Prevalence of neuropsychiatric symptoms in chinese older persons with mild cognitive impairment-a population-based study

Prevalence of sleep disturbances in people with mild cognitive impairment: A systematic review and meta-analysis

This review was performed to determine sleep disturbance prevalence in individuals with mild cognitive impairment (MCI). The MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science databases were systematically searched from inception to January 20, 2024. Fifty-two studies fulfilling the eligibility criteria were included. However, six of these studies were excluded from data synthesis due to poor methodological quality. The subjective sleep disturbance prevalence among all individuals with MCI was 35.8 % (95 % CI: 31.9-39.7) across 44 studies, and the objective sleep disturbance prevalence was 46.3 % (95 % CI: 36.3-56.3) across 6 studies. Five studies examined TST and WASO, while three assessed SE. Among all potential objective assessments of sleep disturbance prevalence, only TST, WASO, and SE could be meta-analyzed in MCI because of the limited number of studies available. The estimated sleep disturbance prevalence differed significantly according to measurement method, geographical region, and research design. However, the data source did not significantly influence prevalence estimates. In meta-regression analysis, publication year, participant age, percentage of females, and study quality did not predict prevalence. As subjective and objective sleep disturbances are common in people with MCI, effective intervention strategies should be developed to alleviate them.

Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations

BACKGROUND

Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort.

METHODS

The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs).

RESULTS

The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation.

CONCLUSIONS

The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.

Common Neuropsychiatric S ymptoms in Alzheimer's Disease, Mild Cognitive Impairment, and Subjective Memory Complaints: A Unified Framework

The Alzheimer's disease (AD) continuum is a unique spectrum of cognitive impairment that typically involves the stages of subjective memory complaints (SMC), mild cognitive impairment (MCI), and AD dementia. Neuropsychiatric symptoms (NPS), such as apathy, anxiety, stress, and depression, are highly common throughout the AD continuum. However, there is a dearth of research on how these NPS vary across the AD continuum, especially SMC. There is also disagreement on the effects of specific NPS on each stage of the AD continuum due to their collinearity with other NPS, cognitive decline, and environmental factors (e.g., stress). In this article, we conduct a novel perspective review of the scientific literature to understand the presence of NPS across the AD continuum. Specifically, we review the effects of apathy, depression, anxiety, and stress in AD, MCI, and SMC. We then build on this knowledge by proposing two theories of NPS' occurrence across the AD continuum. Consequently, we highlight the current landscape, limitations (e.g., differing operationalization), and contentions surrounding the NPS literature. We also outline theories that could clear up contention and inspire future NPS research.

Apathy co-occurs with subjective cognitive decline among community-dwelling older adults

OBJECTIVE

To investigate the relationship between apathy and subjective cognitive decline (SCD) in community-dwelling older adults.

METHODS

A total of 211 participants without objective cognitive impairment were included in this study. Their SCD, apathy, sleep quality, depression, and anxiety were assessed by face-to-face interviews. Multivariate logistic regression was constructed to examine the independent relationship between apathy and SCD with adjustment for confounders.

RESULTS

The participants' average SCD-questionnaire and apathy evaluation scale-self scores were 7.13 and 30.65, respectively. Nearly half of the participants were categorized as having SCD. A quarter of participants were identified as apathetic. The apathy score was significantly associated with an increased risk of SCD (odds ratio 1.05, 95% confidence interval 1.01-1.10) after controlling for covariates.

CONCLUSION

Apathy was independently and significantly associated with SCD in community-dwelling older adults without objective cognitive impairment. Thus early intervention on apathy is important to protect elderly cognitive functioning.

Distinguishing apathy and depression in older adults with mild cognitive impairment using text, audio, and video based on multiclass classification and shapely additive explanations

OBJECTIVES

This study aimed to develop a classification model to detect and distinguish apathy and depression based on text, audio, and video features and to make use of the shapely additive explanations (SHAP) toolkit to increase the model interpretability.

METHODS

Subjective scales and objective experiments were conducted on 319 mild cognitive impairment (MCI) patients to measure apathy and depression. The MCI patients were classified into four groups, depression only, apathy only, depressed-apathetic, and the normal group. Speech, facial and text features were extracted using the open-source data analysis toolkits. Multiclass classification and SHAP toolkits were used to develop a classification model and explain the contribution of specific features.

RESULTS

The macro-averaged f1 score and accuracy for overall model were 0.91 and 0.90, respectively. The accuracy for the apathetic, depressed, depressed-apathetic, and normal groups were 0.98, 0.88, 0.93, and 0.82, respectively. The SHAP toolkit identified speech features (Mel-frequency cepstral coefficient (MFCC) 4, spectral slopes, F0, F1), facial features (action unit (AU) 14, 26, 28, 45), and text feature (text 6 semantic) associated with apathy. Meanwhile, speech features (spectral slopes, shimmer, F0) and facial expression (AU 2, 6, 7, 10, 14, 26, 45) were associated with depression. Apart from the shared features mentioned above, new speech (MFCC 2, loudness) and facial (AU 9) features were observed in the depressive-apathetic group.

CONCLUSIONS

Apathy and depression shared some verbal and facial features while also exhibited distinct features. A combination of text, audio, and video could be used to improve the early detection and differential diagnosis of apathy and depression in MCI patients.

Late-Life Depression Is Associated With Reduced Cortical Amyloid Burden: Findings From the Alzheimer's Disease Neuroimaging Initiative Depression Project

BACKGROUND

We evaluated the role of cortical amyloid deposition as a factor contributing to memory dysfunction and increased risk of dementia associated with late-life depression (LLD).

METHODS

A total of 119 older adult participants with a current diagnosis of major depression (LLD) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) Depression Project study and 119 nondepressed (ND) cognitively unimpaired participants matched on age, sex, and APOE genotype were obtained from the ADNI database.

RESULTS

Thirty-three percent of LLD participants met ADNI criteria for mild cognitive impairment. Compared with ND individuals, the LLD group exhibited less global amyloid beta (Aβ) accumulation (p = .05). The proportion of amyloid positivity in the LLD group was 19.3% compared with 31.1% for the ND participants (p = .02). Among LLD participants, global Aβ was not associated with lifetime number of depressive episodes, lifetime length of depression, length of lifetime selective serotonin reuptake inhibitor use, or lifetime length of untreated depression (p > .21 for all). Global Aβ was associated with worse memory performance (p = .05). Similar results were found in secondary analyses restricting comparisons to the cognitively unimpaired LLD participants as well as when comparing the LLD group with an ND group that included participants with mild cognitive impairment.

CONCLUSIONS

Contrary to expectation, the LLD group showed less Aβ deposition than the ND group and Aβ deposition was not associated with depression history characteristics. Aβ was associated with memory, but this relationship did not differ between LLD and ND. Our results suggest that memory deficits and accelerated cognitive decline reported in previous studies of LLD are not due to greater cortical Aβ accumulation.

Prevalence of anxiety in patients with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Prevalence rates of anxiety in patients with mild cognitive impairment (MCI) varied widely across studies and may confer a higher likelihood of progression to dementia. Our aim was to estimate the prevalence of anxiety in MCI and identify reasons for heterogeneity in the reported results.

METHODS

A computerized search in PubMed, EMBASE, and Psyc INFO for studies on anxiety in MCI was performed up to March 2017. The overall prevalence of anxiety in patients with MCI was pooled using a random-effects model. Heterogeneity was explored using stratification (recruitment resource; method of anxiety diagnosis; method of MCI diagnosis; and region) and random-effects meta-regression.

RESULTS

Of 2494 unique abstracts, 290 were selected for full-text review, and 39 studies, representing 10,587 patients, met all inclusion criteria. The overall pooled prevalence of depression in patients with MCI was 21.0% (95% CI, 16.2-26.7) with significant heterogeneity present (I² = 97.2%, p < 0.001). When stratified by source, the prevalence of anxiety in patients with MCI in community-based samples was 14.3% (95% CI, 9.7-20.5) and was 31.2% (95% CI, 23.6-40.0) in clinic-based samples, which was significantly different (p < 0.01). The prevalence of anxiety estimates also differed significantly, when stratification by the method of anxiety diagnosis (p < 0.01). However, the criteria used for MCI diagnosis and geographical region did not significantly influence the prevalence estimate.

LIMITATIONS

We did not consider the usage of anti-anxiety drugs and language bias.

CONCLUSIONS

The prevalence of anxiety in patients with MCI was common and variability in prevalence of anxiety across studies can be attributed partly to the source of the sample and method of anxiety diagnosis. Further research is needed to identify sources of heterogeneity.

Prevalence, neurobiology, and treatments for apathy in prodromal dementia

BACKGROUND

Apathy, characterized by diminished motivation, is a highly prevalent neuropsychiatric symptom in dementia. However, there is a substantial knowledge gap with regard to prevalence rates, neurobiological underpinnings, and effective treatments for apathy in pre-dementia states, including mild cognitive impairment (MCI) and mild behavioral impairment (MBI).

METHODS

We conducted a comprehensive literature search using MEDLINE, Embase, and PsycINFO databases to identify available research on apathy in prodromal dementia.

RESULTS

Apathy has consistently been detected in individuals with MCI with varying prevalence rates, and only recently has literature discussed the prevalence of apathy in MBI. Few pharmacological treatments have been utilized for apathy, with galantamine and risperidone showing mild reductions in apathetic behaviors. Non-pharmacological interventions in prodromal dementia are beginning to be explored and show promise, but few studies have replicated those results.

DISCUSSION

More comprehensive guidelines for diagnosing apathy and further research investigating neurobiological mechanisms of apathy in MCI and MBI are required in order to effectively treat apathetic patients in prodromal dementia.

Neuropsychiatric symptoms in South-East Asian patients with mild cognitive impairment and dementia: prevalence, subtypes, and risk factors

BACKGROUND

The subtypes and risk factors of neuropsychiatric symptoms remain largely unexplored in South-East Asian populations.

OBJECTIVE

We investigated the prevalence, subtypes, and risk factors, namely, demographic, medical morbidity, and cognitive impairment associated with neuropsychiatric symptoms in a South-East Asian cohort of patients with mild cognitive impairment (MCI) and dementia.

METHODS

A clinical cohort of 38 MCI and 198 mild-moderate dementia patients were assessed using the Neuropsychiatric Inventory-Questionnaire.

RESULTS

Neuropsychiatric symptoms were equally prevalent among patients with MCI (74%) and mild-moderate dementia (85%). Three subtypes of symptoms were identified for each diagnostic group; for MCI, they included mood disturbances, anxiety/sleep problems, and psychosis, while for dementia, the subtypes included behavioral disturbances, psychosis/mood, and hyperactive behaviors. The largest risk for neuropsychiatric symptoms for both MCI and dementia patients was male gender. Among patients with MCI, burden of cerebrovascular disease and global cognitive impairment were small risks for neuropsychiatric symptoms, while for patients with dementia, an older age (>65 years) was a small risk and lower educational attainment was a moderate risk.

DISCUSSION

These findings contribute to the worldwide epidemiology of neuropsychiatric symptoms in MCI and dementia and highlight that the profile of symptoms, subtypes, and risks is fairly homogenous across Western and Asian cultures. Copyright © 2017 John Wiley & Sons, Ltd.

Sex differences in the prevalence and incidence of mild cognitive impairment: A meta-analysis

OBJECTIVE

More women have Alzheimer's disease (AD) than men. Understanding sex differences in mild cognitive impairment (MCI) may further knowledge of AD etiology and prevention. We conducted a meta-analysis to examine sex differences in the prevalence and incidence of MCI, which included amnestic and non-amnestic subtypes.

METHOD

Systematic searches were performed in July 2015 using MEDLINE/PubMed, Scopus, and PsycINFO for population-or community-based studies with MCI data for men and women. Random-effects model were used.

RESULTS

Fifty-six studies were included. There were no statistically significant sex differences in prevalence or incidence of amnestic MCI. There was a significantly higher prevalence (p=0.038), but not incidence, of non-amnestic MCI among women. There were no sex differences in studies that combined both subtypes of MCI.

CONCLUSION

The only statistically significant finding emerging from this study was that women have a higher prevalence of non-amnestic MCI. To better understand sex differences in the preclinical stages of dementia, studies must better characterize the etiology of the cognitive impairment.

Association of neuropsychiatric symptoms and sub-syndromes with cognitive impairment in community-dwelling Asian elderly

OBJECTIVES

To investigate the presence of neuropsychiatric symptoms (NPS) and sub-syndromes in elderly community-dwelling Asians with varying severity of cognitive impairment.

METHODS

Chinese and Malay participants (n = 613) from the Epidemiology of Dementia in Singapore (EDIS) Study aged ≥ 60 years underwent clinical examination, neuropsychological testing, and NPS assessment using the Neuropsychiatric Inventory (NPI). Diagnosis of no cognitive impairment (NCI), cognitive impairment-no dementia (CIND), including CIND-mild and CIND-moderate, and dementia were made using established criteria.

RESULTS

A significant increase in the numbers of NPS was observed accompanying with increasing severity of cognitive impairment (p < 0.001). Compared to those with NCI/CIND-mild, participants with CIND-moderate [Odds ratio (OR): 4.2, 95% confidence interval (CI): 1.8-10.0] or dementia [OR: 9.2, 95% CI: 2.3-36.0] were more likely to have two or more neuropsychiatric sub-syndromes. Participants with CIND-moderate were more likely to have hyperactivity [OR: 2.0, 95% CI: 1.0-3.8] and apathy [OR: 2.9, 95% CI: 1.0-8.4] sub-syndromes, whereas patients with dementia were more likely to have psychosis [OR: 6.9, 95% CI: 2.4-20.1], affective (OR: 8.7, 95% CI: 1.8-42.9), and hyperactivity (OR: 5.4, 95% CI: 1.8-16.1). Furthermore, executive dysfunction and visual memory impairment were associated with the presence of three neuropsychiatric sub-syndromes; whist language and visuomotor speed impairment were related to the presence of two sub-syndromes. By contrast, impairment in attention, verbal memory, and visuoconstruction were not associated with any of the sub-syndromes.

CONCLUSIONS

The presence of NPS and sub-syndromes increase with increasing severities of cognitive impairment, and different neuropsychiatric syndromes are associated with specific impairment on cognitive domains in community-dwelling Asian elderly.

Electroacupuncture for older adults with mild cognitive impairment: study protocol for a randomized controlled trial

BACKGROUND

Mild cognitive impairment is an intermediary state between normal aging and clinical Alzheimer's disease. Early intervention of mild cognitive impairment may be an important strategy in the management of Alzheimer's disease. The proposal aims to evaluate if electroacupuncture would optimize cognitive function in subjects with mild cognitive impairment and understand the role of electroacupuncture in the treatment of Alzheimer's disease.

METHODS/DESIGN

A randomised patient- and assessor-blind sham-controlled trial is designed to assess whether electroacupuncture intervention decreases the rate of cognitive decline amongst older adults with mild cognitive impairment. One hundred and fifty subjects aged 65 years of age or over with a diagnosis of mild cognitive impairment are recruited from the community and elderly centre in Hong Kong. All subjects are randomly allocated into two groups (75 subjects each group): the electroacupuncture group and sham control. Participants in the electroacupuncture group receive electroacupuncture stimulation by sterile, disposable acupuncture needles inserted to the acupoints with a depth of 1 to 3 cm. The acupuncture needles are subjected to 2 Hz electroacupuncture with an intensity of 5 to 10 mA. Each participant receives electroacupuncture for 8 weeks (once a day, 3 days a week) and the treatment lasts for 30 minutes each time. For sham electroacupuncture, needles are inserted to a depth of 1 to 2 mm, and connected to the electroacupuncture device without any current passing through. Outcome measures (including primary and secondary outcome measures) are collected at baseline, at the end day of intervention, and months 4 and 6 after intervention. The primary outcome is measured by the Alzheimer Disease Assessment Scale-Cognitive subscale. Secondary outcomes are measured by the mini-mental state examination, category fluency text and the Short Form 12.

DISCUSSION

The study will provide evidence for evaluating and understanding the role of electroacupuncture in the treatment of Alzheimer's disease.

TRIAL REGISTRATION

This trial is registered with chictr.org (registration number: ChiCTR-TRC-12002414 . Registration date: 11 August 2012.

Depressive symptoms in Chinese-American subjects with cognitive impairment

OBJECTIVES

To compare the prevalence of depressive symptoms and frequency of antidepressant use between a group of elderly Chinese-American subjects with and without cognitive impairment and a group of matched white subjects. A secondary aim was to examine the clinical and demographic predictors of depressive symptoms across these groups.

METHODS

The study was conducted at an academic neurology subspecialty clinic. This was a case-control study with 140 Chinese-American subjects and 140 demographically and cognitively matched white subjects. In each group, there were 48 cognitively normal and 92 cognitively impaired participants (49 with mild cognitive impairment, 43 with Alzheimer disease). The proportion of individuals with significant depressive symptoms, as indicated by a Geriatric Depression Scale score ≥6 of 15, and frequency of antidepressant use were compared across groups by using χ(2) analysis. Factors predicting depressive symptoms, including racial and diagnostic group, age, gender, Mini-Mental State Examination score, level of functional impairment, education level, and medical comorbidities, were assessed by using linear regression analysis.

RESULTS

Significant depressive symptoms were more common in cognitively impaired Chinese-American (35%) than cognitively impaired white (15%; χ(2)[1] = 9.4; p = 0.004) subjects. Chinese-American subjects with cognitive impairment were less likely to be receiving treatment for depression (12%) than white subjects with cognitive impairment (37%; χ(2)[1] = 15.6; p = 0.002). Racial and diagnostic group, age, level of functional impairment, Mini-Mental State Examination score, and education level were all statistically significant independent predictors of Geriatric Depression Scale score.

CONCLUSIONS

Elderly Chinese-American subjects with cognitive impairment are at increased risk for unrecognized and untreated depressive symptoms compared with elderly white subjects with cognitive impairment. Education level may contribute to this risk or it may be a surrogate marker for other factors contributing to depressive symptoms in this group.

Prevalence of Neuropsychiatric Symptoms across the Declining Memory Continuum: An Observational Study in a Memory Clinic Setting

AIMS

The study aimed to compare the frequency of neuropsychiatric symptoms (NPS) across the declining memory continuum, from normal aging, subjective cognitive impairment (SCI), and mild cognitive impairment (MCI) to Alzheimer's disease (AD), and to explore the clinical correlates of NPS.

METHOD

In a memory clinic, 157 subjects (46 mild AD patients, 38 MCI individuals, 24 SCI subjects, and 49 normal controls) completed the neurobehavioral assessments with the Neuropsychiatric Inventory (NPI). The clinical significance of each NPI domain was defined as an item score ≥4.

RESULT

Clinically significant depression was more common in the SCI than in the normal control group (p < 0.05). The frequency of NPS was significantly greater in the mild AD group compared to other groups. Clinically significant apathy and aberrant motor behavior were more common among the AD group than the MCI group (p < 0.05). The MMSE score (OR 4.84, 95% CI 1.92-12.16, p = 0.001) and apathy (OR 12.73, 95% CI 1.48-109.68, p = 0.021) significantly determined the diagnostic status as MCI or mild AD.

CONCLUSION

Across the declining memory continuum, the frequency of NPS was highest among mild AD patients. Depression, apathy, and aberrant motor behavior deserve more attention. Presence of apathy might be an independent determinant for mild AD.

Psychometric properties of the Starkstein Apathy Scale in patients with early untreated Parkinson disease

BACKGROUND

: Although the 14-item Starkstein Apathy Scale (SAS) is recommended to screen for and measure the severity of apathetic symptoms in Parkinson disease (PD), the psychometric attributes of this scale have not yet been fully evaluated.

OBJECTIVE

: The authors examined the reliability, factor structure, and discriminant validity of the SAS in 194 nondemented patients with early untreated PD.

DESIGN

: Cross-sectional multicenter population-based study from Western and Southern Norway.

MEASUREMENTS

: Standardized rating scales for parkinsonism and neuropsychiatric symptoms.

RESULTS

: The SAS showed fair internal consistency (Cronbach's α = 0.69) and exploratory factor analysis identified two factors: the first factor (24.2% of the variance) represented cognitive-behavioral aspects of apathy (items 1, 2, and 4-8; Cronbach's α = 0.74) and the second factor (15.0% of the variance) a general apathy dimension (items 3 and 9-14; Cronbach's α = 0.52). The correlation between these two factors was low (Spearman's r = 0.19, N = 194, p = 0.008), indicating clinically distinct dimensions, but both factor scores were strongly related to the total SAS score (Spearman's r > 0.6, N = 194, p < 0.0005). Item 3 (insight or self-reflection) showed a negative item-total correlation, and removing this item raised the Cronbach's α of the second factor to 0.70, but did not substantially alter the other results. Both the total score and factor scores of SAS showed fair discriminant validity.

CONCLUSIONS

: Although the SAS showed fairly good psychometric properties and the exploratory factor analysis suggested a two-factor solution, the results with this PD sample indicate that item 3 is ambiguous and should be considered removed from the scale.

Are gerontological nurses apathetic about apathy in older adults

Despite its serious health consequences, apathy in older adults is often underrecognized by gerontological nurses and other health care professionals. Within this article, we discuss what apathy is and present a review of the literature and research. Two frameworks emerging from the literature search-one regarding rehabilitation and the other illness-are introduced as ways in which apathy may be conceptualized and addressed. Using these frameworks, implications for gerontological nurses are outlined.