Personality and dementia

Assessment of cognitive games to improve the quality of life of Parkinson's and Alzheimer's patients

Objectives

The core objectives of this study centre on enhancing the quality of life and well-being of individuals diagnosed with Parkinson's and Alzheimer's diseases. Our aim is to facilitate the monitoring of patient information, benefiting both caregivers and healthcare professionals.

Methods

As part of the PROCare4Life platform sensorial ecosystem, a web application with six engaging cognitive games focusing on developing cognitive training and stimulating brain activity are developed. A set of metrics calculated by the application feed machine learning predictive models to evaluate the cognitive status and evolution over time. Long-term analysis of the daily cognitive ability information is used to generate high-level outcomes and identify deviations for each patient from the multimodal fusion engine. And based on these results, a recommender system provides a set of personalized notifications.

Results

A 3-month pilot study that took place in five different countries shows the results obtained from 93 patients. An average of 22.4 games were completed per day and the recommender system generated a total of 260 game notifications, 37.7% of them were marked as read by the patients. The Cognitive State Score and the Deviations in Cognitive Abilities measurement, calculated by the multimodal fusion engine, when used in conjunction present a good overview of the patient's current state and potential deviations.

Conclusion

The cognitive games application was well-received by elderly individuals who took part in the study. This tool can be valuable for caregivers and healthcare providers in assessing the cognitive function of patients through engaging in cognitive games.

Personality traits and disorders in Alzheimer's disease

BACKGROUND

The relationships between axis II personality disorders and the normative personality traits were explored in the context of current and pre-morbid personality assessment in Alzheimer's disease (AD).

METHODS

The study was conducted with four groups who were administered the NEO-FFI and the PDQ-4+, in the form of individual interview sessions. Current personality measure: consisting of 44 female participants (AD group) and, the control group, consisting of 80 female participants from the population at large. Pre-morbid personality measure: AD group informants (n = 40); control group informants (n = 42).

RESULTS

The results are in line with the literature review and provide new research data. By factorial discriminant analysis, the current and pre-morbid personality variables that differentiate AD from control groups are identified. The personality traits variables are the best discriminators such as low agreeableness, low openness to experience, and high neuroticism, suggesting that the maladaptive personality functioning can be described extending the range of psychopathology to a dimensional approach.

CONCLUSIONS

The study of personality variables seems to suggest, in their inclusion, the possibility to increase sensitivity toward an assessment in AD.

The Association Between Subjective Mental Impairment and Objective Cognitive Performance in Non-Demented, Very Mild and Mild Demented Individuals

OBJECTIVES

Explore associations between subjective mental impairment, objective cognitive performance, and subsequent decline in older individuals with different cognitive statuses in Taiwan.

METHODS

Use self-reported questionnaire and cognitive abilities screening instrument to assess subjective and objective cognitive function. Categorize participants as reporters or non-reporters based on subjective reports. Conduct t-tests and regression analysis.

RESULTS

206 participants were assessed: 99 cognitively intact (CI), 44 very mild dementia, and 63 mild dementia. In the CI group, reporters in memory, orientation, daily life, community affairs, and judgement domains performed worse than non-reporters. In very mild dementia group, reporters in memory and personality domains performed better than non-reporters. No association found between subjective reports and 1-year cognitive decline in dementia groups.

CONCLUSION

Association between subjective impairment and objective performance differs in CI and very mild dementia groups. Subjective reports do not predict 1-year cognitive decline in dementia patients. Longer follow-up studies needed.

Premorbid de novo artistic creativity in frontotemporal dementia (FTD) syndromes

The emergence of new artistic activities or shifts in artistic style in patients with frontotemporal dementia (FTD) syndromes is well documented at or after disease onset. However, a closer look in the literature reveals emerging artistic creativity also before FTD onset, although the significance and underlying pathology of such creative endeavors remain elusive. Here, we systematically review relevant studies and report an additional FTD case to elaborate on artistic activities that developed years before disease manifestation by paying particular attention to the sequence of events in individual patients' biography and clinical history. We further discuss the FTD patient's creative activities in the context of their life events, other initial or "premorbid" dementia symptoms or risk factors described in the literature such as mental illness and mild behavioral impairment (MBI), as well as changes in neuronal systems (i.e., neuroimaging and neuropathology). In addition to our FTD patient, we identified five published cases with an FTD syndrome, including three with FTD, one with primary progressive aphasia (PPA), and one with the behavioral variant of PPA (bvPPA). Premorbid novel creativity emerged across different domains (visual, musical, writing), with the FTD diagnosis ensuing artistic productivity by a median of 8 years. Data on late-life and pre-dementia life events were available in four cases. The late creative phase in our case was accompanied by personality changes, accentuation of personality traits, and cessation of painting activities occurred with the onset of memory complaints. Thus, premorbid personality changes in FTD patients can be associated with de novo creative activity. Stressful life events may also contribute to the burgeoning of creativity. Moreover, primary neocortical areas that are largely spared by pathology at early FTD stages may facilitate the engagement in artistic activities, offering a window of opportunity for art therapy and other therapeutic interventions during the MBI stage or even earlier.

Late-life cynical hostility is associated with white matter alterations and the risk of Alzheimer's disease

BACKGROUND

Cynical hostility (CH), a specific dimension of hostility that consists of a mistrust of others, has been suggested as a high-risk trait for dementia. However, the influence of CH on the incidence of Alzheimer's disease (AD) remains poorly understood. This study investigated whether late-life CH is associated with AD risk and structural neuroimaging markers of AD.

METHODS

In community-dwelling older adults from the French ESPRIT cohort (n = 1388), incident dementia rate according to CH level was monitored during an 8-year follow-up and analyzed using Cox proportional hazards regression models. Brain magnetic resonance imaging volumes were measured at baseline (n = 508). Using automated segmentation procedures (Freesurfer 6.0), the authors assessed brain grey and white volumes on all magnetic resonance imaging scans. They also measured white matter hyperintensities volumes using semi-automated procedures. Mean volumes according to the level of CH were compared using ANOVA.

RESULTS

Eighty-four participants developed dementia (32 with AD). After controlling for potential confounders, high CH was predictive of AD (HR 2.74; 95% CI 1.10-6.85; p = 0.030) and all dementia types are taken together (HR 2.30; 95% CI 1.10-4.80; p = 0.027). High CH was associated with white matter alterations, particularly smaller anterior corpus callosum volume (p < 0.01) after False Discovery Rate correction, but not with grey matter volumes.

CONCLUSIONS

High CH in late life is associated with cerebral white matter alterations, designated as early markers of dementia, and higher AD risk. Identifying lifestyle and biological determinants related to CH could provide clues on AD physiopathology and avenues for prevention strategies.

Dementia and Parkinson's Disease: Similar and Divergent Challenges in Providing Palliative Care

Dementia and Parkinson's disease are incurable neurological conditions. Patients often experience specific, complex, and varying needs along their disease trajectory. Current management typically employs a multidisciplinary team approach. Recognition is growing that this team approach should also address palliative care issues to optimize quality of life for patient and family caregivers, but it remains unclear how palliative care is best delivered. To inspire future service development and research, we compare the trajectories and conceptualization of palliative care between dementia and Parkinson's disease. Both Parkinson's disease and dementia are characterized by a protracted course, with progressive but fairly insidious development of disability. However, patients with Parkinson's disease may experience relatively stable periods initially but with time, a wide range of debilitating symptoms develops, many of which do not respond well to treatment. Eventually, dementia develops in most Parkinson patients, while motor disability develops in many dementia patients. In both diseases, symptoms such as pain, apathy, sleeping problems, falls, and a high caregiver burden are prevalent. Advance care planning has benefits in terms of being prepared before the disease progresses into a stage with communication problems or severe cognitive impairment. However, for both conditions, the protracted disease trajectories complicate conceptualization of palliative care through different stages of the disease, with pertinent questions such as when to offer what interventions pro-actively. Given the similarities and differences, we should develop palliative approaches that are partially generic and partially disease-specific. These should be integrated seamlessly with disease-specific care. Substantial research is already being performed on dementia palliative care. This may also inform the further development of palliative care for Parkinson's disease, including an evaluation of palliative interventions and services.

Depressive vulnerability in women with Alzheimer's disease: Relationship with personality traits and abnormal personality dimensions

BACKGROUND

This study sought to determine the evaluation of current and pre-morbid depressive vulnerability dimensions in Alzheimer's disease. Sidney Blatt´s personality developmental perspective, the Five-Factor model and Axis II personality disorders were taken as references.

METHODS

The study was conducted with two groups which were assessed using the Depressive Experiences Questionnaire, the NEO-FFI and the Personality Diagnostic Questionnaire-4+, in the form of individual interview sessions. Current personality measure: Alzheimer's disease Group, consisting of 44 female participants (M_Age= 81.36 years); Pre-morbid personality measure: Alzheimer's disease Group Informants (n = 40).

RESULTS

Self-Criticism personality vulnerability is a general indicator of psychopathology. In pre-morbidity, Neuroticism (β = 0.41), Agreeableness (β = -0.63) and Conscientiousness (β = -0.08) predicted Self-Criticism, explaining 64% of the variance; additionally, Self-Criticism (β = 0.72) and Neediness (β = 2.05) predicted the PDQ-4+ total, explaining 58% of the variance. In terms of current personality, the PDQ-4+ total was predicted by Self-Criticism (β = 0.55), explaining 30% of the variance.

LIMITATIONS

The small size of the samples, especially since it is difficult to access individuals diagnosed with AD at the onset or in its early stages; measuring personality changes by means of retrospective assessment by proxies may have introduced some memory bias.

CONCLUSIONS

These findings are relevant to research relating depressive vulnerability to personality traits and psychopathology in Alzheimer's disease.

[Premorbid personality as a risk factor in the appearance of psychological and behavioural symptoms of dementia: Systematic review]

The aetiology of behavioural and psychological symptoms of dementia (BPSD) is defined by a diversity of factors, and recent studies suggest that premorbid personality could be a risk factor for BPSD. This study aimed to review studies on the relationship between premorbid personality and BPSD. Studies were identified using PsycInfo, MedLine, and PubMed. The searches combined terms for premorbid personality, dementia and BPSD. Ten studies have been included in this review. Eight out of ten studies show a relationship between premorbid personality and BPSD. Neuroticism is associated with behavioural disturbances and anxiety. Extraversion is associated with wandering. Low agreeableness is associated with affective disturbance and aggression-related behaviours and high agreeableness is associated with wandering. The studies found no congruent results for openness and conscientiousness. In conclusion, premorbid personality may increase the risk of developing BPSD during the course of the disease. Even so, the relationship between personality and BPSD is complex due to multifactorial aetiology.

Personality and its Relationship to Depression and Cognition in Older Adults: Implications for Practice

OBJECTIVES

Personality is an important contributor to an individual's mental health and is consistently linked to the two most prevalent mental health conditions among older adults: dementia and depression. This review summarizes the current findings on personality and its association with cognitive decline and depression, as well as treatment outcomes and possible intervention strategies.

METHODS

Literature searches were conducted in Web of Science, PubMed, and PsycINFO. Search terms included 'personality traits,' 'depression,' 'treatment,' and 'older adults.'

RESULTS

Cognitive decline and depressive disorders are both associated with a common personality profile: high neuroticism, and low conscientiousness, extraversion, openness, and agreeableness. Across studies, the most consistent predictor of late-life depression, its course, and treatment outcomes is higher neuroticism.

CONCLUSIONS

Personality traits are associated with cognitive decline, as well as the diagnosis and course of late-life depression in older adults. However, formal personality assessment is not typically incorporated in clients' treatment plans, even though personality traits may influence treatment efficacy and outcomes.

CLINICAL IMPLICATIONS

Formal assessment of personality traits may be beneficial in terms of treatment adherence and outcomes for older adults. Tailored interventions that specifically target the client's strengths are likely to be well received by both clients and clinicians.

Behavioral Problems and Dementia

Behavioral problems decrease quality of life of people with dementia and their care providers. Three main consequences of dementia are functional impairment and in some cases also mood disorders and psychosis. These consequences, alone or in combination, result in 3 main behavioral problems: apathy, agitation, and rejection of care/aggression. Nonpharmacologic management strategies include meaningful activities and individualized comfort care, for example, Namaste Care. If needed, pharmacologic management should concentrate on treatment of main dementia consequences, especially depression, instead of treating secondary symptoms, for example, insomnia. Use of antipsychotics should be minimized but antipsychotics may be necessary for augmentation of antidepressants.

Cognitive Impairment, Dementia, and Personality Stability Among Older Adults

There is contrasting evidence on personality stability in advanced age, and limited knowledge on the impact of cognitive impairment and dementia on trait stability. Group- and individual-level longitudinal analyses of the five major dimensions of personality assessed twice over 4 years ( N = 9,935) suggest that rank-order stability was progressively lower with advancing age (from rtt = 0.68 for age 50 to 60 years to rtt = 0.58 for age >80 years). Stability was low in the dementia group ( rtt = 0.43), and this was not simply due to lower reliability given that internal consistency remained adequate in the dementia group. Among individuals with no cognitive impairment or dementia, there was no association between stability and age ( rtt = 0.70 even for age >80 years). These results suggest that the lower personality stability in older adults is not due to age but cognitive impairment and dementia.

Spousal recollections of early signs of primary progressive aphasia

BACKGROUND

Although primary progressive aphasia (PPA) is characterized by progressive loss of language and communication skills, knowledge about the earliest emerging signs announcing the onset of this condition is limited.

AIMS

To explore spousal recollections regarding the earliest signs of PPA and to compare the nature of the earliest perceived symptoms across the three PPA variants.

METHODS & PROCEDURES

In-depth interviews focusing on the earliest signs of illness onset were conducted with 13 spouses whose partners were diagnosed with PPA. The earliest recollections and observations described by the spouses were analyzed and coded according to the DSM-5 criteria for a mild neurocognitive disorder. These data were then compared across and within each of the three PPA variants.

OUTCOMES & RESULTS

Spousal retrospective accounts indicated the three PPA variants (semantic, logopenic and non-fluent) had a signature profile announcing illness onset. Changes in social cognition presented in all three variants of PPA, but at different points in the illness trajectory. In particular, the findings suggest the possibility that PPA initially presents as subtle changes in social cognition for semantic variant PPA (svPPA) and logopenic variant PPA (IvPPA) rather than overt language impairments as defined in the current diagnostic criteria.

CONCLUSIONS & IMPLICATIONS

Understanding the nature of symptoms perceived in the earliest stages of PPA has potential to inform earlier and accurate diagnosis and interventions to assist those living with the illness.

Armed and Aging: Dementia and Firearms Do Not Mix !

The possibility that persons with dementia possess firearms is cause for concern, but only a limited number of research studies have been conducted on such a topic, usually in the form of case reports. Reducing the occurrence of the firearm-related violence requires effectively identifying dangerous individuals and keeping firearms out of their hands. The health care professionals, i.e. the social workers and the physicians, need to work together and to produce a suitable evaluation of patients with dementia to prevent firearm-related injuries and serious and irreparable damage to persons.

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.

Personality and global cognitive decline in Japanese community-dwelling elderly people: A 10-year longitudinal study

OBJECTIVES

To examine the longitudinal associations between the big five personality and changes in global cognitive function among community-dwelling elderly people involved in the National Institute for Longevity Sciences - Longitudinal Study of Aging.

METHODS

The participants were 594 individuals (age range 60-81years) and followed for 10years and tested six times. Personality was assessed by the Japanese version of NEO five factor inventory at baseline. Cognitive function was assessed by the Japanese version of Mini Mental State Examination (MMSE) at all visits. For participants with a baseline MMSE score≥28, logistic generalized estimating equation models estimated the odds ratio (OR) and 95% confidence interval (CI) for MMSE score≤27 at each follow-up visit, according to a 1-SD increase of the baseline personality score. Post hoc analyses were performed for mild cognitive deficits, baseline MMSE score≥24 and ≤27, to estimate the OR and CI for MMSE score≤23.

RESULTS

The adjusted OR for MMSE score≤27 was 0.78 (95% CI, 0.69-0.88), with a 1-SD increase in Openness to Experience score. In post hoc analyses, the adjusted OR for MMSE score≤23 was 0.50 (95% CI, 0.35-0.72) with a 1-SD increase in Conscientiousness score. Relationships between other personality traits and the decline in MMSE score were not significant.

CONCLUSIONS

Higher Openness to Experience was associated with a reduction in risk for cognitive decline in community-dwelling older adults. Higher Conscientiousness might also predict lower risk for severe cognitive decline, especially for individuals with mild cognitive deficits.

Exploring the Relationship Between Premorbid Personality and Dementia-Related Behaviors

The purpose of the current study was to investigate whether premorbid personality traits (i.e., neuroticism, extroversion, openness, agreeableness, and conscientiousness) can predict behavioral and psychological symptoms of dementia (BPSD). In particular, agitation-related behaviors were examined. The current study used convenience sampling from 14 residential care facilities in Melbourne, Australia. Demographic and health data, cognitive ability, BPSD, and premorbid personality characteristics were collected from 62 female and 27 male older adults. Close informants of participants were asked to provide premorbid personality data (i.e., before the development of dementia) using the NEO-Five-Factor Inventory. Residential care staff used the Cohen-Mansfield Agitation Inventory to rate agitation-related behaviors over a 2-week period. Correlational analyses revealed associations between premorbid agreeableness and verbally nonaggressive behaviors, and between premorbid conscientiousness and verbally nonaggressive behaviors. Although the findings provide some support that premorbid personality shapes problematic behaviors exhibited in dementia, they are inconsistent with previous research and the hypotheses were generally not supported.

Dissecting Complex and Multifactorial Nature of Alzheimer's Disease Pathogenesis: a Clinical, Genomic, and Systems Biology Perspective

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by loss of memory and other cognitive functions. AD can be classified into familial AD (FAD) and sporadic AD (SAD) based on heritability and into early onset AD (EOAD) and late onset AD (LOAD) based on age of onset. LOAD cases are more prevalent with genetically complex architecture. In spite of significant research focused on understanding the etiological mechanisms, search for diagnostic biomarker(s) and disease-modifying therapy is still on. In this article, we aim to comprehensively review AD literature on established etiological mechanisms including role of beta-amyloid and apolipoprotein E (APOE) along with promising newer etiological factors such as epigenetic modifications that have been associated with AD suggesting its multifactorial nature. As genomic studies have recently played a significant role in elucidating AD pathophysiology, a systematic review of findings from genome-wide linkage (GWL), genome-wide association (GWA), genome-wide expression (GWE), and epigenome-wide association studies (EWAS) was conducted. The availability of multi-dimensional genomic data has further coincided with the advent of computational and network biology approaches in recent years. Our review highlights the importance of integrative approaches involving genomics and systems biology perspective in elucidating AD pathophysiology. The promising newer approaches may provide reliable means of early and more specific diagnosis and help identify therapeutic interventions for LOAD.