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Singh AK, Malviya R, Prakash A, Verma S. Neuropsychiatric Manifestations in Alzheimer's Disease Patients: Genetics and Treatment Options. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:39-54. [PMID: 36856177 DOI: 10.2174/1871527322666230301111216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/03/2022] [Accepted: 12/27/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by neuropsychiatric symptoms (NPS), which cause great misery to those with dementia and those who care for them and may lead to early institutionalization. OBJECTIVE The present systematic review aims to discuss the various aspects of Alzheimer's, including treatment options. METHODS The databases Embase, PubMed, and Web of Science were searched to collect data. RESULTS Incipient cognitive deterioration is commonly accompanied by these early warning signals of neurocognitive diseases. The neurobiology of NPSs in Alzheimer's disease, as well as particular symptoms, including psychosis, agitation, apathy, sadness, and sleep disorders, will be examined in this review. For NPSs in Alzheimer's disease, clinical trial designs, as well as regulatory issues, were also addressed. A fresh wave of research, however, is helping to push the discipline ahead. For medication development and repurposing, we highlight the most recent results in genetics, neuroimaging, and neurobiology. Even though identifying and treating psychosis in adults with dementia is still a challenging endeavor, new options are coming up that give the field fresh focus and hope. Conclsuion: It can be concluded from the complete literature survey that Alzheimer's-related psychosis as well as other symptoms that are not psychotic, have made significant progress in the last decade. These milestones in the development of safer, more effective treatments have been achieved as a consequence of great focus on non-pharmacological interventions like DICE or WHELD; the investigation into ways to improve existing drugs like aripiprazole, risperidone, amisulpride, and Escitalopram for safer precision-based treatment; and the development of a clinical trial program for pimavanserin.
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Affiliation(s)
- Arun Kumar Singh
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Anuj Prakash
- Reference Standard Division, Indian Pharmacopoeia Commission, Sec-23, Raj Nagar, Ghaziabad, Uttar Pradesh, India
| | - Swati Verma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
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2
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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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Benmelouka AY, Ouerdane Y, Outani O, Alnasser YT, Alghamdi BS, Perveen A, Ashraf GM, Ebada MA. Alzheimer's Disease-Related Psychosis: An Overview of Clinical Manifestations, Pathogenesis, and Current Treatment. Curr Alzheimer Res 2022; 19:285-301. [PMID: 35440308 DOI: 10.2174/1567205019666220418151914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
Abstract
Behavioral and psychotic manifestations, including aggression, delusions, and hallucinations, are frequent comorbidities in patients with debilitating nervous illnesses such as Alzheimer's disease (AD), Amyotrophic Lateral Sclerosis, Multiple Sclerosis, and Parkinson's disease. AD-related psychosis may be linked to a poor disease prognosis, highlighting that early detection and management are mandatory. The manifestations are variable and may be very heterogeneous, imposing a real diagnostic issue. Some assessment tools such as BEHAVE-AD, CERAD-BRSD, and the Psycho-Sensory Hallucinations Scale have been designed to facilitate the diagnosis. The mechanisms behind neurodegeneration-related psychosis are complex and are not fully understood, imposing a burden on researchers to find appropriate management modalities. Familial history and some genetic disturbances may have a determinant role in these delusions and hallucinations in cases with AD. The loss of neuronal cells, atrophy in some regions of the central nervous, and synaptic dysfunction may also contribute to these comorbidities. Furthermore, inflammatory disturbances triggered by pro-inflammatory agents such as interleukins and tumor necrosis factors are stratified among the potential risk factors of the onset of numerous psychotic symptoms in Alzheimer's patients. Little is known about the possible management tools; therefore, it is urgent to conduct well-designed trials to investigate pharmacological and non-pharmacological interventions that can improve the care process of these patients. This review summarizes the current findings regarding the AD-related psychosis symptoms, pathological features, assessment, and management.
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Affiliation(s)
| | | | - Oumaima Outani
- Faculty of Medicine and Pharmacy of Rabat, Mohammed 5 University
| | | | - Badrah S Alghamdi
- Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah.,Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah
| | - Asma Perveen
- Glocal University, Mirzapur Pole, Saharanpur, Uttar Pradesh
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah.,Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah
| | - Mahmoud Ahmed Ebada
- Faculty of Medicine, Zagazig University, Zagazig, Al-Sharkia.,Internal Medicine Resident, Ministry of Health and Population of Egypt, Cairo
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Psychosis in Alzheimer disease - mechanisms, genetics and therapeutic opportunities. Nat Rev Neurol 2022; 18:131-144. [PMID: 34983978 PMCID: PMC9074132 DOI: 10.1038/s41582-021-00597-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
Psychosis is a common and distressing symptom in people with Alzheimer disease, and few safe and effective treatments are available. However, new approaches to symptom assessment and treatment are beginning to drive the field forward. New nosological perspectives have been provided by incorporating the emergence of psychotic symptoms in older adults - even in advance of dementia - into epidemiological and neurobiological frameworks as well as into diagnostic and research criteria such as the International Psychogeriatric Association criteria for psychosis in neurocognitive disorders, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) research criteria for psychosis in neurodegenerative disease, and the ISTAART criteria for mild behavioural impairment. Here, we highlight the latest findings in genomics, neuroimaging and neurobiology that are informing approaches to drug discovery and repurposing. Current pharmacological and non-pharmacological treatment options are discussed, with a focus on safety and precision medicine. We also explore trial data for pimavanserin, a novel agent that shows promise for the treatment of psychosis in people with dementia, and discuss existing agents that might be useful but need further exploration such as escitalopram, lithium, cholinesterase inhibitors and vitamin D. Although the assessment and management of psychosis in people with dementia remain challenging, new opportunities are providing direction and hope to the field.
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5
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Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame? Int J Mol Sci 2019; 20:ijms20153647. [PMID: 31349706 PMCID: PMC6695658 DOI: 10.3390/ijms20153647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Alzheimer’s disease and vascular dementia are estimated to be the most common causes of dementia, although mixed dementia could represent the most prevalent form of dementia in older adults aged more than 80 years. Behavioral disturbances are common in the natural history of dementia. However, so far, there is a paucity of studies that investigated the causal association between behavioral psychological symptoms of dementia and dementia sub-types, due to the high heterogeneity of methodology, study design and type of clinical assessment. To understand the scant evidence on such a relevant clinical issue, it could be hypothesized that a new shifting paradigm could result in a better identification of the relationship between behavioral disturbances and dementia. This narrative review provides an update of evidence on the behavioral patterns associated with different dementia sub-types and offers a potential future perspective as common ground for the development of new translational studies in the field of behavioral disturbances in dementia and the appropriateness of psychoactive treatments.
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Krivinko JM, Erickson SL, Ding Y, Sun Z, Penzes P, MacDonald ML, Yates NA, Ikonomovic MD, Lopez OL, Sweet RA, Kofler J. Synaptic Proteome Compensation and Resilience to Psychosis in Alzheimer's Disease. Am J Psychiatry 2018; 175:999-1009. [PMID: 30021459 PMCID: PMC6167138 DOI: 10.1176/appi.ajp.2018.17080858] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The presence of psychosis in Alzheimer's disease denotes a phenotype with more rapid cognitive deterioration than in Alzheimer's disease without psychosis. Discovery of novel pharmacotherapies that engage therapeutic targets for prevention or treatment of Alzheimer's disease with psychosis would benefit from identifying the neurobiology of resilience to psychosis in Alzheimer's disease. The primary objective of this study was to determine whether alterations in the synaptic proteome were associated with resilience to psychotic symptoms in Alzheimer's disease and, if present, were independent of neuropathologic burden. METHOD Quantitative immunohistochemistry was used to measure multiple neuropathologies in dorsolateral prefrontal cortex from subjects with early and middle-stage Alzheimer's disease who differed in psychosis status. Synaptic proteins were quantified by liquid chromatography-mass spectrometry in gray matter homogenates from these subjects and from neuropathologically unaffected subjects. The synaptic proteome was similarly evaluated in cortical gray matter homogenate and in postsynaptic density fractions from an APPswe/PSEN1dE9 mouse model of amyloidosis with germline reduction in Kalrn, which has been shown to confer resilience to progression of psychosis-associated behaviors relative to APPswe/PSEN1dE9 alone. RESULTS Subjects resilient to psychotic symptoms in Alzheimer's disease had higher levels of synaptic proteins compared with those with psychosis and unaffected control subjects. Neuropathologic burden predicted less than 20% of the variance in psychosis status and did not account for the synaptic protein level differences between groups. Reduction of Kalrn in APPswe/PSEN1dE9 mice resulted in higher levels of synaptic proteins in cortical homogenate and normalized protein levels in the postsynaptic density. CONCLUSIONS Accumulation of synaptic proteins, particularly those that are enriched in the postsynaptic density, is associated with resilience to psychosis in Alzheimer's disease. One candidate mechanism for this synaptic proteome compensation is alteration in levels of proteins that facilitate the transport of synaptic proteins to and from the postsynaptic density.
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Affiliation(s)
- Josh M Krivinko
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Susan L Erickson
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Ying Ding
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Zhe Sun
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Peter Penzes
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Matthew L MacDonald
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Nathan A Yates
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Milos D Ikonomovic
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Oscar L Lopez
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Robert A Sweet
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
| | - Julia Kofler
- From the Departments of Psychiatry, Cell Biology, Neurology, and Pathology, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh; the Departments of Physiology and Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago; the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh; and the Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh
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Chen X, Wang C, Zhou S, Li X, Wu L. The Impact of EGFR Gene Polymorphisms on the Risk of Alzheimer's Disease in a Chinese Han Population: A Case-Controlled Study. Med Sci Monit 2018; 24:5035-5040. [PMID: 30026459 PMCID: PMC6067016 DOI: 10.12659/msm.907809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the association between polymorphisms of the epidermal growth factor receptor (EGFR) gene with the risk of Alzheimer's disease (AD) in a Chinese Han population. MATERIAL AND METHODS A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was used to genotype 139 patients with AD and 152 healthy control individuals. The Hardy-Weinberg equilibrium (HWE) was analyzed using the chi-squared (χ²) test, and genotype and allele frequencies were compared between the two population groups, using the χ² test. The odds ratios (ORs) and corresponding 95% confidence intervals (CI) were calculated to express the degree of risk of AD resulting from polymorphisms in the EGFR gene. Linkage disequilibrium among EGFR polymorphisms was analyzed using the Haploview bioinformatics software. RESULTS The CC genotype and C allele frequencies of rs730437 were significantly lower in patients with AD compared with the controls (P=0.037), indicating that rs730437 was associated with a reduced risk of AD (CC vs. AA: OR=0.446, 95% CI=0.207-0.960) (C vs. A: OR=0.702, 95% CI=0.502-0.980). The presence of the TT genotype of rs1468727 significantly reduced the risk of AD (P=0.003; OR=0.333, 95% CI=0.160-0.691), and T allele carriers of rs1468727 had a 0.605-fold increased risk of AD. Haplotype A-C-C was significantly correlated with an increased risk of AD (OR=1.922, 95% CI=1.130-3.269). CONCLUSIONS In a Han Chinese population, EGFR gene polymorphisms, rs730437 and rs1468727 and haplotype A-C-C were shown to be possible protective factors for the development of AD.
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Affiliation(s)
- Xiuhong Chen
- School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing, P.R. China
- Inner Mongolia Autonomous Region Peoples’ Hospital, Hohhot, Inner Mongolia, P.R. China
| | - Changhai Wang
- Inner Mongolia Autonomous Region Peoples’ Hospital, Hohhot, Inner Mongolia, P.R. China
| | - Shuangbao Zhou
- Hohhot Mongolian and Traditional Chinese Medicine Hospital, Hohhot, Inner Mongolia, P.R. China
| | - Xueyong Li
- Inner Mongolia International Mongolian Hospital, Hohhot, Inner Mongolia, P.R. China
| | - Lan Wu
- Inner Mongolia International Mongolian Hospital, Hohhot, Inner Mongolia, P.R. China
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Yatawara C, Hiu S, Tan L, Kandiah N. Neuropsychiatric symptoms in South-East Asian patients with mild cognitive impairment and dementia: prevalence, subtypes, and risk factors. Int J Geriatr Psychiatry 2018; 33:122-130. [PMID: 28239920 DOI: 10.1002/gps.4693] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subtypes and risk factors of neuropsychiatric symptoms remain largely unexplored in South-East Asian populations. OBJECTIVE We investigated the prevalence, subtypes, and risk factors, namely, demographic, medical morbidity, and cognitive impairment associated with neuropsychiatric symptoms in a South-East Asian cohort of patients with mild cognitive impairment (MCI) and dementia. METHODS A clinical cohort of 38 MCI and 198 mild-moderate dementia patients were assessed using the Neuropsychiatric Inventory-Questionnaire. RESULTS Neuropsychiatric symptoms were equally prevalent among patients with MCI (74%) and mild-moderate dementia (85%). Three subtypes of symptoms were identified for each diagnostic group; for MCI, they included mood disturbances, anxiety/sleep problems, and psychosis, while for dementia, the subtypes included behavioral disturbances, psychosis/mood, and hyperactive behaviors. The largest risk for neuropsychiatric symptoms for both MCI and dementia patients was male gender. Among patients with MCI, burden of cerebrovascular disease and global cognitive impairment were small risks for neuropsychiatric symptoms, while for patients with dementia, an older age (>65 years) was a small risk and lower educational attainment was a moderate risk. DISCUSSION These findings contribute to the worldwide epidemiology of neuropsychiatric symptoms in MCI and dementia and highlight that the profile of symptoms, subtypes, and risks is fairly homogenous across Western and Asian cultures. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chathuri Yatawara
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Shaun Hiu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Laura Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
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9
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El Haj M, Roche J, Jardri R, Kapogiannis D, Gallouj K, Antoine P. Clinical and neurocognitive aspects of hallucinations in Alzheimer's disease. Neurosci Biobehav Rev 2017; 83:713-720. [PMID: 28235545 PMCID: PMC5565710 DOI: 10.1016/j.neubiorev.2017.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 01/14/2023]
Abstract
Due to their prevalence, hallucinations are considered as one of the most frequent psychotic symptoms in Alzheimer's disease (AD). These psychotic manifestations reduce patients' well-being, increase the burden of caregivers, contribute to early institutionalization, and are related with the course of cognitive decline in AD. Considering their consequences, we provide a comprehensive account of the current state of knowledge about the prevalence and characteristics of hallucinations in AD. We propose a comprehensive and testable theoretical model about hallucinations in AD: the ALZHA (ALZheimer and HAllucinations) model. In this model, neurological, genetic, cognitive, affective, and iatrogenic factors associated with hallucinations in AD are highlighted. According to the ALZHA model, hallucinations in AD first involve trait markers (i.e., cognitive deficits, neurological deficits, genetic predisposition and/or sensory deficits) to which state markers that may trigger these experiences are added (e.g., psychological distress and/or iatrogenic factors). Finally, we provide recommendations for assessment and management of these psychotic manifestations in AD, with the aim to benefit patients, caregivers, and health professionals.
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Affiliation(s)
- Mohamad El Haj
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
| | - Jean Roche
- CHU de Lille, Unité de Psychogériatrie, Pôle de gérontologie, 59037 Lille, France
| | - Renaud Jardri
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | | | - Karim Gallouj
- Department of Geriatrics, Tourcoing Hospital, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
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10
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Anor CJ, O'Connor S, Saund A, Tang-Wai DF, Keren R, Tartaglia MC. Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia. NEURODEGENER DIS 2017; 17:127-134. [PMID: 28245482 DOI: 10.1159/000455127] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/13/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/AIMS Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD) and vascular dementia (VaD), and are distressful to patients and caregivers. NPS are likely related to the underlying pathology. Previous studies suggest that frontal lobe lesions and vascular changes such as white matter hyperintensities (WMH) have a significant association with specific NPS. The current study aimed to compare NPS in patients with AD, VaD, and mixed AD/VaD, and to evaluate the differences in the prevalence of NPS in relation to frontal WMH volume. METHODS In total, 180 patients with NPS and MRI data (92 probable AD, 51%; 34 probable VaD, 19%; and 54 probable mixed AD/VaD, 30%) were included in the study. Regression analyses were performed to determine the relationships between NPS prevalence and diagnosis, and between NPS and frontal WMH. RESULTS VaD patients had significantly more agitation (p < 0.05; 40 vs. 14%) and sleep disturbances (p < 0.05; 57 vs. 32%) than AD patients, and significantly more depression (p < 0.05; 48 vs. 20%) and aberrant motor behaviors (p < 0.05; 31 vs. 13%) than mixed AD/VaD patients. AD patients with delusions had significantly greater right frontal WMH volumes than those without (p < 0.05; delusions 1/0 = 314.8/112.6 mm3). CONCLUSION Differences in NPS prevalence are likely related to the underlying pathology and warrant further study as they have implications for treatment.
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Affiliation(s)
- Cassandra J Anor
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
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