoms in Pre-Dementia Populations. J Alzheimers Dis 2018; 56:929-938. [PMID: 28059789 DOI: 10.3233/jad-160979] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mild behavioral impairment (MBI) is a construct that describes the emergence at ≥50 years of age of sustained and impactful neuropsychiatric symptoms (NPS), as a precursor to cognitive decline and dementia. MBI describes NPS of any severity, which are not captured by traditional psychiatric nosology, persist for at least 6 months, and occur in advance of or in concert with mild cognitive impairment. While the detection and description of MBI has been operationalized in the International Society to Advance Alzheimer's Research and Treatment - Alzheimer's Association (ISTAART-AA) research diagnostic criteria, there is no instrument that accurately reflects MBI as described. OBJECTIVE To develop an instrument based on ISTAART-AA MBI criteria. METHODS Eighteen subject matter experts participated in development using a modified Delphi process. An iterative process ensured items reflected the five MBI domains of 1) decreased motivation; 2) emotional dysregulation; 3) impulse dyscontrol; 4) social inappropriateness; and 5) abnormal perception or thought content. Instrument language was developed a priori to pertain to non-demented functionally independent older adults. RESULTS We present the Mild Behavioral Impairment Checklist (MBI-C), a 34-item instrument, which can easily be completed by a patient, close informant, or clinician. CONCLUSION The MBI-C provides the first measure specifically developed to assess the MBI construct as explicitly described in the criteria. Its utility lies in MBI case detection, and monitoring the emergence of MBI symptoms and domains over time. Studies are required to determine the prognostic value of MBI for dementia development, and for predicting different dementia subtypes.
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Affiliation(s)
- Zahinoor Ismail
- Department of Psychiatry, and the Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, and The Ron and Rene Ward Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Luis Agüera-Ortiz
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM,Department of Psychiatry & Research Institute i+12, Hospital, Universitario 12 de Octubre, Madrid, Spain
| | - Henry Brodaty
- Centre for Healthy Brain Ageing and Dementia Collaborative Research Centre, University of New South Wales, New South Wales, Sydney, Australia
| | - Alicja Cieslak
- Department of Clinical Neurosciences, and The Ron and Rene Ward Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Faculty of Medicine, Department of Psychiatry, University of Toronto, ON, Canada
| | - Serge Gauthier
- McGill Centre for Studies in Aging, Douglas Mental Health Research Institute, Montreal, Quebec, Canada
| | - Yonas E Geda
- Departments of Psychiatry and Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Nathan Herrmann
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Neuropsychopharmacology Research Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology/Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jamila Kanji
- Department of Clinical Neurosciences, and The Ron and Rene Ward Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology/Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Moyra E Mortby
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, NHMRC National Institute for Dementia Research, Canberra, Australia
| | - Chiadi U Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric E Smith
- Department of Clinical Neurosciences, and The Ron and Rene Ward Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences and Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David L Sultzer
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, and the Brain, Behavior, and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Constantine Lyketsos
- Memory and Alzheimer's Treatment Center and Alzheimer's Disease Research Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins Medicine, Baltimore, MD, USA
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Abstract
The World Alzheimer Report 2016 estimated that 47 million people are living with dementia worldwide (Alzheimer's Disease International, 2016). In the inaugural World Health Organization Ministerial Conference on Global Action against Dementia, six of the top ten research priorities were focused on prevention, identification, and reduction of dementia risk, and on delivery and quality of care for people with dementia and their carers (Shah et al., 2016). While the Lancet Neurology Commission has suggested that even minor advances to delay progression or ameliorate symptoms might have substantial financial and societal benefits (Winblad et al., 2016), advances have been slow.
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Case series of mild behavioral impairment: toward an understanding of the early stages of neurodegenerative diseases affecting behavior and cognition. Int Psychogeriatr 2018; 30:273-280. [PMID: 29017626 DOI: 10.1017/s1041610217001855] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mild behavioral impairment (MBI) is characterized by later life acquired, sustained, and impactful neuropsychiatric symptoms (NPS) of any severity that cannot be better accounted for by other formal medical and psychiatric nosology. MBI is an "at risk" state for incident cognitive decline and dementia, and for some, MBI is the index manifestation of neurodegeneration, observed in advance of cognitive impairment. Initially described in Frontotemporal Dementia (FTD), MBI evolved to describe a preclinical stage of all cause dementia, and has been operationalized in the International Society to Advance Alzheimer's Research and Treatment-Alzheimer's Association (ISTAART-AA) proposed research diagnostic criteria. Here, we describe three cases in which patients diagnosed with a variety of dementing conditions initially presented with NPS to the Cognitive Neurosciences Clinic at the University of Calgary, Canada. All patients described in our series were given a final diagnosis of dementia; the etiology supported by clinical, cognitive, and neuroimaging findings. In all three cases, the progression to dementia was preceded by NPS that meet criteria for MBI. With these examples, we are able to illustrate that MBI can represent a premonitory stage of dementia of different etiologies. These cases demonstrate early use of the MBI checklist (MBI-C). The cases presented in this series serve as examples of NPS as early manifestations of dementia. Our case examples include both FTD and AD, and demonstrate that before a diagnosis of a neurodegenerative disease is considered, often patients will be diagnosed with and treated for a psychiatric condition. These early NPS can be characterized within the domains outlined in the ISTAART-AA MBI criteria, and detected with the MBI-C, which may help clinicians consider neurodegenerative disease in the differential diagnosis of later life onset psychiatric symptomatology.
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Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment symptoms of depression, anxiety, irritability, and euphoria. Int Psychogeriatr 2018; 30:185-196. [PMID: 28899446 DOI: 10.1017/s1041610217001880] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. METHODS Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: "mild cognitive impairment," "dementia," "prodromal dementia," "preclinical dementia," "Alzheimer's," "depression," "dysphoria," "mania," "euphoria," "bipolar disorder," and "irritability." RESULTS Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. CONCLUSION Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
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