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Thompson JL, Woods SP, Medina LD, Garcia JM, Teixeira AL. Apathy in persons living with HIV disease: A systematic narrative review. J Affect Disord 2024; 350:133-147. [PMID: 38224740 DOI: 10.1016/j.jad.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Apathy was identified as a feature of HIV early in the epidemic; however, there are no systematic reviews of the diverse literature on the sociodemographic and clinical correlates of apathy in HIV disease. METHODS The current study adopted a hybrid systematic-narrative review methodology in which we used PRISMA guidelines to identify, summarize, and critique peer-reviewed, empirical studies of apathy in HIV disease in the era of combination antiretroviral therapy. RESULTS A total of 34 studies of apathy in persons living with HIV (PLWH) were identified. Findings across these studies showed that apathy was reliably related to the structure of grey and white matter pathways commonly implicated in apathy, poorer everyday functioning, education, and other neuropsychiatric symptoms (e.g., depression). Apathy was not reliably associated with age, sex, race/ethnicity, cognition, and clinical markers of HIV disease. LIMITATIONS The current review does not provide rigorous quantitative estimates of clinical correlates of apathy, and the exclusion criteria of non-English and non-peer reviewed publications introduces risk of bias and Type I error. CONCLUSIONS Apathy occurs at higher rates in PLWH and is linked to neuroanatomical differences, as well as negative outcomes for everyday functions, aspects of neurocognition, and neuropsychiatric symptoms. As such, apathy is an important component to consider in the clinical assessment, diagnosis, and management of neurocognitive disorders in PLWH. Future work is needed to replicate existing findings with larger sample sizes and longitudinal designs, examine apathy as a multi-dimensional construct, and develop evidence-based treatments for apathy in PLWH.
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Affiliation(s)
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX 77004, USA.
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Antonio L Teixeira
- Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX 77054, USA
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Bradson ML, Cadden MH, Riegler KE, Thomas GA, Randolph JJ, Arnett PA. Cognitive Reserve Moderates the Effects of Fatigue and Depressive Symptoms in Multiple Sclerosis. Arch Clin Neuropsychol 2023; 38:1597-1609. [PMID: 37279369 DOI: 10.1093/arclin/acad041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
To investigate cognitive reserve as a possible moderator in the relationship between fatigue and depressive symptoms in persons with multiple sclerosis (PwMS). Fifty-three PwMS (37 female; mean age, 52.66; mean education, 14.81) completed comprehensive neuropsychological testing and psychosocial questionnaires assessing the perceived effects of fatigue (Fatigue Impact Scale) and depressive symptoms (Beck Depression Inventory-Fast Screen). Cognitive reserve (CR) was operationalized as Fixed CR and Malleable CR. Fixed CR was quantified as the standardized mean of years of education and a vocabulary-based estimate of premorbid intelligence. Malleable CR was quantified as the standardized mean of cognitive exertion, exercise, and socializing items from the Cognitive Health Questionnaire. Regressions on depressive symptoms examining fatigue, both conceptualizations of CR, and their interactions were explored. A Bonferroni correction was used; results were considered significant at an alpha level of p < .01. The interactions between fatigue and both conceptualizations of CR were significant, p = .005 (Fixed CR); p = .004 (Malleable CR). Simple effects tests revealed that fatigue only predicted depressive symptoms in PwMS with low Fixed CR or low Malleable CR (p's < .001), and not in those with high Fixed or high Malleable CR (p > .01). Cognitive reserve moderated the relationship between fatigue and depressive symptoms in PwMS. Specifically, fatigue does not appear to influence depression in PwMS with high cognitive reserve. Having higher cognitive reserve (either Fixed or Malleable) may reduce the likelihood that fatigue will lead to depressive symptoms in MS.
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Affiliation(s)
- Megan L Bradson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Margaret H Cadden
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Kaitlin E Riegler
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Garrett A Thomas
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - John J Randolph
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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3
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Poletti B, Solca F, Maffi S, Torre S, Carelli L, Aiello EN, Ferrucci R, Priori A, Monti A, Verde F, Ticozzi N, Migliore S, Scaricamazza E, Casella M, Squitieri F, Ciammola A, Silani V. Semiology and determinants of apathy across neurodegenerative motor disorders: A comparison between amyotrophic lateral sclerosis, Parkinson’s and Huntington’s disease. Front Aging Neurosci 2022; 14:1031908. [PMID: 36408105 PMCID: PMC9667083 DOI: 10.3389/fnagi.2022.1031908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background The semiology and determinants of apathy are largely unknown across amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), and Huntington’s disease (HD), due to both motor and non-motor confounders. This study thus aimed at (1) profiling apathy in ALS, PD, and HD and (2) exploring its clinical determinants. Materials Consecutive ALS (N = 99), PD (N = 73), and HD (N = 25) patients underwent a motor-free assessment of apathy (Dimensional Apathy Scale, DAS), global cognition, anxiety and depression. Function was assessed through disease-specific scales. The DAS was also completed by N = 101 healthy controls (HCs). Between-group comparisons on DAS scores were implemented by covarying for all applicable confounders. Predictive models on DAS scores were built through multiple, stepwise regressions. Results Parkinson’s disease and HD, but not ALS, patients were more apathetic than HCs—with HD patients also selectively showing lower initiation and poorer goal-directed planning than HCs. Higher apathetic features were detected in PD and HD as compared to ALS. Education was a protective factor against apathy in ALS. Anxiety was a risk factor for global apathy in ALS, HD, and to a lesser extent, in PD, whereas, protective only toward affective disintegration in PD and ALS. Cognitive inefficiency was a risk factor toward apathy in both PD and ALS. Depression was a risk factor for executive-related apathy in PD. Discussion This study provides unprecedented insights into the heterogeneous semiology and determinants of apathy across ALS, PD, and HD via the DAS, in turn informing clinical practice and research.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Barbara Poletti, ; orcid.org/0000-0003-4398-2051
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Sabrina Maffi
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Ph.D Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Roberta Ferrucci
- Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center,” Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center,” Università degli Studi di Milano, Milan, Italy
| | - Simone Migliore
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Eugenia Scaricamazza
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Melissa Casella
- Italian League for Research on Huntington Foundation, Rome, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center,” Università degli Studi di Milano, Milan, Italy
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Foley ÉM, Tripodis Y, Yhang E, Koerte IK, Martin BM, Palmisano J, Makris N, Schultz V, Lepage C, Muehlmann M, Wróbel PP, Guenette JP, Cantu RC, Lin AP, Coleman M, Mez J, Bouix S, Shenton ME, Stern RA, Alosco ML. Quantifying and Examining Reserve in Symptomatic Former National Football League Players. J Alzheimers Dis 2022; 85:675-689. [PMID: 34864657 PMCID: PMC8926024 DOI: 10.3233/jad-210379] [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: 01/03/2023]
Abstract
BACKGROUND Repetitive head impacts (RHI) from contact sports have been associated with cognitive and neuropsychiatric disorders. However, not all individuals exposed to RHI develop such disorders. This may be explained by the reserve hypothesis. It remains unclear if the reserve hypothesis accounts for the heterogenous symptom presentation in RHI-exposed individuals. Moreover, optimal measurement of reserve in this population is unclear and likely unique from non-athlete populations. OBJECTIVE We examined the association between metrics of reserve and cognitive and neuropsychiatric functioning in 89 symptomatic former National Football League players. METHODS Individual-level proxies (e.g., education) defined reserve. We additionally quantified reserve as remaining residual variance in 1) episodic memory and 2) executive functioning performance, after accounting for demographics and brain pathology. Associations between reserve metrics and cognitive and neuropsychiatric functioning were examined. RESULTS Higher reading ability was associated with better attention/information processing (β=0.25; 95% CI, 0.05-0.46), episodic memory (β=0.27; 95% CI, 0.06-0.48), semantic and phonemic fluency (β=0.24; 95% CI, 0.02-0.46; β=0.38; 95% CI, 0.17-0.59), and behavioral regulation (β=-0.26; 95% CI, -0.48, -0.03) performance. There were no effects for other individual-level proxies. Residual episodic memory variance was associated with better attention/information processing (β=0.45; 95% CI, 0.25, 0.65), executive functioning (β=0.36; 95% CI, 0.15, 0.57), and semantic fluency (β=0.38; 95% CI, 0.17, 0.59) performance. Residual executive functioning variance was associated with better attention/information processing (β=0.44; 95% CI, 0.24, 0.64) and episodic memory (β=0.37; 95% CI, 0.16, 0.58) performance. CONCLUSION Traditional reserve proxies (e.g., years of education, occupational attainment) have limitations and may be unsuitable for use in elite athlete samples. Alternative approaches of reserve quantification may prove more suitable for this population.
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Affiliation(s)
- Éimear M. Foley
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Eukyung Yhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Inga K. Koerte
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Brett M. Martin
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Nikos Makris
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Center for Morphometric Analysis, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vivian Schultz
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chris Lepage
- QEII Health Sciences Centre, Nova Scotia, Canada
| | - Marc Muehlmann
- Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Paweł P. Wróbel
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey P. Guenette
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Concussion Legacy Foundation, Boston, MA, USA,Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA,Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Alexander P. Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Coleman
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Sylvain Bouix
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E. Shenton
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA,Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Correspondence to: Michael L. Alosco, PhD, Boston University Alzheimer’s Disease Research Center and Boston University CTE Center, Department of Neurology, Boston University School of Medicine, 72 E. Concord Street, Suite B7800, Boston, MA 02118, USA. Tel.: +1 617 358 6029;
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Joseph ALC, Lippa SM, McNally SM, Garcia KM, Leary JB, Dsurney J, Chan L. Estimating premorbid intelligence in persons with traumatic brain injury: an examination of the Test of Premorbid Functioning. APPLIED NEUROPSYCHOLOGY. ADULT 2021; 28:535-543. [PMID: 31519111 PMCID: PMC7067634 DOI: 10.1080/23279095.2019.1661247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knowledge of intelligence is essential for interpreting cognitive performance following traumatic brain injury (TBI). The Test of Premorbid Functioning (ToPF), a word reading test co-normed with the Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV), was examined as a tool for estimating premorbid intelligence in persons with a history of TBI. Fifty-two participants with mild, moderate, or severe TBI were administered the ToPF and WAIS-IV between two weeks and 19 months post-injury. The independent ability of the ToPF/demographic score and the Verbal Comprehension Index (VCI) to predict WAIS-IV Full Scale IQ (FSIQ) was examined, as were discrepancies between ToPF and WAIS-IV scores within and between participants. The ToPF/demographic predicted FSIQ accounted for a significant proportion of variability in actual FSIQ, above and beyond that accounted for by education or time since injury. ToPF and WAIS-IV scores did not differ by injury severity. In our sample, the ToPF/demographic predicted FSIQ underestimated intelligence in a substantial portion of our participants (31%), particularly in those with high average to superior intelligence. Finally, VCI scores were more predictive of actual FSIQ than the ToPF/demographic predicted FSIQ. The ToPF frequently underestimated post-injury intelligence and is therefore not accurately measuring premorbid intelligence in our sample, particularly in those with above average to superior intelligence. Clinicians are encouraged to administer the entire WAIS-IV, or at minimum the VCI subtests, for a more accurate measure of intelligence in those with above average intelligence and history of TBI.
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Affiliation(s)
- Annie-Lori C. Joseph
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - S. M. Lippa
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - S. M. McNally
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - K. M. Garcia
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - J. B. Leary
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - J. Dsurney
- Tampa Psychological Associates, Tampa, FL, USA
| | - L. Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
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Neuropsychiatric Disorders, Emotional Disturbances, and Their Associations with HIV-Associated Neurocognitive Disorder. Curr Top Behav Neurosci 2021; 50:347-366. [PMID: 34081306 DOI: 10.1007/7854_2021_233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current chapter provides a critical and narrative review of recent research on the neuropsychiatric disorders, emotional disturbances, and their associations with neurocognitive functioning in people living with HIV infection. We review a range of neuropsychiatric disorders including depression and anxiety disorders, but also emotional disturbances, which can be partly distinguished from depression and anxiety (apathy, alexithymia, and emotional processing impairment). While reviewing the research into the neuropsychiatric disorders and HIV-associated neurocognitive disorders, we also cover the questions of self-reported cognitive symptoms evaluation and interpretation. The chapter includes research on the role of coping skills, perceived stress and response to stressful life events, and connections to neurocognitive impairment in people living with HIV. Promising non-pharmacological interventions are highlighted. The chapter concludes with the clinical implications on how to best consider neuropsychiatric disorders and cognitive symptoms for the diagnosis of HIV-associated neurocognitive disorders, as well as future research directions.
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Ripamonti E, Clerici M. Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:386-396. [PMID: 34370420 PMCID: PMC8384087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.
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Affiliation(s)
- Enrico Ripamonti
- Send correspondence to Enrico Ripamonti, Milan Center for Neuroscience NeuroMI, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy, or email
| | - Mario Clerici
- Head of the Department of Pathophysiology and Transplantation at the University of Milan in Italy
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Cadden MH, Guty ET, Arnett PA. Cognitive Reserve Attenuates the Effect of Disability on Depression in Multiple Sclerosis. Arch Clin Neuropsychol 2019; 34:495-502. [PMID: 30165504 DOI: 10.1093/arclin/acy067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/16/2018] [Accepted: 07/23/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The current study explored the moderating role of cognitive reserve on the relationship between disability and depression in a sample of individuals in which brain pathology is thought to contribute to depression (multiple sclerosis; MS). METHOD Fifty-four individuals with MS were examined. Depression was measured using the Beck Depression Inventory-Fast Screen (BDI-FS). In addition to collecting demographic (education) and disease burden (Expanded Disability Status Scale; EDSS) related variables, participants completed a neuropsychological test battery and psychosocial questionnaires. Cognitive reserve (CR) was conceptualized in two ways: Fixed CR and Malleable CR. Fixed CR was measured using years of education and crystallized intelligence (Shipley Vocabulary). Malleable CR was operationalized as a composite of measures from the Cognitive Heath Questionnaire (CHQ). Two regressions on depression (BDI-FS) examining either type of cognitive reserve, EDSS, and their interactions were explored. Results: The interaction between EDSS and both conceptualizations of cognitive reserve were significant, t(50) = -2.60, p = .013, PRE = .12 (Fixed CR); t(47) = -2.02, p = .049, PRE = .08 (Malleable CR). Simple effects testing revealed the same pattern regardless of the type of cognitive reserve examined; EDSS predicted depression only in those with low cognitive reserve. CONCLUSIONS Cognitive reserve moderates the relationship between disability and depression in MS; disability does not appear to influence depression in those with high cognitive reserve.
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Affiliation(s)
- Margaret H Cadden
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Erin T Guty
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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9
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Donders J, Stout J. The Influence of Cognitive Reserve on Recovery from Traumatic Brain Injury. Arch Clin Neuropsychol 2019; 34:206-213. [PMID: 29659665 DOI: 10.1093/arclin/acy035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/24/2018] [Indexed: 11/14/2022] Open
Abstract
Objective we sought to determine the degree to which cognitive reserve, as assessed by the Test of Premorbid Functioning in combination with demographic variables, could act as a buffer against the effect of traumatic brain injury (TBI) on cognitive test performance. Method retrospective analysis of a cohort of 121 persons with TBI who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) within 1-12 months after injury. Results regression analyses indicated that cognitive reserve was a statistically significant predictor of all postinjury WAIS-IV factor index scores, after controlling for various premorbid and comorbid confounding variables. Only for Processing Speed did injury severity make an additional statistically significant contribution to the prediction model. Conclusions cognitive reserve has a protective effect with regard to the impact of TBI on cognitive test performance but this effect is imperfect and does not completely negate the effect of injury severity.
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Affiliation(s)
- Jacobus Donders
- Psychology Service, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Jacob Stout
- Department of Psychology, Calvin College, Grand Rapids, MI, USA
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10
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Jones SA, De Marco M, Manca R, Bell SM, Blackburn DJ, Wilkinson ID, Soininen H, Venneri A. Altered frontal and insular functional connectivity as pivotal mechanisms for apathy in Alzheimer's disease. Cortex 2019; 119:100-110. [PMID: 31091485 DOI: 10.1016/j.cortex.2019.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/10/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Apathy is a common and early symptom in Alzheimer's disease (AD) and is linked to poorer prognosis. Theoretical interpretations of apathy implicate alterations of connections amongst fronto-striatal and limbic regions. OBJECTIVE To test the association between presence of apathy and patterns of brain functional connectivity in patients with clinically-established AD. METHODS Seventy AD patients were included. Thirty-five patients experienced apathy as defined by the screening question of the Neuropsychiatric Inventory, and thirty-five did not. All patients agreed to undergo an MRI protocol inclusive of resting-state acquisitions. The hemodynamic-dependent signal was extracted bilaterally from five regions of interest: ventromedial prefrontal cortices, anterior cingulate cortices, dorsolateral prefrontal cortices, insulae and amygdalae. t tests were run to compare connectivity maps of apathetic and non-apathetic patients. Age, education, Mini Mental State Examination score, gray matter volumes and gray matter fractions served as covariates. RESULTS At a pFWE < .05 threshold, apathetic patients had reduced connectivity between the left insula and right superior parietal cortex. Apathetic patients had also increased connectivity between the right dorsolateral prefrontal seed and the right superior parietal cortex. Patients with apathy were significantly more likely to experience other psychiatric symptoms. CONCLUSION Our findings support a role of frontal and insular connections in coordinating value-based decisions in AD. Both down-regulation and maladaptive up-regulation mechanisms appear to be at play in these regions.
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Affiliation(s)
- Sarah A Jones
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Simon M Bell
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Hilkka Soininen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, UK.
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Reynoso-Alcántara V, Silva-Pereyra J, Fernández-Harmony T, Mondragón-Maya A. Principales efectos de la reserva cognitiva sobre diversas enfermedades: una revisión sistemática. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.psiq.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Medaglia JD, Pasqualetti F, Hamilton RH, Thompson-Schill SL, Bassett DS. Brain and cognitive reserve: Translation via network control theory. Neurosci Biobehav Rev 2017; 75:53-64. [PMID: 28104411 PMCID: PMC5359115 DOI: 10.1016/j.neubiorev.2017.01.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Abstract
Traditional approaches to understanding the brain's resilience to neuropathology have identified neurophysiological variables, often described as brain or cognitive "reserve," associated with better outcomes. However, mechanisms of function and resilience in large-scale brain networks remain poorly understood. Dynamic network theory may provide a basis for substantive advances in understanding functional resilience in the human brain. In this perspective, we describe recent theoretical approaches from network control theory as a framework for investigating network level mechanisms underlying cognitive function and the dynamics of neuroplasticity in the human brain. We describe the theoretical opportunities offered by the application of network control theory at the level of the human connectome to understand cognitive resilience and inform translational intervention.
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Affiliation(s)
- John Dominic Medaglia
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Fabio Pasqualetti
- Department of Mechanical Engineering, University of California-Riverside, Riverside, CA 92521, United States
| | - Roy H Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | | | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, PA 19104, United States; Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104, United States.
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13
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Ikanga J, Hill EM, MacDonald DA. The conceptualization and measurement of cognitive reserve using common proxy indicators: Testing some tenable reflective and formative models. J Clin Exp Neuropsychol 2016; 39:72-83. [PMID: 27647132 DOI: 10.1080/13803395.2016.1201462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The examination of cognitive reserve (CR) literature reveals a lack of consensus regarding conceptualization and pervasive problems with its measurement. This study aimed at examining the conceptual nature of CR through the analysis of reflective and formative models using eight proxies commonly employed in the CR literature. We hypothesized that all CR proxies would significantly contribute to a one-factor reflective model and that educational and occupational attainment would produce the strongest loadings on a single CR factor. METHOD The sample consisted of 149 participants (82 male/67 female), with 18.1 average years of education and ages of 45-99 years. Participants were assessed for eight proxies of CR (parent socioeconomic status, intellectual functioning, level of education, health literacy, occupational prestige, life leisure activities, physical activities, and spiritual and religious activities). Primary statistical analyses consisted of confirmatory factor analysis (CFA) to test reflective models and structural equation modeling (SEM) to evaluate multiple indicators multiple causes (MIMIC) models. RESULTS CFA did not produce compelling support for a unitary CR construct when using all eight of our CR proxy variables in a reflective model but fairly cogent evidence for a one-factor model with four variable proxies. A second three-factor reflective model based upon an exploratory principal components analysis of the eight proxies was tested using CFA. Though all eight indicators significantly loaded on their assigned factors, evidence in support of overall model fit was mixed. Based upon the results involving the three-factor reflective model, two alternative formative models were developed and evaluated. While some support was obtained for both, the model in which the formative influences were specified as latent variables appeared to best account for the contributions of all eight proxies to the CR construct. CONCLUSION While the findings provide partial support for our hypothesis regarding CR as a one-dimensional reflective construct, the results strongly suggest that the construct is more complex than what can be captured in a reflective model alone. There is a need for theory to better identify and differentiate formative from reflective indicators and to articulate the mechanisms by which CR develops and operates.
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Affiliation(s)
- Jean Ikanga
- a Department of Rehabilitation Medicine , Emory University School of Medicine , Atlanta , GA , USA.,b Department of Psychology , University of Detroit Mercy , Detroit , MI , USA
| | - Elizabeth M Hill
- b Department of Psychology , University of Detroit Mercy , Detroit , MI , USA
| | - Douglas A MacDonald
- b Department of Psychology , University of Detroit Mercy , Detroit , MI , USA
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14
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Wee N, Kandiah N, Acharyya S, Chander RJ, Ng A, Au WL, Tan LCS. Baseline predictors of worsening apathy in Parkinson's disease: A prospective longitudinal study. Parkinsonism Relat Disord 2015; 23:95-8. [PMID: 26705846 DOI: 10.1016/j.parkreldis.2015.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/11/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Apathy is one of the most common behavioural disorders in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. METHODS We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring apathy symptoms at 6-monthly intervals using the Starkstein Apathy Scale, as well as measures of motor and non-motor symptoms, cognitive function, and functional disability at baseline. Mixed-effects models were used to characterise the individual trajectories of apathy symptom severity, and linear regression with stepwise elimination procedure was used to select significant baseline predictors. RESULTS Clinically significant levels of apathy were present in 42.7% of our sample at baseline, with symptom severity remaining relatively stable on average over the course of 18 months. Male gender, lower educational attainment, higher depression symptom severity, more severe functional disability, and the presence of dyskinesias at study entry predicted increasing apathy over the subsequent 18 months. CONCLUSIONS Patients with these factors are at risk for progression of apathy, which may be prevented by treating depression and functional disability. Further studies are needed to address both the specific neurobiological pathways and psychosocial factors underpinning apathy in PD.
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Affiliation(s)
- Natalie Wee
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Sanchalika Acharyya
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Russell J Chander
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Aloysius Ng
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Wing Lok Au
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
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15
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Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders. AIDS Behav 2015; 19:1430-7. [PMID: 25533921 DOI: 10.1007/s10461-014-0970-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression and apathy are common among people living with HIV (PLWH). However, in PLWH, it is unclear whether depression and apathy are distinct conditions, which contribute to different patterns of disruption to cognitive processing and brain systems. Understanding these conditions may enable the development of prognostic indicators for HIV associated neurocognitive disorders (HAND). The present study examined substance use behavior and cognitive deficits, associated with depression and apathy, in 120 PLWH, using hierarchical regression analyses. Higher levels of depression were associated with a history of alcohol dependence and greater deficits in processing speed, motor and global cognitive functioning. Higher levels of apathy were associated with a history of cocaine dependence. It is recommended that PLWH get screened appropriately for apathy and depression, in order to receive the appropriate treatment, considering the comorbidities associated with each condition. Future research should examine the neurological correlates of apathy and depression in PLWH.
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16
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Abstract
PURPOSE OF REVIEW The purpose of this study is to summarize recent advances in ageing and neuroAIDS by reviewing relevant articles from the preceding 18 months from PubMed and PsycINFO databases. RECENT FINDINGS The success of combination antiretroviral therapy (cART) has led to ageing of the HIV-infected population, which in turn contributes to the prevalence of HIV-associated neurocognitive disorder (HAND). Biomedical advances continue to clarify the pathophysiology of HAND despite effective cART, including chronic inflammatory and neurovascular causes. In recent months, associations between HAND and nonneurological medical diseases have been identified, as well as linkage to neuroimaging in those ageing with HIV. Developing effective screening tools to detect impairment remains an important scientific gap, although promoting factors associated with successful cognitive ageing is emerging as a possible means of enhancing quality of life. SUMMARY A greater understanding of HAND pathophysiology among treated individuals with suppressed virus will aid in explaining the high prevalence of HAND despite effective cART and allow for development of novel targeted interventions. Neuroimaging and other biomarkers show promise in discerning HAND from age-associated cognitive disorders. Effective screening tools remain critically needed. Together, this work will inform promising strategies needed to address issues pertinent to an expanding group of older patients living with HIV.
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17
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Liemburg EJ, Dlabac-De Lange JJLAS, Bais L, Knegtering H, van Osch MJP, Renken RJ, Aleman A. Neural correlates of planning performance in patients with schizophrenia--relationship with apathy. Schizophr Res 2015; 161:367-75. [PMID: 25497221 DOI: 10.1016/j.schres.2014.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/06/2014] [Accepted: 11/22/2014] [Indexed: 11/15/2022]
Abstract
Patients with schizophrenia often suffer from apathy: a quantitative reduction of voluntary, goal-directed behaviors that impairs daily functioning. We hypothesized that schizophrenia patients with high levels of apathy would show decreased activation in brain regions involved in planning and goal-directed behavior. Patients with schizophrenia or psychotic spectrum disorder (n=47) and healthy controls (n=20) performed the Tower of London (ToL) task during fMRI scanning using arterial spin labeling. To investigate the relationship between apathy and planning in patients, a proxy measure of apathy based on the Positive and Negative syndrome Scale was regressed against the task-related brain activation. Brain activation was also compared between patients and healthy controls. Higher levels of apathy were associated with less task-related activation within the inferior parietal lobule precuneus and thalamus. Compared to controls, patients showed lower activation in lateral prefrontal regions, parietal and motor areas, and a higher activation of medial frontal areas. Apathy was related to abnormal activation in thalamus and parietal regions during the ToL task. This supports the hypothesis that impaired function of brain regions involved in planning and goal-directed behavior may underlie apathy in schizophrenia. Moreover, impaired lateral prefrontal activation in schizophrenia patients compared to controls is consistent with the hypofrontality model of schizophrenia. In contrast, stronger medial frontal activation in patients may be related to increased effort to perform a task with conflicting task solutions.
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Affiliation(s)
- Edith J Liemburg
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Rob Giel Research Centrum, University of Groningen, University Medical Center Groningen, CC72, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Jozarni J L A S Dlabac-De Lange
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands.
| | - Leonie Bais
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Lentis Research, Center for Mental Health, Hereweg 80, 9725 AG Groningen, The Netherlands.
| | - Henderikus Knegtering
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Rob Giel Research Centrum, University of Groningen, University Medical Center Groningen, CC72, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Matthias J P van Osch
- Department of Radiology, Leiden University Medical Center, Postzone C2S, Postbox 9600, 2300 RC, Leiden, The Netherlands.
| | - Remco J Renken
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands.
| | - André Aleman
- Department of Neuroscience, and BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, FA32, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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Njomboro P, Deb S. Distinct neuropsychological correlates of cognitive, behavioral, and affective apathy sub-domains in acquired brain injury. Front Neurol 2014; 5:73. [PMID: 24904518 PMCID: PMC4032882 DOI: 10.3389/fneur.2014.00073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/01/2014] [Indexed: 11/13/2022] Open
Abstract
Apathy has a high prevalence and a significant contribution to treatment and rehabilitation outcomes in acquired brain damage. Research on the disorder's neuropsychological correlates has produced mixed results. While the mixed picture may be due to the use of varied assessment tools on different patient populations, it is also the case that most studies treat apathy as a unitary syndrome. This is despite the evidence that apathy is a multifaceted and multidimensional syndrome. This study investigates the neuropsychological correlates of apathy in 49 patients with acquired brain damage. It further fractionates apathy symptoms into affective, cognitive, and behavioral sub-domains and investigates their individual relations with standard measures of affective, cognitive, and behavioral functioning. Global apathy scores were not related to any of these measures. Affective apathy was associated with emotion perception deficits, and cognitive apathy was associated with executive deficits on the Brixton test. These results demonstrate that treating apathy as a single entity may hide important correlates to apathy symptoms that become visible when the disorder is fractionated into its sub-domains. The study highlights the research and clinical importance of treating apathy as a multidimensional syndrome.
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Affiliation(s)
- Progress Njomboro
- Department of Psychology, University of Cape Town , Cape Town , South Africa
| | - Shoumitro Deb
- Division of Brain Sciences, Department of Medicine, Imperial College London , London , UK
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Harezlak J, Cohen R, Gongvatana A, Taylor M, Buchthal S, Schifitto G, Zhong J, Daar ES, Alger JR, Brown M, Singer EJ, Campbell TB, McMahon D, So YT, Yiannoutsos CT, Navia BA. Predictors of CNS injury as measured by proton magnetic resonance spectroscopy in the setting of chronic HIV infection and CART. J Neurovirol 2014; 20:294-303. [PMID: 24696364 DOI: 10.1007/s13365-014-0246-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/07/2014] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
Abstract
The reasons for persistent brain dysfunction in chronically HIV-infected persons on stable combined antiretroviral therapies (CART) remain unclear. Host and viral factors along with their interactions were examined in 260 HIV-infected subjects who underwent magnetic resonance spectroscopy (MRS). Metabolite concentrations (NAA/Cr, Cho/Cr, MI/Cr, and Glx/Cr) were measured in the basal ganglia, the frontal white matter, and gray matter, and the best predictive models were selected using a bootstrap-enhanced Akaike information criterion (AIC). Depending on the metabolite and brain region, age, race, HIV RNA concentration, ADC stage, duration of HIV infection, nadir CD4, and/or their interactions were predictive of metabolite concentrations, particularly the basal ganglia NAA/Cr and the mid-frontal NAA/Cr and Glx/Cr, whereas current CD4 and the CPE index rarely or did not predict these changes. These results show for the first time that host and viral factors related to both current and past HIV status contribute to persisting cerebral metabolite abnormalities and provide a framework for further understanding neurological injury in the setting of chronic and stable disease.
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Affiliation(s)
- J Harezlak
- Indiana University Fairbanks School of Public Health, 410 W 10th St., Suite 3000, Indianapolis, IN, 46202, USA,
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20
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Sanmarti M, Ibáñez L, Huertas S, Badenes D, Dalmau D, Slevin M, Krupinski J, Popa-Wagner A, Jaen A. HIV-associated neurocognitive disorders. J Mol Psychiatry 2014; 2:2. [PMID: 25945248 PMCID: PMC4416263 DOI: 10.1186/2049-9256-2-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/25/2014] [Indexed: 01/03/2023] Open
Abstract
Currently, neuropsychological impairment among HIV+ patients on antiretroviral therapy leads to a reduction in the quality of life and it is an important challenge due to the high prevalence of HIV-associated neurocognitive disorders and its concomitant consequences in relation to morbidity and mortality- including those HIV+ patients with adequate immunological and virological status. The fact that the virus is established in CNS in the early stages and its persistence within the CNS can help us to understand HIV-related brain injury even when highly active antiretroviral therapy is effective. The rising interest in HIV associated neurocognitive disorders has let to development new diagnostic tools, improvement of the neuropsychological tests, and the use of new biomarkers and new neuroimaging techniques that can help the diagnosis. Standardization and homogenization of neurocognitive tests as well as normalizing and simplification of easily accessible tools that can identify patients with increased risk of cognitive impairment represent an urgent requirement. Future efforts should also focus on diagnostic keys and searching for useful strategies in order to decrease HIV neurotoxicity within the CNS.
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Affiliation(s)
- Montserrat Sanmarti
- />Servei de Medicina Interna, Unitat VIH/Sida, Hospital Universitari MútuaTerrassa, Pl.Dr.Robert, 5, 088221 Terrassa, Barcelona, Spain
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Laura Ibáñez
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sonia Huertas
- />Servei de Neurologia, Hospital Universitari MútuaTerrassa, Barcelona, Spain
| | - Dolors Badenes
- />Servei de Neurologia, Hospital Universitari MútuaTerrassa, Barcelona, Spain
| | - David Dalmau
- />Servei de Medicina Interna, Unitat VIH/Sida, Hospital Universitari MútuaTerrassa, Pl.Dr.Robert, 5, 088221 Terrassa, Barcelona, Spain
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Mark Slevin
- />Department of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Jerzy Krupinski
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
- />Servei de Neurologia, Hospital Universitari MútuaTerrassa, Barcelona, Spain
- />Department of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Aurel Popa-Wagner
- />Clinic for Psychiatry and Psychotherapy, University of Medicine Rostock, Rostock, Germany
| | - Angeles Jaen
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
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