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Macedo AC, Therriault J, Tissot C, Aumont É, Servaes S, Rahmouni N, Fernandez-Arias J, Lussier FZ, Wang YT, Ng KP, Vermeiren M, Bezgin G, Socualaya KQ, Stevenson J, Hosseini SA, Chamoun M, Ferrari-Souza JP, Ferreira PCL, Bellaver B, Leffa DT, Vitali P, Zimmer ER, Ismail Z, Pascoal TA, Gauthier S, Rosa-Neto P. Modeling the progression of neuropsychiatric symptoms in Alzheimer's disease with PET-based Braak staging. Neurobiol Aging 2024; 144:127-137. [PMID: 39326302 DOI: 10.1016/j.neurobiolaging.2024.09.009] [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: 04/18/2024] [Revised: 08/15/2024] [Accepted: 09/14/2024] [Indexed: 09/28/2024]
Abstract
In Alzheimer's disease (AD), neuropsychiatric symptoms (NPS) correlate with tau deposition in the brain. Here, we investigated the association of PET-based Braak stages with NPS and assessed whether they predict annual changes in NPS. We evaluated 231 individuals in the aging and AD continuum. Participants were assigned a Braak stage at baseline and followed for 1.97 (s.d. 0.62) years. NPS were investigated using the Mild Behavioral Impairment Checklist (MBI-C) and the Neuropsychiatric Inventory Questionnaire severity (NPI-Q-S) and distress (NPI-Q-D) scales. Multiple linear regressions (MLR) assessed the association of Braak stages with baseline NPS and the annual change in NPS scores. At baseline, stages I-II, III-IV, and V-VI were associated with higher MBI-C, NPI-Q-S, and NPI-Q-D scores. Stages V-VI were associated with a significant annual increase in MBI-C scores. These findings suggest that tau accumulation may manifest clinically with an increase in NPS, which seems to be an early event in AD pathophysiology. Moreover, PET-based Braak staging appears to be a good predictor of NPS severity progression.
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Affiliation(s)
- Arthur C Macedo
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Joseph Therriault
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Cécile Tissot
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada; Lawrence Berkeley National Laboratory, 1 Cyclotron Rd, Berkeley, CA 94720, USA
| | - Étienne Aumont
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Psychology, University of Québec at Montréal, 100 Rue Sherbrooke O, Montréal, QC H2X 3P2, Canada
| | - Stijn Servaes
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Nesrine Rahmouni
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Jaime Fernandez-Arias
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Firoza Z Lussier
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Yi-Ting Wang
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Marie Vermeiren
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada
| | - Gleb Bezgin
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Kely Quispialaya Socualaya
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Jenna Stevenson
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Seyyed Ali Hosseini
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Mira Chamoun
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - João Pedro Ferrari-Souza
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Pâmela C L Ferreira
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Bruna Bellaver
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Douglas Teixeira Leffa
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Paolo Vitali
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada
| | - Eduardo R Zimmer
- Department of Pharmacology, Graduate Program in Biological Sciences: Pharmacology and Therapeutics; and Biochemistry, Universidade Federal do Rio Grande do Sul, 2600 Ramiro Barcelo St, Porto Alegre, RS 90.035-003, Brazil; Brain Institute of Rio Grande do Sul, PUCRS, Av. Ipiranga, 6690, Porto Alegre, RS 90610-000, Brazil
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology, Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada; National Institute for Health and Care Research Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Tharick A Pascoal
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Serge Gauthier
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health Institute, Montréal, 6875 LaSalle Blvd, Montréal, QC H4H 1R3, Canada; Department of Neurology and Neurosurgery, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Montreal Neurological Institute, 3801 University Street, Montréal, QC H3A 2B4, Canada.
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Zheng X, Wang S, Huang J, Li C, Shang H. Predictors for survival in patients with Alzheimer's disease: a large comprehensive meta-analysis. Transl Psychiatry 2024; 14:184. [PMID: 38600070 PMCID: PMC11006915 DOI: 10.1038/s41398-024-02897-w] [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: 01/23/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
The prevalence of Alzheimer's disease (AD) is increasing as the population ages, and patients with AD have a poor prognosis. However, knowledge on factors for predicting the survival of AD remains sparse. Here, we aimed to systematically explore predictors of AD survival. We searched the PubMed, Embase and Cochrane databases for relevant literature from inception to December 2022. Cohort and case-control studies were selected, and multivariable adjusted relative risks (RRs) were pooled by random-effects models. A total of 40,784 reports were identified, among which 64 studies involving 297,279 AD patients were included in the meta-analysis after filtering based on predetermined criteria. Four aspects, including demographic features (n = 7), clinical features or comorbidities (n = 13), rating scales (n = 3) and biomarkers (n = 3), were explored and 26 probable prognostic factors were finally investigated for AD survival. We observed that AD patients who had hyperlipidaemia (RR: 0.69) were at a lower risk of death. In contrast, male sex (RR: 1.53), movement disorders (including extrapyramidal signs) (RR: 1.60) and cancer (RR: 2.07) were detrimental to AD patient survival. However, our results did not support the involvement of education, hypertension, APOE genotype, Aβ42 and t-tau in AD survival. Our study comprehensively summarized risk factors affecting survival in patients with AD, provided a better understanding on the role of different factors in the survival of AD from four dimensions, and paved the way for further research.
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Affiliation(s)
- Xiaoting Zheng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shichan Wang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingxuan Huang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chunyu Li
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Therrien S, Turnbull A, Anthony M, Conwell Y, Lin FV. Influence of affective states on informant impression of neuropsychiatric symptoms in people living with MCI. Aging Ment Health 2023; 27:2128-2133. [PMID: 36995269 PMCID: PMC10544672 DOI: 10.1080/13607863.2023.2191928] [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: 08/08/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
Objectives: Alzheimer's disease (AD) and mild cognitive impairment (MCI) are often accompanied by neuropsychiatric symptoms (NPS; e.g. depression/apathy/irritability) causing challenges for people living with dementia/caregivers and predicting worse disease progression. Accurately assessing NPS is critical to research on AD/MCI. However, there are limitations to both self-reports and clinician evaluations; the field often relies on informants to assess NPS. Informants' perception of NPS are influenced by disease and caregiver factors that may lead to biased assessments. We aimed to assess the relationship between participants self-reported affective states (valence/arousal) and informant-reported NPS.Methods: Data from a double-blinded intervention design (primarily testing neurostimulation's effect on NPS) were used to examine the relationship between participant-reported affective states and informant-reported NPS over 1 month. Forty participants (24 females) with MCI and NPS (mean age = 71.7, SD = 7) were enrolled along with informants (primarily spouses/partners) who regularly interact with participants. NPS assessment occurred weekly and at pre- and post-intervention, and participant-reported affective states were assessed at 14 timepoints.Results: Generalized Estimating Equations showed that participant levels of arousal, but not valence, were significantly related to corresponding informant-reported NPS at weekly (arousal: B= -0.59, SE = 0.27, Wald's χ2 = 4.61, p=.032; valence: B = 0.17, SE = 0.19, Wald's χ2 = 0.80, p=.37) and pre-/post- (arousal: B= -4.00, SE = 1.58, Wald's χ2 = 6.42, p=.011; valence: B= -3.34, SE = 1.80, Wald's χ2 = 3.43, p=.06) assessments.Conclusion: The findings indicate that informant-reported NPS may be more strongly influenced by arousal, and informants may be less attuned to valence in people living with MCI.
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Affiliation(s)
- Sarah Therrien
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
| | - Adam Turnbull
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
- Department of Brain and Cognitive Sciences, University of Rochester, NY 14627, USA
| | - Mia Anthony
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
- Department of Brain and Cognitive Sciences, University of Rochester, NY 14627, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester, NY 14627, USA
| | - Feng Vankee Lin
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA
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Rantsi M, Kortelainen L, Hyttinen V, Jyrkkä J, Kankaanpää E. Trends in the use of psychotropics in older people with dementia: interrupted time series of Finnish clinical guidelines of behavioural and psychological symptoms of dementia. Age Ageing 2023; 52:afad094. [PMID: 37366328 PMCID: PMC10294559 DOI: 10.1093/ageing/afad094] [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: 11/04/2022] [Revised: 03/15/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Up to 90% of people with dementia experience behavioural and psychological symptoms of dementia (BPSD) as part of their illness. Psychotropics are not recommended as the first-line treatment of BPSD because older people are more prone to adverse reactions. In this study, we evaluate the impact of the Finnish clinical guidelines of BPSD (published in 2017) on psychotropic use in people with dementia. METHODS This study is based on Finnish Prescription Register data from 2009 to 2020. The data included all community-dwelling Finnish people aged ≥65 and who had anti-dementia medication purchases (n = 217,778). We used three-phased interrupted time series design to evaluate the changes in levels and trends of monthly (n = 144) psychotropic user rates compared with the predicted trends. In addition, we evaluated the changes in levels and trends of monthly new psychotropic user rates. RESULTS The level of monthly psychotropic user rate decreased non-significantly during the intervention period (β -0.057, P = 0.853), and during the post-intervention period, there was an increase in the level (β 0.443, P = 0.091) and slope (β 0.199, P = 0.198), but not statistically significant. The level of monthly new psychotropic user rate (β -0.009, P = 0.949) during the intervention period and the level (β 0.044, P = 0.714) and slope (β 0.021, P = 0.705) during the post-intervention period were almost unchanged. CONCLUSIONS Results may indicate possible challenges in deprescribing and better adherence to the guidelines at the beginning of BPSD treatment. Further research into the barriers to implement BPSD guidelines and the availability of non-pharmacological treatments is needed.
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Affiliation(s)
- Mervi Rantsi
- Address correspondence to: Mervi Rantsi. Tel: +358 46 920 2963.
| | - Lauri Kortelainen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Information and Development Services Unit, Finnish Medicines Agency, Helsinki, Finland
| | - Eila Kankaanpää
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Kouloutbani K, Venetsanou F, Karteroliotis KE, Politis A. Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia: A Meta-analysis of Randomized Controlled Trials. Alzheimer Dis Assoc Disord 2023; 37:73-81. [PMID: 36821178 DOI: 10.1097/wad.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management. METHODS Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis. RESULTS The meta-analyses revealed that exercise significantly limits NPS [mean difference: -5.28, (95% CI, -9.46, -1.11), P = 0.01] and symptoms of depression [standardized mean difference: -0.16, (95% CI, -0.29, -0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively. CONCLUSIONS Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.
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Affiliation(s)
- Komanthi Kouloutbani
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni
| | - Fotini Venetsanou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni
| | | | - Antonios Politis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
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Bartsch CJ, Nordman JC. Promises and Pitfalls of NMDA Receptor Antagonists in Treating Violent Aggression. Front Behav Neurosci 2022; 16:938044. [PMID: 35801096 PMCID: PMC9253591 DOI: 10.3389/fnbeh.2022.938044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Treatment options for chronically aggressive individuals remain limited despite recent medical advances. Traditional pharmacological agents used to treat aggression, such as atypical antipsychotics, have limited efficacy and are often replete with dangerous side effects. The non-competitive NMDAR antagonists ketamine and memantine are promising alternatives, but their effects appear to be highly dependent on dosage, context, and personal experience. Importantly, these drugs can increase aggression when combined with substances of abuse or during periods of heightened stress. This is likely due to mechanistic differences operating at specific synapses under different contexts. Previous findings from our lab and others have shown that early life stress, substance abuse, and attack experience promote aggression through NMDAR-dependent synaptic plasticity within aggression-related brain circuits. Ketamine and memantine affect these types of aggression in opposite ways. This has led us to propose that ketamine and memantine oppositely affect aggression brought on by early life stress, substance abuse, or attack experience through opposite effects on NMDAR-dependent synaptic plasticity. This would account for the persistent effects of these drugs on aggression and suggest they could be leveraged as a more long-lasting treatment option. However, a more thorough examination of the effects of ketamine and memantine on cellular and synaptic function will be necessary for responsible administration. Additionally, because the effects of ketamine and memantine are highly dependent on prior drug use, traumatic stress, or a history of aggressive behavior, we propose a more thorough medical evaluation and psychiatric assessment will be necessary to avoid possible adverse interactions with these drugs.
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Affiliation(s)
- Caitlyn J. Bartsch
- Department of Physiology, University of Southern Illinois Carbondale, Carbondale, IL, United States
| | - Jacob C. Nordman
- Department of Physiology, University of Southern Illinois School of Medicine, Carbondale, IL, United States
- *Correspondence: Jacob C. Nordman
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Isaacson SH, Citrome L. Hallucinations and delusions associated with Parkinson's disease psychosis: safety of current treatments and future directions. Expert Opin Drug Saf 2022; 21:873-879. [PMID: 35466847 DOI: 10.1080/14740338.2022.2069240] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Over half of Parkinson's disease (PD) patients develop psychotic symptoms, and PD psychosis (PDP) is associated with significant distress to patients, caregiver burden, and impairs quality of life. Pharmacological therapy is limited to atypical antipsychotics. AREAS COVERED : This review will summarize efficacy but will focus on the safety of antipsychotics for treating PDP, and in particular the off-target safety issues including cognitive impairment, sleep disturbance, cardiovascular effects, and motor function. EXPERT OPINION : Pimavanserin is the only medication approved in the US for treating PDP, however clozapine is also considered efficacious. Despite lack of substantial evidence for efficacy, quetiapine is commonly used to treat PDP. Despite the effectiveness of pimavanserin and clozapine for treating PDP, a need exists for additional pharmacological agents that are effective for PDP while providing an acceptable safety and tolerability profile. Medications to treat PDP should avoid worsening motor function, and also minimize sleep disturbances, cognitive impairment, cardiovascular effects, and other non-motor safety concerns. A neutral effect or reduction in mortality risk associated with PD and PDP would be ideal, and low rate of discontinuation due to AEs is desirable. Lastly, medications that can be used safely in combination with other pharmacological agents is essential.
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Affiliation(s)
- Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida, USA
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Chapman KR, Spitznagel MB. The need for disinhibition-focused interventions in dementia. Int Psychogeriatr 2022; 34:1-9. [PMID: 35249583 DOI: 10.1017/s1041610222000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly R Chapman
- Department of Psychiatry, Rhode Island Hospital, Physicians Office Building, Suite 430, 593 Eddy Street Providence, RI 02903, USA
| | - Mary Beth Spitznagel
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, Ohio, 44240, USA
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Kelleher JE, Weedle P, Donovan MD. The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes. PHARMACY 2021; 9:pharmacy9040160. [PMID: 34698248 PMCID: PMC8544697 DOI: 10.3390/pharmacy9040160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusions: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.
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Affiliation(s)
- Jayne E. Kelleher
- Peter Weedle Allcare Pharmacy, P51HCP4 Cork, Ireland; (J.E.K.); (P.W.)
| | - Peter Weedle
- Peter Weedle Allcare Pharmacy, P51HCP4 Cork, Ireland; (J.E.K.); (P.W.)
| | - Maria D. Donovan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12YN60 Cork, Ireland
- Correspondence:
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Chapman KR, Tremont G, Spitznagel MB. Development of an assessment measure for sexual disinhibition in dementia. Int J Geriatr Psychiatry 2021; 36:1436-1449. [PMID: 33811392 DOI: 10.1002/gps.5552] [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: 11/09/2020] [Accepted: 03/21/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Sexual disinhibition (SD), a neuropsychiatric symptom characterized by sexually inappropriate comments and/or behaviors, remains under identified in dementia, possibly due to a lack of standardized assessment methods. A recent systematic review of measures used to assess SD proposed four behavioral domains and identified the need for a population-specific measure. The present study addressed this by examining the underlying factor structure of SD to create a new caregiver-report measure. METHODS Dementia caregivers (n = 622) recruited online were randomly assigned to Initial Validation (n = 311) or Cross-Validation (n = 311) groups. RESULTS Initial Validation revealed five behavioral domains that served as provisional scales for cross-validation, leading to measure development. CONCLUSIONS The current study is the first to statistically evaluate the underlying factor structure of SD, resulting in a new measure that can help better characterize and identify SD.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA.,Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Geoffrey Tremont
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
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11
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Wang SM, Han KD, Kim NY, Um YH, Kang DW, Na HR, Lee CU, Lim HK. Late-life depression, subjective cognitive decline, and their additive risk in incidence of dementia: A nationwide longitudinal study. PLoS One 2021; 16:e0254639. [PMID: 34260630 PMCID: PMC8279395 DOI: 10.1371/journal.pone.0254639] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Late-life depression and subjective cognitive decline (SCD) are significant risk factors for dementia. However, studies with a large sample size are needed to clarify their independent and combined risks for subsequent dementia. METHODS This nationwide population-based cohort study included all individuals aged 66 years who participated in the National Screening Program between 2009 and 2013 (N = 939,099). Subjects were followed from the day they underwent screening to the diagnosis of dementia, death, or the last follow-up day (December 31, 2017). RESULTS Depressive symptom presentation, recent depressive disorder, and SCD independently increased dementia incidence with adjusted hazard ratio (aHR) of 1.286 (95% CI:1.255-1.318), 1.697 (95% CI:1.621-1.776), and 1.748 (95% CI: 689-1.808) respectively. Subjects having both SCD and depression had a higher risk (aHR = 2.466, 95% CI:2.383-2.551) of dementia than having depression (aHR = 1.402, 95% CI:1.364-1.441) or SCD (aHR = 1.748, 95% CI:1.689-1.808) alone. CONCLUSIONS Depressive symptoms, depressive disorder, and SCD are independent risk factors for dementia. Co-occurring depression and SCD have an additive effect on the risk of dementia; thus, early intervention and close follow up are necessary for patients with co-occurring SCD and depression.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nak-Young Kim
- Department of Psychiatry, Geyo Hospital, Uiwang, Korea
| | - Yoo Hyun Um
- Department of Psychiatry, St. Vincent Hospital, Suwon, Korea
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Woo Kang
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Ran Na
- Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Uk Lee
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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Shao Y, Xu H, Wang J, Dai X, Liang W, Ren L, Wang Y. Agitation and apathy increase risk of dementia in psychiatric inpatients with late-onset psychiatric symptoms. BMC Psychiatry 2021; 21:214. [PMID: 33910556 PMCID: PMC8080316 DOI: 10.1186/s12888-021-03210-5] [Citation(s) in RCA: 3] [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: 12/27/2020] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A diagnosis of dementia in middle-aged and elder people is often complicated by physical frailty and comorbid neuropsychiatric symptoms (NPSs). Previous studies have identified NPSs as a risk factor for dementia. The aim of this study was to figure out to what extent individual NPS and certain demographic factors increased the risk of dementia in middle-aged and senior psychiatric inpatients. METHODS One hundred twenty-seven middle-aged and senior patients admitted to psychiatric wards for late-onset (age ≥ 50 years) psychiatric symptoms were included and categorized into dementia or non-demented psychiatric disorders (NDPD). The patients' demographic information and medical records were collected during the first hospitalization and subjected to statistical analyses. RESULTS 41.73% of the registered psychiatric inpatients were diagnosed as dementia in which Alzheimer's disease (AD) was the dominant subtype. The NDPD group consisted of nine individual diagnoses, except for schizophrenia. The frequencies of dementia inpatients increased with first episode age while that of NDPD inpatients decreased with first episode age. In the enrolled inpatients, most of dementia patients were males while females accounted for a higher proportion of NDPD patients. 58.49% of enrolled dementia inpatients presented cognitive deficit (CD) as the initial symptom while the remaining 41.51% showed NPS as initial symptom. Of the 12 NPSs, agitation and apathy greatly and significantly increased risk of dementia in psychiatric inpatients with late-onset psychiatric symptoms. CONCLUSIONS These results added evidence that the demented patients admitted to psychiatric ward are more likely to be male, older first episode age, and have characteristic NPS including aberrant motor behavior (AMB), hallucinations, agitation, irritability and apathy. Further, this study emphasized the importance of agitation and apathy of NPSs functioning as risk factors of dementia in these inpatients.
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Affiliation(s)
- Yuan Shao
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Haiyun Xu
- grid.268099.c0000 0001 0348 3990The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Jian Wang
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xijian Dai
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Wei Liang
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Lina Ren
- grid.452897.50000 0004 6091 8446Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yongjun Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.
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13
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Isaacson SH, Ballard CG, Kreitzman DL, Coate B, Norton JC, Fernandez HH, Ilic TV, Azulay JP, Ferreira JJ, Abler V, Stankovic S. Efficacy results of pimavanserin from a multi-center, open-label extension study in Parkinson's disease psychosis patients. Parkinsonism Relat Disord 2021; 87:25-31. [PMID: 33933853 DOI: 10.1016/j.parkreldis.2021.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pimavanserin, a selective 5-HT2A inverse agonist/antagonist, was approved for hallucinations and delusions associated with Parkinson's disease psychosis (PDP). We present durability of response with pimavanserin in patients with PDP for an additional 4 weeks of treatment. METHODS This was an open-label extension (OLE) study in patients previously completing one of three double-blind, placebo-controlled (Core) studies. All patients received pimavanserin 34 mg once daily. Efficacy assessments included the Scale for the Assessment of Positive Symptoms (SAPS) PD and H + D scales, Clinical Global Impression (CGI) Improvement and Severity scales and Caregiver Burden Scale (CBS), through 4 weeks in the OLE. Safety assessments were conducted at each visit. RESULTS Of 459 patients, 424 (92.4%) had a Week 4 efficacy assessment. At Week 4 (10 weeks total treatment), SAPS-PD mean (standard deviation) change from OLE baseline was -1.8 (5.5) and for SAPS-H + D was -2.1 (6.2) with pimavanserin 34 mg. Patients receiving placebo during the Core studies had greater improvements (SAPS-PD -2.9 [5.6]; SAPS-H + D -3.5 [6.3]) during the OLE. For participants treated with pimavanserin 8.5 or 17 mg during the Core studies, further improvement was observed during the OLE with pimavanserin 34 mg. The mean change from Core Study baseline for SAPS-PD score was similar among prior pimavanserin 34 mg and prior placebo-treated participants (-7.1 vs. -7.0). The CGI-I response rate (score of 1 or 2) at Week 4 was 51.4%. Adverse events were reported by 215 (46.8%) patients during the first 4 weeks of OLE. The most common AEs were fall (5.9%), hallucination (3.7%), urinary tract infection (2.8%), insomnia (2.4%), and peripheral edema (2.2%) CONCLUSIONS: Patients previously on pimavanserin 34 mg during three blinded core studies had durability of efficacy during the subsequent 4 week OLE SAPS-PD assessment. Patients previously on blinded placebo improved after 4 weeks of OL pimavanserin treatment. These results in over 400 patients from 14 countries support the efficacy of pimavanserin for treating PDP.
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Affiliation(s)
- Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA.
| | | | - David L Kreitzman
- Parkinson's Disease and Movement Disorders Center of Long Island, Commack, NY, USA
| | - Bruce Coate
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Hubert H Fernandez
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Tihomir V Ilic
- Medical Faculty of Military Medical Academy, Belgrade, Serbia
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14
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Webb SL, Birney DP, Loh V, Walker S, Lampit A, Bahar-Fuchs A. Cognition-oriented treatments for older adults: A systematic review of the influence of depression and self-efficacy individual differences factors. Neuropsychol Rehabil 2021; 32:1193-1229. [PMID: 33509053 DOI: 10.1080/09602011.2020.1869567] [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: 10/22/2022]
Abstract
The increasing prevalence of cognitive decline, mild cognitive impairment (MCI), and dementia with the aging population has led to scrutiny of the efficacy of cognition-oriented treatments (COTs) aiming to maintain functioning, and delay or prevent further cognitive decline. However, little is known regarding the role of individual differences patient-variables (such as depression, self-efficacy, and motivation) in moderating the efficacy of COTs. This systematic review aimed to identify and analyze COT trials which investigated the relationship between differences in these patient-variables and intervention outcomes for older adults across healthy, MCI, and dementia populations. Of the 4854 studies extracted from the systematic search, 14 were included for analysis. While results were mixed across interventions and populations, on balance, greater depression severity predicted poorer cognitive functioning, and improvement in depressive symptom severity may account for at least part of the cognitive benefits seen at post-intervention. These findings were strongest for studies of MCI populations, with there being limited evidence of a relationship for healthy older adults or those with dementia. Overall, this review demonstrates the need for further investigation into the role of individual differences and clinical variables - particularly depression symptom severity - in attenuating COT outcomes through larger sample, high-quality randomized controlled trials.
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Affiliation(s)
- Shannon L Webb
- School of Psychology, University of Sydney, Sydney, Australia
| | - Damian P Birney
- School of Psychology, University of Sydney, Sydney, Australia
| | - Vanessa Loh
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sarah Walker
- School of Psychology, University of Sydney, Sydney, Australia
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, The University of Melbourne, Melbourne, Australia
| | - Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age, The University of Melbourne, Melbourne, Australia
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15
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Macfarlane S, Atee M, Morris T, Whiting D, Healy M, Alford M, Cunningham C. Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia. Front Psychiatry 2021; 12:652254. [PMID: 33927656 PMCID: PMC8076549 DOI: 10.3389/fpsyt.2021.652254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 01/07/2023] Open
Abstract
Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs. Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version "NPI-Q" was administered for DBMAS referrals whereas the nursing home version "NPI-NH" was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters. Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect. Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.
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Affiliation(s)
- Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, WA, Australia.,Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Madeleine Healy
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia.,Monash Health, Clayton, VIC, Australia
| | - Marie Alford
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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16
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Montero‐Odasso M, Pieruccini‐Faria F, Ismail Z, Li K, Lim A, Phillips N, Kamkar N, Sarquis‐Adamson Y, Speechley M, Theou O, Verghese J, Wallace L, Camicioli R. CCCDTD5 recommendations on early non cognitive markers of dementia: A Canadian consensus. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2020; 6:e12068. [PMID: 33094146 PMCID: PMC7568425 DOI: 10.1002/trc2.12068] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 12/21/2022]
Abstract
Introduction Cognitive impairment is the hallmark of Alzheimer's disease (AD) and related dementias. However, motor decline has been recently described as a prodromal state that can help to detect at‐risk individuals. Similarly, sensory changes, sleep and behavior disturbances, and frailty have been associated with higher risk of developing dementia. These clinical findings, together with the recognition that AD pathology precedes the diagnosis by many years, raises the possibility that non‐cognitive changes may be early and non‐invasive markers for AD or, even more provocatively, that treating non‐cognitive aspects may help to prevent or treat AD and related dementias. Methods A subcommittee of the Canadian Consensus Conference on Diagnosis and Treatment of Dementia reviewed areas of emerging evidence for non‐cognitive markers of dementia. We examined the literature for five non‐cognitive domains associated with future dementia: motor, sensory (hearing, vision, olfaction), neuro‐behavioral, frailty, and sleep. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assign the strength of the evidence and quality of the recommendations. We provide recommendations to primary care clinics and to specialized memory clinics, answering the following main questions: (1) What are the non‐cognitive and functional changes associated with risk of developing dementia? and (2) What is the evidence that sensory, motor, behavioral, sleep, and frailty markers can serve as potential predictors of dementia? Results Evidence supported that gait speed, dual‐task gait speed, grip strength, frailty, neuropsychiatric symptoms, sleep measures, and hearing loss are predictors of dementia. There was insufficient evidence for recommending assessing olfactory and vision impairments as a predictor of dementia. Conclusions Non‐cognitive markers can assist in identifying people at risk for cognitive decline or dementia. These non‐cognitive markers may represent prodromal symptoms and several of them are potentially amenable to treatment that might delay the onset of cognitive decline.
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Affiliation(s)
- Manuel Montero‐Odasso
- Gait and Brain LaboratoryParkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Division of Geriatric MedicineDepartment of MedicineSchulich School of Medicine and DentistryLondonOntarioCanada
- Department of Epidemiology and BiostatisticsUniversity of Western OntarioLondonOntarioCanada
| | - Frederico Pieruccini‐Faria
- Gait and Brain LaboratoryParkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Division of Geriatric MedicineDepartment of MedicineSchulich School of Medicine and DentistryLondonOntarioCanada
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciencesand Community Health SciencesHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Karen Li
- Centre for Research in Human DevelopmentConcordia UniversityMontrealQuebecCanada
- Department of PsychologyConcordia UniversityQuebecCanada
| | - Andrew Lim
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Natalie Phillips
- Centre for Research in Human DevelopmentConcordia UniversityMontrealQuebecCanada
- Department of PsychologyConcordia UniversityQuebecCanada
| | - Nellie Kamkar
- Gait and Brain LaboratoryParkwood InstituteLawson Health Research InstituteLondonOntarioCanada
| | - Yanina Sarquis‐Adamson
- Gait and Brain LaboratoryParkwood InstituteLawson Health Research InstituteLondonOntarioCanada
| | - Mark Speechley
- Department of Epidemiology and BiostatisticsUniversity of Western OntarioLondonOntarioCanada
| | - Olga Theou
- School of PhysiotherapyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Joe Verghese
- Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Lindsay Wallace
- Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Richard Camicioli
- Division of NeurologyDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
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17
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Long-term evaluation of open-label pimavanserin safety and tolerability in Parkinson's disease psychosis. Parkinsonism Relat Disord 2020; 77:100-106. [DOI: 10.1016/j.parkreldis.2020.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/11/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022]
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18
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Mallo SC, Patten SB, Ismail Z, Pereiro AX, Facal D, Otero C, Juncos-Rabadán O. Does the neuropsychiatric inventory predict progression from mild cognitive impairment to dementia? A systematic review and meta-analysis. Ageing Res Rev 2020; 58:101004. [PMID: 31881368 DOI: 10.1016/j.arr.2019.101004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/22/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuropsychiatric Symptoms (NPS) are common in Mild Cognitive Impairment (MCI). The Neuropsychiatric Inventory (NPI) and its shorter version, the Neuropsychiatric Inventory Questionnaire (NPI-Q), are the most common measures to assess NPS. Our objective was to determine if NPI/NPI-Q ratings predict conversion from MCI to dementia. METHODS Empirical longitudinal studies published in English or Spanish, concerned with the role of NPS as a risk factor for conversion from MCI to dementia, with a diagnosis of MCI following clinical criteria, that reported NPI/NPI-Q total score in converters versus non-converters, were included. Random effects models were used, and heterogeneity was explored with stratification and a random-effects meta-regression. The overall conversion rate and the standardized mean difference (SMD) for evolution, as a function of NPI/NPI-Q scores, were calculated. RESULTS The overall conversion rate was 35 %. Mean NPI/NPI-Q ratings were higher in converters versus in non-converters, with the overall SMD approaching significance. Heterogeneity was observed in studies of more than two years of follow-up and in a study with a mean age of more than 80 years. This heterogeneity concerned the size, not the direction of the difference. CONCLUSIONS Our results suggest that NPI/NPI-Q ratings are associated with conversion from MCI to dementia.
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19
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Gill S, Mouches P, Hu S, Rajashekar D, MacMaster FP, Smith EE, Forkert ND, Ismail Z. Using Machine Learning to Predict Dementia from Neuropsychiatric Symptom and Neuroimaging Data. J Alzheimers Dis 2020; 75:277-288. [PMID: 32250302 PMCID: PMC7306896 DOI: 10.3233/jad-191169] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Machine learning (ML) is a promising technique for patient-specific prediction of mild cognitive impairment (MCI) and dementia development. Neuropsychiatric symptoms (NPS) might improve the accuracy of ML models but have barely been used for this purpose. OBJECTIVES To investigate if baseline mild behavioral impairment (MBI) status used for NPS quantification along with brain morphology features are predictive of follow-up diagnosis, median 40 months later in patients with normal cognition (NC) or MCI. METHOD Baseline neuroimaging, neuropsychiatric, and clinical data from 102 individuals with NC and 239 with MCI were extracted from the Alzheimer's Disease Neuroimaging Initiative database. Neuropsychiatric inventory questionnaire items were transformed to MBI domains using a published algorithm. Diagnosis at latest follow-up was used as the outcome variable and ground truth classification. A logistic model tree classifier combined with information gain feature selection was trained to predict follow-up diagnosis. RESULTS In the binary classification (NC versus MCI/AD), the optimal ML model required only two features from over 200, MBI total score and left hippocampal volume. These features correctly classified participants as remaining normal or developing cognitive impairment with 84.4% accuracy (area under the receiver operating characteristics curve [ROC-AUC] = 0.86). Seven features were selected for the three-class model (NC versus MCI versus dementia) achieving an accuracy of 58.8% (ROC-AUC=0.73). CONCLUSION Baseline NPS, categorized for MBI domain and duration, have prognostic utility in addition to brain morphology measures for predicting diagnosis change using ML. MBI total score, followed by impulse dyscontrol and affective dysregulation were most predictive of future diagnosis.
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Affiliation(s)
- Sascha Gill
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Pauline Mouches
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Hu
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Science, University of Calgary, Calgary, Alberta, Canada
| | - Deepthi Rajashekar
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Frank P. MacMaster
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Addictions and Mental Health Strategic Clinical Network, Alberta, Canada
| | - Eric E. Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nils D. Forkert
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Science, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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20
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Nordström P, Nordström A. Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort. Osteoporos Int 2019; 30:1983-1993. [PMID: 31363793 PMCID: PMC6795622 DOI: 10.1007/s00198-019-05085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
UNLABELLED Numerous observational studies suggest that hypnotics increase the risk of fractures, and long-acting hypnotics are suggested to be especially harmful. This study showed that the highest risk of fracture was found before start of treatment and remained after end of therapy, suggesting that the increased risk during treatment is influenced by other factors, such as underlying disease. INTRODUCTION The purpose of this study was to evaluate associations between the use of short-acting and long-acting hypnotics and the risk of fracture. METHODS Four cohorts were formed from all individuals living in Sweden aged ≥ 50 years in 2005 (n = 3,341,706). In the first cohort, individuals prescribed long-acting propiomazine (n = 233,609) were matched 1:1 with controls. In the second cohort, individuals prescribed short-acting z-drugs (zopiclone, zolpidem, and zaleplon, n = 591,136) were matched 1:1 with controls. The third and fourth cohorts consisted of full sibling pairs with discordant propiomazine (n = 83,594) and z-drug (n = 153,314) use, respectively. RESULTS The risk of fracture was greatest among users of hypnotics in the 90 days before the initiation of treatment, both for propiomazine (odds ratio [OR], 2.52; 95% confidence interval [CI], 2.28-2.79) and z-drugs (OR, 4.10; 95% CI, 3.86-4.35) compared with that in matched controls. Furthermore, this risk was significantly reduced after the initiation of treatment with propiomazine (OR, 1.42; 95% CI, 1.27-1.60) and z-drugs (OR, 1.67; 95% CI, 1.56-1.80) and remained the first year following the last prescribed dose both for propiomazine (OR, 1.28, 95% CI, 1.21-1.36) and z-drugs (OR, 1.19, 95% CI, 1.16-1.23). The pattern was similar in the sibling cohorts, with the greatest risk of fracture seen in the 90 days before treatment with hypnotics was initiated. CONCLUSION The use of short-acting and long-acting hypnotics is associated with an increased risk of fracture. This risk was highest before initiation of treatment and remained after end of therapy. The results suggest that the increased risk during treatment is influenced by other factors such as underlying disease.
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Affiliation(s)
- P Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 90185, Umeå, Sweden.
| | - A Nordström
- Department of Public Health and Clinical Medicine, Environmental Medicine, Umeå University, 90185, Umeå, Sweden
- School of Sports Science, UiT The Arctic University of Norway, Tromsö, Norway
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21
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Fleiner T, Gersie M, Ghosh S, Mellone S, Zijlstra W, Haussermann P. Prominent physical inactivity in acute dementia care: Psychopathology seems to be more important than the dose of sedative medication. Int J Geriatr Psychiatry 2019; 34:308-314. [PMID: 30403307 PMCID: PMC6587796 DOI: 10.1002/gps.5021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/18/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION To objectively quantify patients' physical activity and analyze the relationships between physical activity levels, psychopathology, and sedative medication in acute hospital dementia care. MATERIALS AND METHODS In this cross-sectional study, we assessed the patients' physical activity based on data collection by hybrid motion sensors attached on their lower back. Daily doses of antipsychotics have been converted to olanzapine-equivalents and daily benzodiazepine medication is reported as diazepam-equivalents. We assessed patients' neuropsychiatric symptoms with the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. RESULTS We analyzed motion sensor data from 64 patients (MMSE M = 18.6). On average, patients were lying for 11.5 hours, sitting/standing sedentary for 10.3 hours, sitting/standing active for 1.0 hours, and walking for 1.2 hours per day. The analysis revealed no correlations between patients' physical activity and antipsychotic or benzodiazepine medication. More severe neuropsychiatric symptoms were associated with a decrease in the patients' physical activity (r = .32, P = .01). In particular, patients with apathy symptoms were less physically active than patients without apathy symptoms. DISCUSSION The results reveal that most of the patients in acute dementia care had very low levels of physical activity. Their physical inactivity may be due to the severity of their neuropsychiatric symptoms, especially apathy. Antipsychotic and benzodiazepine medication appeared to have less impact on patients' physical activity. Dementia care should pay more attention to prevent physical inactivity in patients.
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Affiliation(s)
- Tim Fleiner
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany,Department of Geriatric Psychiatry and PsychotherapyLVR‐Hospital CologneCologneGermany
| | - Marleen Gersie
- Department of Geriatric Psychiatry and PsychotherapyLVR‐Hospital CologneCologneGermany
| | - Sayantan Ghosh
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany,Faculty of Mathematics and TechnologyUniversity of Applied Sciences Koblenz RheinAhrCampusKoblenzGermany
| | - Sabato Mellone
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”University of BolognaBolognaItaly
| | - Wiebren Zijlstra
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany
| | - Peter Haussermann
- Department of Geriatric Psychiatry and PsychotherapyLVR‐Hospital CologneCologneGermany
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22
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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: 273] [Impact Index Per Article: 45.5] [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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23
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Antipsychotic drug use in nursing home residents with and without dementia: keep an eye on the pro re nata medication. Int Clin Psychopharmacol 2017; 32:213-218. [PMID: 28346296 DOI: 10.1097/yic.0000000000000173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Behavioral and psychological symptoms of dementia often lead to the prescription of antipsychotics, especially in nursing homes, but their use remains controversial. This study aimed to assess antipsychotic drug use in residents with dementia compared with those without dementia. Data were obtained through the cross-sectional 'inappropriate medication in patients with renal insufficiency in nursing homes' (IMREN) study including data from 21 nursing homes. Descriptive statistics were used and factors associated with the prescription of antipsychotics were identified by logistic regression. Overall, 57.5% of the 837 residents had a diagnosis of dementia and 47.0% of residents with dementia and 19.5% of those without dementia received antipsychotics. 35.9% of all antipsychotics in residents with dementia were prescribed as pro re nata (PRN) compared with 23.0% for residents without dementia. Typical antipsychotics were prescribed more commonly than atypical ones. The adjusted logistic regression showed a significant association between the prescription of antipsychotics and dementia (odds ratio: 3.58, 95% confidence interval: 2.45-5.25) as well as severe care dependency (odds ratio: 1.68, 95% confidence interval: 1.10-2.55). Despite safety warnings, antipsychotics are still frequently prescribed to residents with dementia. Almost half received antipsychotics and about a third of the antipsychotics are prescribed as PRN. Further studies should assess the use of PRN antipsychotics and guidelines for PRN prescriptions are clearly needed.
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24
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Breining A, Bonnet-Zamponi D, Zerah L, Micheneau C, Riolacci-Dhoyen N, Chan-Chee C, Deligne J, Harlin JM, Boddaert J, Verny M, Leperre-Desplanques A. Exposure to psychotropics in the French older population living with dementia: a nationwide population-based study. Int J Geriatr Psychiatry 2017; 32:750-760. [PMID: 27237864 DOI: 10.1002/gps.4517] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/24/2016] [Accepted: 05/05/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is known about the level of psychotropic chronic exposure in all patients living with dementia. The aim of the study was to quantify chronic psychotropic exposure in older adults with dementia compared with the general population of the same age. METHODS This prospective cohort study was conducted in France between 2009 and 2011. Aged at least 65 years, 10,781,812 individuals (440,215 of them with dementia) either community based or nursing home residents were included. The numbers of single or combined prescriptions, per year for antipsychotics, antidepressants, anxiolytics, or hypnotics were measured. RESULTS Of patients with dementia, 15.5% are exposed to antipsychotics compared with 2.2% of the age-matched population (relative risk [RR] = 6.44, 95% confidence interval [CI] [6.39-6.48]), 39.5% to antidepressants compared with 12.6% (RR = 4.10, 95% CI [.4.07-4.12]), and 39.6% to anxiolytics or hypnotics compared with 26.9% (RR = 1.74, 95% CI [1.72-1.75]). Among older adults with dementia, 13.8% simultaneously consumed at least three psychotropics. All class age of older patients with dementia is more exposed to all psychotropics except for long-acting benzodiazepines. During the study period, chronic anxiolytic/hypnotic and antipsychotic exposure slightly decreased in population with dementia while chronic exposure to antidepressant drugs tended to increase. CONCLUSION This nationwide, population-based, drug-used study showed for the first time that older patients with dementia are chronically overexposed not only to antipsychotics but also to psychotropics.
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Affiliation(s)
- Alice Breining
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France
| | - Dominique Bonnet-Zamponi
- OMEDIT Ile de France, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR 1123 INSERM, Paris, France
| | - Lorène Zerah
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06 and CNRS, UMR 8256 B2A, Paris, France
| | | | | | | | - Jean Deligne
- Régime Social des Indépendants, Saint Denis la Plaine, France
| | - Jean-Marc Harlin
- Caisse Centrale de la Mutualité Sociale Agricole, Bagnolet, France
| | - Jacques Boddaert
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06 and CNRS, UMR 8256 B2A, Paris, France
| | - Marc Verny
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06 and CNRS, UMR 8256 B2A, Paris, France
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25
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Tjia J, Hunnicutt JN, Herndon L, Blanks CR, Lapane KL, Wehry S. Association of a Communication Training Program With Use of Antipsychotics in Nursing Homes. JAMA Intern Med 2017; 177:846-853. [PMID: 28418449 PMCID: PMC5818825 DOI: 10.1001/jamainternmed.2017.0746] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use. OBJECTIVE To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS. DESIGN, SETTING, AND PARTICIPANTS This investigation was a quasi-experimental longitudinal study of NHs in Massachusetts enrolled in the OASIS intervention. Participants were residents living in NHs between March 1, 2011, and August 31, 2013. The data were analyzed from December 2015, to March 2016, and from November through December 2016. EXPOSURES The OASIS educational program targets all NH staff (direct care and nondirect care) using a train-the-trainer model. The program goals were to reframe challenging behaviors of residents with cognitive impairment as the communication of unmet needs, to train staff to anticipate resident needs, and to integrate resident strengths into daily care plans. MAIN OUTCOMES AND MEASURES This study used an interrupted time series model of facility-level prevalence of antipsychotic medication use, other psychotropic medication use (antidepressants, anxiolytics, and hypnotics), and behavioral disturbances to evaluate the intervention's effectiveness in participating facilities compared with control NHs in Massachusetts and New York. The 18-month preintervention (baseline) period was compared with a 3-month training period, a 6-month implementation period, and a 3-month maintenance period. RESULTS This study included 93 NHs enrolled in the OASIS intervention (27 of which had a high prevalence of antipsychotic use) compared with 831 nonintervention NHs. Among OASIS facilities, prevalences of atypical antipsychotic prescribing were 34.1% at baseline and 26.5% at the study end (absolute reduction of 7.6% and relative reduction of 22.3%) compared with a drop of 22.7% to 18.8% in the comparison facilities (absolute reduction of 3.9% and relative reduction of 17.2%). In the OASIS implementation phase, NHs experienced a reduction in antipsychotic use prevalence among OASIS facilities (-1.20%; 95% CI, -1.85% to -0.09% per quarter) greater than that among non-OASIS facilities (-0.23%; 95% CI, -0.47% to 0.01% per quarter), resulting in a net OASIS influence of -0.97% (95% CI, -1.85% to -0.09%; P = .03). A difference in trend was not sustained in the maintenance phase (difference of 0.93%; 95% CI, -0.66% to 2.54%; P = .48). No increases in other psychotropic medication use or behavioral disturbances were observed. CONCLUSIONS AND RELEVANCE Antipsychotic use prevalence declined during OASIS implementation of the intervention, but the decreases did not continue in the maintenance phase. Other psychotropic medication use and behavioral disturbances did not increase. This study adds evidence for nonpharmacological programs to treat behavioral and psychological symptoms of dementia.
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Affiliation(s)
- Jennifer Tjia
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jacob N Hunnicutt
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | | | | | - Kate L Lapane
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Susan Wehry
- Division of Psychiatry, Department of Primary Care, University of New England College of Medicine, Biddeford, Maine
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26
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Lin WC, Hu LY, Tsai SJ, Yang AC, Shen CC. Depression and the risk of vascular dementia: a population-based retrospective cohort study. Int J Geriatr Psychiatry 2017; 32:556-563. [PMID: 27161941 DOI: 10.1002/gps.4493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the association between the risks of depression and vascular dementia (VaD) based on Taiwan's National Health Insurance Research Database. METHODS This retrospective longitudinal matched-cohort study used National Health Insurance Research Database data from 49,955 participants (9,991 with new onset depression, 39,964 controls). A Cox regression analysis was performed on the whole sample and the subgroup of patients with depression. We further excluded patients who developed VaD within 3 or 5 years after enrollment to evaluate depression as an independent risk factor for or a prodrome of VaD. RESULTS During the 10-year follow-up period, the incidence rate ratio of VaD between patients with depression and controls was 4.24 [95% confidence interval (CI) 2.90-6.21, P < 0.001]. After adjustment for covariates, the hazard ratio (HR) of VaD in patients with depression was 3.10 (95% CI 2.13-4.52, P < 0.001). In the whole sample, risk factors for VaD besides depression were aged ≥60 years (HR = 20.08), hypertension (HR = 1.70), diabetes (HR = 1.61), coronary artery disease (HR = 2.26), head injury (HR = 2.20), and cerebrovascular disease (HR = 3.02). In patients with depression, aged ≥60 years (HR = 32.16), coronary artery disease (HR = 2.82), head injury (HR = 2.06), and cerebrovascular disease (HR = 2.37) remained risk factors for VaD. After excluding those who developed VaD within 3 or 5 years, HRs remained high (3.28, 95% CI 2.03-5.31, P < 0.001; 2.12, 95% CI 1.05-4.25, P = 0.035, respectively). CONCLUSIONS Our findings suggest that depression is an independent risk factor for subsequent VaD. Older age, cerebrovascular disease, head injury, and coronary artery disease might increase the risk of VaD among patients with depression.
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Affiliation(s)
- Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.,Department of Information Management, National Chung-Cheng University, Chiayi, Taiwan
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27
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Hsu TJ, Tsai HT, Hwang AC, Chen LY, Chen LK. Predictors of non-pharmacological intervention effect on cognitive function and behavioral and psychological symptoms of older people with dementia. Geriatr Gerontol Int 2017; 17 Suppl 1:28-35. [DOI: 10.1111/ggi.13037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Ting-Jung Hsu
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Hui-Te Tsai
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
| | - An-Chun Hwang
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Aging and Health Research Center; National Yang Ming University; Taipei Taiwan
- Institute of Public Health; National Yang Ming University; Taipei Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Aging and Health Research Center; National Yang Ming University; Taipei Taiwan
- Institute of Public Health; National Yang Ming University; Taipei Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Aging and Health Research Center; National Yang Ming University; Taipei Taiwan
- Institute of Public Health; National Yang Ming University; Taipei Taiwan
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28
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Torrisi M, De Cola MC, Marra A, De Luca R, Bramanti P, Calabrò RS. Neuropsychiatric symptoms in dementia may predict caregiver burden: a Sicilian exploratory study. Psychogeriatrics 2017; 17:103-107. [PMID: 27411501 DOI: 10.1111/psyg.12197] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/30/2015] [Accepted: 01/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia are very common. They represent a main cause of burden and distress in caregivers and can lead to early institutionalization of patients. We aimed to find the most specific behavioural and psychological symptoms of dementia that can strongly affect the caregivers' burden. METHODS Twenty-seven patients and their caregivers were enrolled in this study. All of the patients were affected by Alzheimer's, vascular, or frontotemporal dementia and were evaluated with the Neuropsychiatric Inventory and Mini-Mental State Examination. Caregivers were administered the Caregiver Burden Inventory. RESULTS Apathy, depression, anxiety, and agitation were the most common symptoms and were found in up to 90% of the patients. We detected strong correlations between patient neuropsychiatric symptoms, (i.e. irritability, hallucinations, aberrant motor behavioural, depression, and agitation) and Caregiver Burden Inventory scores. Multiple regression analysis found hallucinations, irritability, and depression to be significant predictors of caregiver burden. Moreover, the Neuropsychiatric Inventory score was more closely related to caregiver burden than the Mini-Mental State Examination score. CONCLUSION Our results revealed that demented patients' behavioural problems are related to the level of caregiver burden and distress. Further investigations are needed to differentiate the present findings among dementia subtypes and to better evaluate the effect of caregivers' personal characteristics on their own burden.
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Affiliation(s)
- Michele Torrisi
- Behavior and Robotic Neurorehabilitation Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
| | - Maria C De Cola
- Behavior and Robotic Neurorehabilitation Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
| | - Angela Marra
- Behavior and Robotic Neurorehabilitation Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
| | - Rosaria De Luca
- Behavior and Robotic Neurorehabilitation Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
| | - Placido Bramanti
- Behavior and Robotic Neurorehabilitation Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
| | - Rocco S Calabrò
- Behavior and Robotic Neurorehabilitation Laboratory, Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
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29
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Esteban G, Van Schoors J, Sun P, Van Eeckhaut A, Marco-Contelles J, Smolders I, Unzeta M. In-vitro and in-vivo evaluation of the modulatory effects of the multitarget compound ASS234 on the monoaminergic system. J Pharm Pharmacol 2017; 69:314-324. [PMID: 28134992 DOI: 10.1111/jphp.12697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/29/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the in-vitro and in-vivo effects on monoaminergic neurotransmission of ASS234, a promising multitarget-directed ligand (MTDL), for Alzheimer's disease (AD) therapy. METHODS In vitro was explored the effect of ASS234 on the monoaminergic metabolism in SH-SY5Y and PC12 cell lines, and remaining activity of both monoamine oxidase (MAO) isoforms was assessed. The corresponding dopamine (DA), homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid (DOPAC) and noradrenaline (NA) levels were determined by HPLC-ED. In-vivo experiments were carried out Wistar rats and intracerebral guide cannulas were implanted in the hippocampus and in the prefrontal cortex by sterotaxic coordinates. The day after microdialysis samples were collected and levels of 5-HT, DA and NA were determined by (UHPLC) with electrochemical detector. KEY FINDINGS ASS234 induced a significant increase in serotonin (5-HT) levels in SH-SY5Y cells. In PC12 cells, ASS234 increased significantly the ratio of dopamine (DA)/(HVA + DOPAC), although no apparent differences in (NA) were observed. By in-vivo microdialysis, ASS234 showed a significant increase in the extracellular levels of 5-HT and NA in hippocampus whereas in the prefrontal cortex, DA and NA also increased significantly. CONCLUSIONS This study reveals the ability of ASS234 a MTDL compound, to enhance the monoaminergic neurotransmission supporting its potential use in AD therapy.
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Affiliation(s)
- Gerard Esteban
- Departament de Bioquímica i Biologia Molecular, Facultat de Medicina, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Jolien Van Schoors
- Department of Pharmaceutical Chemistry and Drug Analysis (FASC), Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium
| | - Ping Sun
- Departament de Bioquímica i Biologia Molecular, Facultat de Medicina, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Ann Van Eeckhaut
- Department of Pharmaceutical Chemistry and Drug Analysis (FASC), Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium
| | | | - Ilse Smolders
- Department of Pharmaceutical Chemistry and Drug Analysis (FASC), Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium
| | - Mercedes Unzeta
- Departament de Bioquímica i Biologia Molecular, Facultat de Medicina, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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Szczepura A, Wild D, Khan AJ, Owen DW, Palmer T, Muhammad T, Clark MD, Bowman C. Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period. BMJ Open 2016; 6:e009882. [PMID: 27650756 PMCID: PMC5051335 DOI: 10.1136/bmjopen-2015-009882] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. SETTING AND PARTICIPANTS Retrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. PRIMARY AND SECONDARY OUTCOME MEASURES Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated. RESULTS No statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices). CONCLUSIONS The NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear standards specifying recommended agents, dosages and length of treatment, together with routine monitoring and greater accountability for antipsychotic prescribing, may be required.
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Affiliation(s)
- Ala Szczepura
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Deidre Wild
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Amir J Khan
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - David W Owen
- Institute for Employment Research, University of Warwick, Coventry, UK
| | - Thomas Palmer
- Department Mathematics & Statistics, Lancaster University, Lancaster, UK
| | | | | | - Clive Bowman
- School of Health Sciences, City University London, London, UK
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Franchi B. Pharmacological management of behavioural and psychological symptoms of dementia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Bruno Franchi
- Department of Geriatric and Rehabilitation Medicine; Royal Adelaide Hospital; Adelaide Australia
- Adelaide Rural Clinical School; University of Adelaide; Adelaide Australia
- Calvary Wakefield and Rehabilitation Private Hospitals; Adelaide Australia
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Ling C, Fangyu D, Wanhua H, Kelong C, zhimin W, yuting Z, rong Z. DNMT3A rs1550117 Polymorphism is Associated With Late-Onset Alzheimer's Disease in a Chinese Population. Am J Alzheimers Dis Other Demen 2016; 31:278-81. [PMID: 26371346 PMCID: PMC10852886 DOI: 10.1177/1533317515603688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Alzheimer's disease (AD) is classified as a neurodegenerative disease, impacting on brain integrity and functioning, resulting in a progressive deterioration of cognitive capabilities. Epigenetic changes can be acquired over the life span and mediate environmental effects on gene expression. DNA-methyltransferase 3A (DNMT3A) plays an important role in the development of embryogenesis and the generation of aberrant methylation late-onset AD (LOAD). In this study, the rs1550117 polymorphism of DNMT3A was determined by polymerase chain reaction/restriction fragment length polymorphism and confirmed by sequencing. The results showed that AA genotype carriers had a 2.08-fold risk of developing LOAD in comparison with GG genotype carriers (odds ratio [OR] = 2.08, 95% confidence interval [CI]: 1.03-4.21,P= .038) and had a 2.05-fold risk for LOAD compared with GG+GA genotype carriers (OR = 2.05, 95% CI: 1.03-4.11,P= .038), indicating that the DNMT3A polymorphism supports a major role in the pathogenesis of LOAD and can be used as a stratification marker to predict an individual's susceptibility to LOAD.
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Affiliation(s)
- Chen Ling
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Zhejiang, PR China
| | - Dai Fangyu
- Department of Neurology, Zhoushan Hospital, Zhejiang, PR China
| | - Hu Wanhua
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Zhejiang, PR China
| | - Chen Kelong
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Zhejiang, PR China
| | - Wu zhimin
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Zhejiang, PR China
| | - Zhang yuting
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Zhejiang, PR China
| | - Zhou rong
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Zhejiang, PR China
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Yoshiyama K, Arita H, Suzuki J. The Effect of Aroma Hand Massage Therapy for People with Dementia. J Altern Complement Med 2015; 21:759-65. [PMID: 26383176 DOI: 10.1089/acm.2015.0158] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Clinical aromatherapy is a complementary therapy that may be very helpful for elderly dementia care. Aromatherapy may reduce the behavioral and psychological symptoms of dementia (BPSD), improve quality of care, and thus improve the quality of life for people with dementia. In this pilot study, aroma hand massage therapy was used for elderly patients in a medical institution in Japan. The study assessed the effectiveness and safety of clinical aromatherapy as part of routine integrative care among people with dementia in a clinical care setting. INTERVENTIONS The randomized, crossover pilot trials were performed among 14 patients with mild-to-moderate dementia older than age 65 years living in a nursing home in Nara, Japan. Participants were divided into two groups and offered, alternately, control therapy and clinical aromatherapy 3 times a week for the 4-week trials. The effects on BPSD and activities of daily living (ADLs) were evaluated quantitatively before and after the study and 4 weeks after the study ended as a follow-up. Observation records were also collected to obtain qualitative data. RESULTS The quantitative data showed that neither therapy significantly improved the BPSD or ADL results. The qualitative data were classified into four main categories-mood, behavior, verbal communication, and nonverbal communication-reflecting the positive experiences of participants during both therapies. No harmful reactions or changes in medication occurred during the study. CONCLUSIONS This pilot study demonstrated that clinical aromatherapy was clinically safe but did not lead to statistically significant improvements in BPSD or ADL among people with dementia. Further research on therapeutic effects is needed to develop high-quality care with clinical aromatherapy for elderly patients with dementia in Japan and to fully establish evidence for effective and safe practice in health care institutions.
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Affiliation(s)
| | | | - Jinichi Suzuki
- 3 Public Health & Medical Center of Sagamihara City , Kanagawa, Japan
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Paddick SM, Kisoli A, Longdon A, Dotchin C, Gray WK, Chaote P, Teodorczuk A, Walker R. The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. Int J Geriatr Psychiatry 2015; 30:815-23. [PMID: 25351844 DOI: 10.1002/gps.4218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms (BPS) in dementia are common in high-income countries, but there are few data from sub-Saharan Africa. Our aim was to estimate the prevalence and pattern of BPS and associated caregiver distress in rural Tanzania. METHODS Prevalent cases of dementia (aged 70 and over) were identified during a community-based door-to-door study in six rural villages in Tanzania. Following cognitive screening, a stratified sample (over-sampled for people with dementia) of cases underwent a detailed clinical assessment including the brief 12 item neuropsychiatric inventory (NPI-Q), which assesses BPS and associated caregiver distress over the preceding 30 days. RESULTS Of 78 people with dementia, at least one current BPS was reported by 69 (88.4%), with 40 (51.3%) reporting 3 or more symptoms. In 172 people with no cognitive impairment, 110 (64.0%) reported at least one symptom and 48 (27.9%) reported 3 or more. In dementia cases, the most frequent symptoms reported were anxiety (47.4%), agitation/aggression (38.5%), night-time behavioural disturbance (34.6%), irritability (33.3%) and depression (33.3%). CONCLUSION The frequency of BPS in dementia in this rural Tanzanian population is high and comparable to that reported in prevalence studies from high income countries. Symptoms were also common, although to a lesser degree, amongst cognitively intact subjects. BPS are likely to have a significant impact on quality of life for elderly persons and their carers in low-income settings. Low-cost interventions, such as community-based therapy and education, are needed.
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Affiliation(s)
- S-M Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - A Kisoli
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Longdon
- South Devon Healthcare Trust, Torquay, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK
| | - P Chaote
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Teodorczuk
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Northumberland, Tyne and Wear NHS Trust, Newcastle Upon Tyne, UK
| | - R Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Tjia J, Field T, Mazor K, Lemay CA, Kanaan AO, Donovan JL, Briesacher BA, Peterson D, Pandolfi M, Spenard A, Gurwitz JH. Dissemination of Evidence-Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial. J Am Geriatr Soc 2015; 63:1289-98. [PMID: 26173554 DOI: 10.1111/jgs.13488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). DESIGN Three-arm, cluster randomized trial. SETTING NHs. PARTICIPANTS NHs in the state of Connecticut. MEASUREMENTS Evidence-based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders, and 42 NHs were recruited and randomized to one of three toolkit dissemination strategies: mailed toolkit delivery (minimal intensity); mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing (moderate intensity); and in-person toolkit delivery with academic detailing, on-site behavioral management training, and quarterly audit and feedback reports (high intensity). Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS Toolkit awareness of 30% (7/23) of leadership of low-intensity NHs, 54% (19/35) of moderate-intensity NHs, and 82% (18/22) of high-intensity NHs reflected adoption and implementation of the intervention. Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs. Antipsychotic prescribing levels declined during the study period, but there were no statistically significant differences between study arms or from secular trends. CONCLUSION RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends. Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents.
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Affiliation(s)
- Jennifer Tjia
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Terry Field
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Kathleen Mazor
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Celeste A Lemay
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Abir O Kanaan
- University of Massachusetts Medical School, Worcester, Massachusetts.,MCPHS University, Worcester, Massachusetts
| | - Jennifer L Donovan
- University of Massachusetts Medical School, Worcester, Massachusetts.,MCPHS University, Worcester, Massachusetts
| | - Becky A Briesacher
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Daniel Peterson
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | | | - Jerry H Gurwitz
- University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
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Neuroprotective effects of the monoamine oxidase inhibitor tranylcypromine and its amide derivatives against Aβ(1-42)-induced toxicity. Eur J Pharmacol 2015; 764:256-263. [PMID: 26162702 DOI: 10.1016/j.ejphar.2015.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022]
Abstract
Monoamine oxidase (MAO) enzymes play a central role in the pathogenesis of Alzheimer's disease (AD) and MAO inhibitors (MAOIs) are antidepressant drugs currently studied for their neuroprotective properties in neurodegenerative disorders. In the present work MAOIs such as tranylcypromine [trans-(+)-2-phenylcyclopropanamine, TCP] and its amide derivatives, TCP butyramide (TCP-But) and TCP acetamide (TCP-Ac), were tested for their ability to protect cortical neurons challenged with synthetic amyloid-β (Aβ)-(1-42) oligomers (100 nM) for 48 h. TCP significantly prevented Aβ-induced neuronal death in a concentration-dependent fashion and was maximally protective only at 10 µM. TCP-But was maximally protective in mixed neuronal cultures at 1 µM, a lower concentration compared to TCP, whereas the new derivative, TCP-Ac, was more efficacious than TCP and TCP-But and significantly protected cortical neurons against Aβ toxicity at nanomolar concentrations (100 nM). Experiments carried out with the Thioflavin-T (Th-T) fluorescence assay for fibril formation showed that TCP and its amide derivatives influenced the early events of the Aβ aggregation process in a concentration-dependent manner. TCP-Ac was more effective than TCP-But and TCP in slowing down the Aβ(1-42) aggregates formation through a lengthening at the lag phase. In our experimental model co-incubation of Aβ(1-42) oligomers with TCP-Ac was able to almost completely prevent Aβ-induced neurodegeneration. These results suggest that inhibition of Aβ oligomer-mediated aggregation significantly contributes to the overall neuroprotective activity of TCP-Ac and also raise the possibility that TCP, and in particular the new compound TCP-Ac, might represent new pharmacological tools to yield neuroprotection in AD.
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Tartaglia MC, Hu B, Mehta K, Neuhaus J, Yaffe K, Miller BL, Boxer A. Demographic and neuropsychiatric factors associated with off-label medication use in frontotemporal dementia and Alzheimer's disease. Alzheimer Dis Assoc Disord 2015; 28:182-9. [PMID: 23995817 DOI: 10.1097/wad.0b013e3182a7159d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Off-label medication use for treating cognitive impairments and neuropsychiatric symptoms occurs in frontotemporal dementia (FTD) and Alzheimer disease (AD). We compared the use of cognitive and psychiatric medications in FTD and AD and evaluated the relationship between neuropsychiatric symptoms and medication use. METHODS Cognitive and psychiatric medication use, demographic variables, and Neuropsychiatric Inventory (NPI) subscale symptoms were obtained from the National Alzheimer's Coordinating Center Uniform Data Set (n=3958, 8.1% FTD). Bivariate statistics and logistic regressions were calculated to evaluate which demographic or NPI subscale symptoms predicted medication use. RESULTS Although cognitive medication was used more commonly in AD (78%), it was also commonly used off-label in FTD (56%). Psychiatric medications were in greater use in FTD than in AD (68% vs. 45%, respectively, P<0.001). In FTD, cognitive medication use was associated with elevated NPI elation scores and psychiatric medication use was associated with history of prior psychiatric disease. In AD, demographic variables (white, longer disease duration, higher education, more severe disease, or being male) were most predictive of cognitive medication use, whereas having psychiatric disease, being white, having longer disease duration, being younger, greater disease severity, and being disinhibited or anxious were associated with psychiatric medication use. Off-label antipsychotics were used by 4.7% of patients with AD and 10% of patients with FTD. CONCLUSIONS Our results revealed significant off-label medication use in both FTD and AD. A notable finding from this study was the lack of consistent relationships between medication use and neuropsychiatric symptoms across the 2 illnesses.
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Affiliation(s)
- Maria Carmela Tartaglia
- *Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON †Department of Neurology, Memory and Aging Center §Department of Psychiatry, University of California, San Francisco ‡Stanford Geriatric Education Center, Stanford University School of Medicine, Palo Alto, CA
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Bianchi AJ, Guépet-Sordet H, Manckoundia P. [Changes in olfaction during ageing and in certain neurodegenerative diseases: up-to-date]. Rev Med Interne 2014; 36:31-7. [PMID: 25304170 DOI: 10.1016/j.revmed.2014.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/18/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
Abstract
Olfaction is a complex sensory system, and increasing interest is being shown in the link between olfaction and cognition, notably in the elderly. In this literature review, we revisit the specific neurophysiological features of the olfactory system and odorants that lead to a durable olfactory memory and an emotional memory, for which the implicit component produces subconscious olfactory conditioning. Olfaction is known to affect cognitive abilities and mood. We also consider the impairment of olfactory function due to ageing and to neurodegenerative diseases, in particular Alzheimer's disease and Parkinson's disease, through anatomopathological changes in the peripheral and central olfactory structures. The high frequency of these olfactory disorders as well as their early occurrence in Alzheimer disease and Parkinson disease are in favour of their clinical detection in subjects suffering from these two neurodegenerative diseases. Finally, we analyse the impact of olfactory stimulation on cognitive performance and attention. Current observational data from studies in elderly patients with Alzheimer-type dementia are limited to multiple sensory stimulation methods, such as the Snoezelen method, and aromatherapy. These therapies have shown benefits for dementia-related mood and behaviour disorders in the short term, with few side effects. Since olfactory chemosensory stimulation may be beneficial, it may be proposed in patients with dementia, especially Alzheimer-type dementia, as a complementary or even alternative therapy to existing medical strategies.
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Affiliation(s)
- A-J Bianchi
- Service de soins de suite et de réadaptation gériatrique, hospices civils de Beaune, BP 40104, avenue Guigone-de-Salins, 21203 Beaune cedex, France
| | - H Guépet-Sordet
- Service de médecine interne gériatrie, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - P Manckoundia
- Service de médecine interne gériatrie, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France; Inserm U1093 motricité-plasticité : performance, dysfonctionnement, vieillissement et technologies d'optimisation, université de Bourgogne, BP 27877, 21078 Dijon cedex, France.
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Corbett A, Husebo BS, Achterberg WP, Aarsland D, Erdal A, Flo E. The importance of pain management in older people with dementia. Br Med Bull 2014; 111:139-48. [PMID: 25190763 DOI: 10.1093/bmb/ldu023] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pain is common in people with dementia, representing a critical aspect of treatment and care. However, there remain considerable gaps in evidence to support pain assessment and treatment. SOURCES OF DATA An updated literature search focussing on systematic reviews and randomized controlled trials. AREAS OF AGREEMENT There are key areas of consistency around the prevalence, causes and current treatment trends for pain in dementia, the impact of untreated pain and the need for an accurate, fully validated assessment tool. AREAS OF CONTROVERSY Accurate assessment due to inherent issues in dementia is a critical challenge. There is also a lack of evidence around alternative treatment options. GROWING POINTS New pain predictors are being identified, including physical function, depression and specific pain types, which should inform assessment methodology. AREAS TIMELY FOR DEVELOPING RESEARCH Future research should focus on developing integrated pain management approaches with optimized assessment and evidence-based treatment guidance.
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Affiliation(s)
- Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway Stavanger University Hospital, Stavanger, Norway
| | - Wilco P Achterberg
- Department of Public Health and Primary Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Dag Aarsland
- Stavanger University Hospital, Stavanger, Norway
| | - Ane Erdal
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
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Bloniecki V, Aarsland D, Cummings J, Blennow K, Freund-Levi Y. Agitation in dementia: relation to core cerebrospinal fluid biomarker levels. Dement Geriatr Cogn Dis Extra 2014; 4:335-43. [PMID: 25298777 PMCID: PMC4176467 DOI: 10.1159/000363500] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to examine the associations of agitation with the cerebrospinal fluid dementia biomarkers total-tau (T-tau), phosphorylated-tau (P-tau) and Aβ1-42. Methods One hundred patients (mean age ± SD, 78.6 ± 7.5 years) with dementia and neuropsychiatric symptoms, of whom 67% were female, were included. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI; 46.5 ± 11.8 points). Results Total CMAI correlated with T-tau [rs (31) = 0.36, p = 0.04] and P-tau [rs (31) = 0.35, p = 0.05] in patients with Alzheimer's disease (AD; n = 33) but not in the total dementia population (n = 95). Conclusions Our results suggest that tau-mediated pathology including neurofibrillary tangles and the intensity of the disease process might be associated with agitation in AD.
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Affiliation(s)
- Victor Bloniecki
- Division of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden
| | - Dag Aarsland
- Center for Alzheimer Research, Division for Neurogeriatrics, Department of Neurobiology, Caring Sciences and Society (NVS), Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden ; Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Yvonne Freund-Levi
- Division of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden
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Farokhnia M, Shafiee Sabet M, Iranpour N, Gougol A, Yekehtaz H, Alimardani R, Farsad F, Kamalipour M, Akhondzadeh S. Comparing the efficacy and safety of Crocus sativus L. with memantine in patients with moderate to severe Alzheimer's disease: a double-blind randomized clinical trial. Hum Psychopharmacol 2014; 29:351-9. [PMID: 25163440 DOI: 10.1002/hup.2412] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/27/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Limited pharmacological options are available for the management of Alzheimer's disease (AD) in severe stages. Cognitive-enhancing properties of saffron, the dried stigma of Crocus sativus L., have been evidenced in different studies. We aimed to compare the efficacy and safety of saffron extract versus memantine in reducing cognitive deterioration of patients with moderate to severe AD. METHODS In this randomized double-blind parallel-group study, 68 patients with moderate to severe AD (Mini-Mental State Examination score of 8-14) received memantine (20 mg/day) or saffron extract (30 mg/day) capsules for 12 months. Participants were evaluated every month by Severe Cognitive Impairment Rating Scale (SCIRS) and Functional Assessment Staging (FAST) in addition to recording the probable adverse events. RESULTS Both treatment groups showed similar outcomes as demonstrated by insignificant effect for time × treatment interaction on SCIRS scores [F(2.95, 194.78) = 2.25, p = 0.08]. There was no significant difference between the two groups in the scores changes from baseline to the endpoint on SCIRS (p = 0.38) and FAST (p = 0.87). The frequency of adverse events was not significantly different between the two groups as well. CONCLUSIONS In addition to its favorable safety profile, 1-year administration of saffron extract capsules showed to be comparable with memantine in reducing cognitive decline in patients with moderate to severe AD. Confirmatory studies with larger sample sizes and longer follow-up periods are warranted.
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Affiliation(s)
- Mehdi Farokhnia
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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The response of agitated behavior to pain management in persons with dementia. Am J Geriatr Psychiatry 2014; 22:708-17. [PMID: 23611363 DOI: 10.1016/j.jagp.2012.12.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 12/08/2012] [Accepted: 12/12/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Behavioral disturbances and pain are common in nursing home (NH) patients with dementia. An association between pain and increased agitation has been suggested, and recently a significant reduction of agitation has been demonstrated by pain treatment in patients with moderate to severe dementia. We now examined which specific agitated behaviors respond to individualized pain treatment. DESIGN Cluster randomized clinical trial. SETTING 60 clusters (i.e., clusters defined as single independent NH units) in 18 NHs within five municipalities of Western Norway. PARTICIPANTS 352 patients with moderate to severe dementia and clinically significant behavioral disturbances. INTERVENTION The control group received usual treatment and care. According to a predefined scheme for 8 weeks, all patients in the intervention group received individual daily pain treatment with acetaminophen, extended release morphine, buprenorphine transdermal patch, and/or pregabaline. MEASUREMENTS Cohen-Mansfield Agitation Inventory subscales and items. RESULTS Analyses demonstrated that Factor 3 (Verbally agitated behaviors) showed the largest significant difference (DF = 1204.0, t = -4.308, p <0.001), followed by Factor 2 (Physically non-aggressive behaviors) (DF = 1198.0, t = -2.672, p = 0.008), and Factor 1 (Aggressive behaviors) (DF = 1196.0, t = -2.093, p = 0.037) after 8 weeks, by a linear random intercept mixed model in two-way repeated-measures configuration with adjustment for heteroscedasticity. CONCLUSION We found that verbal agitation behaviors such as complaining, negativism, repetitious sentences and questions, constant request for attention, and cursing or verbal aggression responded to pain treatment. In addition, restlessness and pacing were sensible to analgesics. Such behaviors should therefore lead to an assessment of pain, and pain treatment. Further studies comparing how pain treatment should be balanced against other strategies including psychotropic drugs are needed.
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Ford AH. Neuropsychiatric aspects of dementia. Maturitas 2014; 79:209-15. [PMID: 24794580 DOI: 10.1016/j.maturitas.2014.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 03/28/2014] [Accepted: 04/01/2014] [Indexed: 11/15/2022]
Abstract
Dementia affects approximately 6.5% of people over the age of 65. Whilst cognitive impairment is central to the dementia concept, neuropsychiatric symptoms are invariably present at some stage of the illness. Neuropsychiatric symptoms result in a number of negative outcomes for the individual and their caregivers and are associated with higher rates of institutionalization and mortality. A number of factors have been associated with neuropsychiatric symptoms including neurobiological changes, dementia type, and illness severity and duration. Specific patient, caregiver and environmental factors are also important. Neuropsychiatric symptoms can be broadly divided into four clusters: psychotic symptoms, mood/affective symptoms, apathy, and agitation/aggression. Neuropsychiatric symptoms tend to persist over time although differing symptom profiles exist at various stages of the illness. Assessment should take into account the presenting symptoms together with an appreciation of the myriad of likely underlying causes for the symptoms. A structured assessment/rating tool can be helpful. Management should focus on non-pharmacological measures initially with pharmacological approaches reserved for more troubling symptoms. Pharmacological approaches should target specific symptoms although the evidence-base for pharmacological management is quite modest. Any medication trial should include an adequate appreciation of the risk-benefit profile in individual patients and discussion of these with both the individual and their caregiver.
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Affiliation(s)
- Andrew H Ford
- Western Australian Centre for Health & Ageing (M573), Centre for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia.
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McIlroy G, Thomas SK, Coleman JJ. Second-generation antipsychotic drug use in hospital inpatients with dementia: the impact of a safety warning on rates of prescribing. J Public Health (Oxf) 2014; 37:346-52. [PMID: 24681910 DOI: 10.1093/pubmed/fdu023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia are distressing for patients and are frequently treated with second-generation antipsychotics. Concerns about the drugs' safety resulted in a Medicines and Healthcare Products Regulatory Agency (MHRA) warning against their use in March 2009. METHODS Second-generation antipsychotic drug use was determined amongst patients with dementia admitted to the University Hospitals Birmingham National Health Service Foundation Trust, between July 2005 and December 2011. An interrupted time series analysis was carried out to investigate changes in rates of prescribing following the safety warning. Risperidone was analysed separately, in accordance with its limited licence for use in older adults with dementia, granted in October 2008. RESULTS Before the safety warning, second-generation antipsychotic use was increasing in patients with dementia. After the MHRA warning, their use fell by 1.9% per month compared with that before. Use of risperidone continued to rise over the same period, often against the terms of its licence. CONCLUSIONS Drug safety warnings may influence prescribing practice, although continued use of antipsychotics in dementia could reflect a lack of alternative treatment options.
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Affiliation(s)
- Graham McIlroy
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sarah K Thomas
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK
| | - Jamie J Coleman
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK
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Zhang S, Edwards H, Yates P, Guo Q, Li C. Partial mediation role of self-efficacy between positive social interaction and mental health in family caregivers for dementia patients in Shanghai. PLoS One 2013; 8:e83326. [PMID: 24386178 PMCID: PMC3873294 DOI: 10.1371/journal.pone.0083326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 11/02/2013] [Indexed: 11/19/2022] Open
Abstract
We explored the mediation effect of caregiver self-efficacy on the influences of behavioral and psychological symptoms (BPSD) of dementia care recipients (CRs) or family caregivers' (CGs) social supports (informational, tangible and affectionate support and positive social interaction) on CGs' mental health. We interviewed 196 CGs, using a battery of measures including demographic data of the dyads, CRs' dementia-related impairments, and CGs' social support, self-efficacy and the Medical Outcome Study (MOS) Short-Form (SF-36) Health Survey. Multiple regression analyses showed that gathering information on self-efficacy and managing CG distress self-efficacy were the partial mediators of the relationship between positive social interaction and CG mental health. Managing caregiving distress self-efficacy also partial mediated the impact of BPSD on CG mental health. We discuss implications of the results for improving mental health of the target population in mainland China.
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Affiliation(s)
- Shuying Zhang
- Tongji University School of Medicine, Shanghai, China
| | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Qihao Guo
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunbo Li
- Department of Biological Psychiatry Shanghai Mental Health Center, Shanghai Institute of Mental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lemay CA, Mazor KM, Field TS, Donovan J, Kanaan A, Briesacher BA, Foy S, Harrold LR, Gurwitz JH, Tjia J. Knowledge of and perceived need for evidence-based education about antipsychotic medications among nursing home leadership and staff. J Am Med Dir Assoc 2013; 14:895-900. [PMID: 24074962 DOI: 10.1016/j.jamda.2013.08.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/15/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/OBJECTIVES Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members' knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Survey of leadership and direct care staff of nursing homes in Connecticut was conducted in June 2011. Questionnaire domains included knowledge of antipsychotic risks, attitudes about caring for residents with dementia, satisfaction with current behavior management training, beliefs about antipsychotic effectiveness, and need for staff training about antipsychotics and behavior management. RESULTS A total of 138 nursing home leaders and 779 direct care staff provided useable questionnaires. Only 24% of nursing home leaders identified at least 1 severe adverse effect of antipsychotics; 13% of LPNs and 12% of RNs listed at least 1 severe adverse effect. Fifty-six percent of direct care staff believed that medications worked well to manage resident behavior. Leaders were satisfied with the training that staff received to manage residents with challenging behaviors (62%). Fifty-five percent of direct care staff felt that they had enough training on how to handle difficult residents; only 37% felt they could do so without using medications. CONCLUSIONS Findings suggest that a comprehensive multifaceted intervention designed for nursing homes should aim to improve knowledge of antipsychotic medication risks, change beliefs about appropriateness and effectiveness of antipsychotics for behavior management, and impart strategies and approaches for nonpharmacologic behavior management.
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Affiliation(s)
- Celeste A Lemay
- Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, MA.
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Schulze J, Glaeske G, van den Bussche H, Kaduszkiewicz H, Koller D, Wiese B, Hoffmann F. Prescribing of antipsychotic drugs in patients with dementia: a comparison with age-matched and sex-matched non-demented controls. Pharmacoepidemiol Drug Saf 2013; 22:1308-16. [DOI: 10.1002/pds.3527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/21/2013] [Accepted: 09/09/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Jana Schulze
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
| | - Gerd Glaeske
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
| | - Hendrik van den Bussche
- Institute of Primary Medical Care; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Hanna Kaduszkiewicz
- Institute of Primary Medical Care; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Daniela Koller
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
| | - Birgitt Wiese
- Institute of Biometrics; Hannover Medical School; Hannover Germany
| | - Falk Hoffmann
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
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Bosco P, Ferri R, Salluzzo MG, Castellano S, Signorelli M, Nicoletti F, Nuovo SD, Drago F, Caraci F. Role of the Transforming-Growth-Factor-β1 Gene in Late-Onset Alzheimer's Disease: Implications for the Treatment. Curr Genomics 2013; 14:147-56. [PMID: 24082824 PMCID: PMC3637679 DOI: 10.2174/1389202911314020007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 01/31/2013] [Accepted: 02/01/2013] [Indexed: 11/22/2022] Open
Abstract
Late-onset Alzheimer's disease (LOAD) is the most common form of dementia in the elderly. LOAD has a complex and largely unknown etiology with strong genetic determinants. Genetics of LOAD is known to involve several genetic risk factors among which the Apolipoprotein E (APOE) gene seems to be the major recognized genetic determinant. Recent efforts have been made to identify other genetic factors involved in the pathophysiology of LOAD such as genes associated with a deficit of neurotrophic factors in the AD brain. Genetic variations of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), and transforming-growth-factor-β1 (TGF-β1) are known to increase the risk to develop LOAD and have also been related to depression susceptibility in LOAD. Transforming-Growth-Factor-β1 (TGF-β1) is a neurotrophic factor that exerts neuroprotective effects against ß-amyloid-induced neurodegeneration. Recent evidence suggests that a specific impairment in the signaling of TGF-β is an early event in the pathogenesis of AD. TGF-β1 protein levels are predominantly under genetic control, and the TGF-β1 gene, located on chromosome 19q13.1–3, con-tains several single nucleotide polymorphisms (SNPs) upstream and in the transcript region, such as the SNP at codon +10 (T/C) and +25 (G/C), which is known to influence the level of expression of TGF-β1. In the present review, we summarize the current literature on genetic risk factors for LOAD, focusing on the role of the TGF-β1 gene, finally discussing the possible implications of these genetic studies for the selection of patients eligible for neuroprotective strategies in AD.
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Affiliation(s)
- Paolo Bosco
- IRCCS Associazione Oasi Maria S.S. - Institute for Research on Mental Retardation and Brain Aging, 94018 Troina, Enna, Italy
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Dillon C, Serrano CM, Castro D, Leguizamón PP, Heisecke SL, Taragano FE. Behavioral symptoms related to cognitive impairment. Neuropsychiatr Dis Treat 2013; 9:1443-55. [PMID: 24092982 PMCID: PMC3788702 DOI: 10.2147/ndt.s47133] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, mild behavioral impairment (MBI) in patients who usually have normal cognition indicates an increased risk of developing dementia. Whatever the cause, all dementias carry a high rate of NPI. These symptoms can be observed at any stage of the disease, may fluctuate over its course, are a leading cause of stress and overload for caregivers, and increase rates of hospitalization and early institutionalization for patients with dementia. The clinician should be able to promptly recognize NPI through the use of instruments capable of measuring their frequency and severity to support diagnosis, and to help monitor the treatment of behavioral symptoms. The aims of this review are to describe and update the construct 'MBI' and to revise the reported NPS related to prodromal stages of dementia (MCI and MBI) and dementia stages of Alzheimer's disease and frontotemporal lobar degeneration.
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Affiliation(s)
- Carol Dillon
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
| | - Cecilia M Serrano
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
| | - Diego Castro
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
| | | | - Silvina L Heisecke
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
- CONICET (Consejo Nacional de Investigaciones Cientificas y Técnicas), Buenos Aires, Argentina
| | - Fernando E Taragano
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
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Impact of safety warnings on antipsychotic prescriptions in dementia: nothing has changed but the years and the substances. Eur Neuropsychopharmacol 2013; 23:1034-42. [PMID: 23498307 DOI: 10.1016/j.euroneuro.2013.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/31/2013] [Accepted: 02/01/2013] [Indexed: 11/21/2022]
Abstract
Dementia patients suffering from behavioral and psychological symptoms (BPSD) are often treated with antipsychotics. Trial results document an increased risk for serious adverse events and mortality in dementia patients taking these agents. Furthermore, the efficacy of treating BPSD with antipsychotics seems to be only modest. Using data of a German statutory health insurance company, we examined prescription trends of antipsychotics in prevalent dementia patients in the context of official warnings. The study period is 2004-2009. We studied trends in demographics, age and sex, as well as need of care and the intake of typical and atypical antipsychotics. Seeking for linear trends adjusted for age, sex and level of care between 2004 and 2009, we obtained p-values from a multivariate logistic regression. Prescription volumes were calculated by number of packages as well as defined daily doses (DDDs) using multiple linear regressions for trends in prescriptions amount. We included 3460-8042 patients per year (mean age 80 years). The prescription prevalence of antipsychotics decreased from 35.5% in 2004 to 32.5% in 2009 (multivariate analysis for linear trend: p=0.1645). Overall prescriptions for typical antipsychotics decreased (from 27.2% in 2004 to 23.0% in 2009, p<0.0001) and prescriptions for atypical antipsychotics increased from 17.1% to 18.9% (p<0.0001). The mean DDD per treated patient increased from 80.5 to 91.2 (2004-2009; p=0.0047). Our findings imply that warnings of international drug authorities and manufacturers against adverse drug events in dementia patients receiving antipsychotics did not impact overall prescription behavior.
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