1
|
Malyutina S, Zabolotskaia A, Savilov V, Syunyakov T, Kurmyshev M, Kurmysheva E, Lobanova I, Osipova N, Karpenko O, Andriushchenko A. Are subjective language complaints in memory clinic patients informative? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:795-822. [PMID: 37865966 DOI: 10.1080/13825585.2023.2270209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
To diagnose mild cognitive impairment, it is crucial to understand whether subjective cognitive complaints reflect objective cognitive deficits. This question has mostly been investigated in the memory domain, with mixed results. Our study was one of the first to address it for language. Participants were 55-to-93-year-old memory clinic patients (n = 163). They filled in a questionnaire about subjective language and memory complaints and performed two language tasks (naming-by-definition and sentence comprehension). Greater language complaints were associated with two language measures, thus showing a moderate value in predicting language performance. Greater relative severity of language versus memory complaints was a better predictor, associated with three language performance measures. Surprisingly, greater memory complaints were associated with better naming, probably due to anosognosia in further disease progression or personality-related factors. Our findings highlight the importance of relative complaint severity across domains and, clinically, call for developing self-assessment questionnaires asking specific questions about multiple cognitive functions.
Collapse
Affiliation(s)
| | | | - Victor Savilov
- Day Hospital Memory Clinic, Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Timur Syunyakov
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
- Republican Specialized Scientific and Practical Medical Center for Mental Health, Tashkent, Uzbekistan
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Samara, Russia
| | - Marat Kurmyshev
- Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Elena Kurmysheva
- Day Hospital Memory Clinic, Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Irina Lobanova
- Center for Language and Brain, HSE University, Moscow, Russia
| | - Natalia Osipova
- Day Hospital Memory Clinic, Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Olga Karpenko
- Scientific Сollaborations Department, Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Alisa Andriushchenko
- Department of Mental Disorders in Neurodegenerative Diseases of the Brain, Scientific Center of Neuropsychiatry, Mental Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
- Department of Mental Health, Faculty of Psychology, Lomonosov Moscow State University, Moscow, Russia
| |
Collapse
|
2
|
Zhang H, Wang Y, Zhang Y, Hilal S, Cheng CY, Wong TY, Chen C, Venketasubramanian N, Xu X. Housing status is protective of neuropsychiatric symptoms among dementia-free multi-ethnic Asian elderly. BMC Geriatr 2024; 24:698. [PMID: 39179981 PMCID: PMC11342485 DOI: 10.1186/s12877-024-05203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/05/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Housing has been associated with dementia risk and disability, but associations of housing with differential patterns of neuropsychiatric symptoms (NPS) among dementia-free older adults remain to be explored. The present study sought to explore the contribution of housing status on NPS and subsyndromes associated with cognitive dysfunction in community-dwelling dementia-free elderly in Singapore. METHODS A total of 839 dementia-free elderly from the Epidemiology of Dementia in Singapore (EDIS) study aged ≥ 60 were enrolled in the current study. All participants underwent clinical, cognitive, and neuropsychiatric inventory (NPI) assessments. The housing status was divided into three categories according to housing type. Cognitive function was measured by a comprehensive neuropsychological battery. The NPS were assessed using 12-term NPI and were grouped into four clinical subsyndromes: psychosis, hyperactivity, affective, and apathy. Associations of housing with composite and domain-specific Z-scores, as well as NPI scores, were assessed using generalized linear models (GLM). Binary logistic regression models analysed the association of housing with the presence of NPS and significant NPS (NPI total scores ≥ 4). RESULTS Better housing status (5-room executive apartments, condominium, or private housing) was associated with better NPS (OR = 0.49, 95%CI = 0.24 to 0.98, P < 0.05) and significant NPS profile (OR = 0.20, 95%CI = 0.08 to 0.46, P < 0.01), after controlling for demographics, risk factors, and cognitive performance. Compared with those living in 1-2 room apartments, older adults in better housing had lower total NPI scores (β=-0.50, 95%CI=-0.95 to -0.04, P = 0.032) and lower psychosis scores (β=-0.36, 95%CI=-0.66 to -0.05, P = 0.025), after controlling for socioeconomic status (SES) indexes. Subgroup analysis indicated a significant correlation between housing type and NPS in females, those of Malay ethnicity, the more educated, those with lower income, and those diagnosed with cognitive impairment, no dementia (CIND). CONCLUSIONS Our study showed a protective effect of better housing arrangements on NPS, especially psychosis in a multi-ethnic Asian geriatric population without dementia. The protective effect of housing on NPS was independent of SES and might have other pathogenic mechanisms. Improving housing could be an effective way to prevent neuropsychiatric disturbance among the elderly.
Collapse
Affiliation(s)
- Haoran Zhang
- School of Public Health and The 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310000, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yuwei Wang
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Yaping Zhang
- School of Public Health and The 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310000, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Saima Hilal
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Centre for Innovation and Prevision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Christopher Chen
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Narayanaswamy Venketasubramanian
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
| | - Xin Xu
- School of Public Health and The 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310000, China.
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
3
|
Ferreira DA, Macedo LBC, Foss MP. Neuropsychiatric symptoms as a prodromal factor in Alzheimer's type neurodegenerative disease: A scoping review. Clin Neuropsychol 2024; 38:1031-1059. [PMID: 37881945 DOI: 10.1080/13854046.2023.2273574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Objective: Identifying neuropsychiatric symptoms (NPS) can aid in the early detection of Alzheimer's disease (AD); however, there is still a need for a greater consensus. This review aims to delineate the predominant NPS, compile a comprehensive list of the most commonly employed NPS assessment tools, and corroborate the principal findings regarding the link between NPS and neuropsychological assessment and neurobiological substrates. Methods: To conduct this scoping review, we followed the Preferred Reporting Items for Systematic Reviews guidelines and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched for relevant articles published between 2017 and 2023 in MEDLINE, PsycINFO, PubMed, Web of Science, and Cochrane Library. Results: Of the 61 eligible articles, depression, anxiety, and apathy were the main NPSs. The Neuropsychiatric Inventory Questionnaire and Neuropsychiatric Inventory were the primary assessment tools used to evaluate NPS. Correlations between NPS severity and neurobiological markers were considered clinically significant. Furthermore, clinical procedures prioritized the use of global cognitive screening tools, assessments of executive functions, and functionality evaluations. Conclusion: Standardization of procedures is necessary because of the diversity of methods. The data show that NPS can predict the etiology, severity, form, and type of disease progression, serving as a precursor sign of AD. The results of the most common cognitive screening tools and NPS instruments provided an interesting overview of future clinical approaches.
Collapse
Affiliation(s)
- Diego Alves Ferreira
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lorena Barbosa Cunha Macedo
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Paula Foss
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
4
|
Kuring JK, Mathias JL, Ward L, Tachas G. Inflammatory markers in persons with clinically-significant depression, anxiety or PTSD: A systematic review and meta-analysis. J Psychiatr Res 2023; 168:279-292. [PMID: 37931509 DOI: 10.1016/j.jpsychires.2023.10.009] [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: 06/06/2023] [Revised: 08/30/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Depression, anxiety and PTSD appear to be risk factors for dementia, but it is unclear whether they are causal or prodromal. The inflammatory-mediated neurodegeneration hypothesis suggests a causal link, proposing that mental illness is associated with an inflammatory response which, in turn, triggers neurodegenerative changes that lead to dementia. Existing meta-analyses have yet to examine inflammatory markers in depression, anxiety or PTSD with the view to exploring the inflammatory-mediated neurodegeneration hypothesis. The current meta-analysis therefore examined whether: a) depression, anxiety and PTSD are individually associated with inflammation, independently of comorbid mental illnesses and physical health problems with known inflammatory responses, and b) there are any similarities in the inflammatory profiles of these disorders in order to provide a basis for exploring inflammation in people with dementia who have a history of clinically-significant anxiety, depression or PTSD. METHODS PubMed, EMBASE, PsycINFO and CINAHL searches identified 64 eligible studies. RESULTS Depression is associated with an inflammatory response, with tentative evidence to suggest anxiety and PTSD are also associated with inflammation. However, the specific response may differ across these disorders. LIMITATIONS The data for anxiety, PTSD and multiple inflammatory markers were limited. CONCLUSIONS Depression, anxiety, and PTSD each appear to be associated with an inflammatory response in persons who do not have comorbid mental or physical health problems that are known to be associated with inflammation. Whether this inflammatory response underlies the increased risk of dementia in persons with a history of depression and anxiety, and possibly PTSD, remains to be determined.
Collapse
Affiliation(s)
- J K Kuring
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J L Mathias
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - L Ward
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - G Tachas
- Antisense Therapeutics Ltd, Melbourne, Australia
| |
Collapse
|
5
|
Lopatkiewicz AM, Slowik A, Dziedzic T. Pre-stroke and early post-stroke apathy is associated with increased risk of dementia 3 months after stroke. Int J Geriatr Psychiatry 2023; 38:e6043. [PMID: 38141049 DOI: 10.1002/gps.6043] [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: 05/10/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Apathy is a frequent neuropsychiatric syndrome after stroke. We determined whether pre-morbid and early post-stroke apathy predicts dementia 3 months after stroke. METHODS We included ischemic stroke patients without dementia who participated in the Prospective Observational Polish Study on post-stroke delirium. We used the Neuropsychiatric Inventory and clinician-reported version of Apathy Evaluation Scale to score apathy symptoms before stroke and on day 8 after stroke. Patients underwent neuropsychological examination 3 months after stroke. RESULTS Of 422 patients with ischemic stroke and without pre-stroke dementia, 194 patients (mean age: 67.5 ± 12.3; 45.9% female) underwent neuropsychological examination. Dementia was diagnosed in 21.6% of them. Patients with dementia had higher apathy scores before stroke (mean: 0.9 ± 1.7 vs. 0.2 ± 0.9, p < 0.01) and on day 8 (mean: 37.2 ± 9.3 vs. 29.0 ± 9.6, p < 0.01). Depressive symptoms did not differ between groups. In multivariate analysis adjusted for age, diabetes mellitus, stroke severity and in-hospital delirium, apathy symptoms before stroke and on day 8 after stroke predicted post-stroke dementia (adjusted OR: 1.59, 95%CI: 1.13-2.26, p = 0.01 and OR: 1.06, 95%CI: 1.01-1.11, p = 0.03, respectively). CONCLUSIONS Pre-stroke and early post-stroke apathy independently from age, stroke severity and delirium predicted dementia 3 months after stroke. Apathy might be useful in identifying at-risk patients.
Collapse
Affiliation(s)
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
6
|
Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
Collapse
Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| |
Collapse
|
7
|
Chu C, Pan W, Ren Y, Mao P, Yang C, Liu C, Tang YL. Executive function deficits and medial temporal lobe atrophy in late-life depression and Alzheimer's disease: a comparative study. Front Psychiatry 2023; 14:1243894. [PMID: 37720905 PMCID: PMC10501151 DOI: 10.3389/fpsyt.2023.1243894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Alzheimer's disease (AD) and late-life depression (LLD) frequently exhibit executive function deficits (EFD) and medial temporal lobe atrophy (MTA) as shared characteristics. The objective of this research was to examine the utility of the Trail Making Test (TMT) and the MTA scale in distinguishing between LLD and AD. Methods A study of 100 patients, 50 with AD and 50 with LLD, was conducted using a cross-sectional design. The individuals were subjected to clinical evaluations to assess their level of depression and overall cognitive abilities, which included the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). We evaluated executive function deficits (EFD) through the use of the TMT, which includes both TMT-A and TMT-B. MTA was measured using magnetic resonance imaging. To evaluate the ability of TMT and MTA scale to distinguish between the two groups, a receiver operating characteristic (ROC) curve was utilized. To investigate the connections between MTA and neuropsychological measures, a correlation analysis was performed. Results AD patients exhibited notably reduced MMSE, MoCA, and GDS scores, as well as an increased MTA total scores, time spent on TMT-A, and TMT-B compared to LLD patients (p < 0.05). TMT-A and TMT-B both exhibited excellent discriminatory power between AD and LLD, achieving area under curve (AUC) values of 92.2 and 94.2%, respectively. In AD patients, there was a negative correlation between MMSE and MoCA scores and MTA scores, while in LLD patients, there was a positive correlation between time spent on TMT-A and GDS scores and MTA scores. Conclusion AD patients experience more severe EFD and MTA than LLD patients. The differential diagnosis of AD and LLD can be aided by the useful tool known as TMT. It is important to acknowledge that TMT is capable of capturing only a fraction of the executive function, thus necessitating a cautious interpretation of research findings.
Collapse
Affiliation(s)
- Changbiao Chu
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Weigang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chunlin Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chaomeng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States
| |
Collapse
|
8
|
Spampinato MV, Ulber JL, Fayyaz H, Sullivan A, Collins HR. Neuropsychiatric Symptoms and In Vivo Alzheimer's Biomarkers in Mild Cognitive Impairment. J Alzheimers Dis 2023; 96:1827-1836. [PMID: 38007644 DOI: 10.3233/jad-220835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) carry an increased risk of progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD). There is a need to understand how to integrate NPS into the paradigm outlined in the 2018 NIA-AA Research Framework. OBJECTIVE To evaluate a prediction model of MCI-AD progression using a collection of variables, including NPS, cognitive testing, apolipoprotein E4 status (APOE4), imaging and laboratory AD biomarkers. METHODS Of 300 elderly subjects, 219 had stable MCI and 81 MCI-AD progression over a 5-year follow-up. NPS were measured using the Neuropsychiatric Inventory (NPI). A multivariate Cox Proportional Hazards Regression Analysis assessed the effects of APOE4, baseline NPI, baseline CSF amyloid-β, phosphorylated and total tau, baseline AD-signature MRI biomarker, baseline memory and executive function on MCI-AD progression. RESULTS 27% progressed to dementia (median follow-up = 43 months). NPS were found in stable MCI (62.6%) and MCI-AD converters (70.3%). The Cox model exhibited a good fit (p < 0.001), and NPS (HR = 1.033, p = 0.027), phosphorylated tau (HR = 1.011, p = 0.025), total tau (HR = 1.005, p = 0.024), AD-signature MRI biomarker (HR = 0.111, p = 0.002), executive function (HR = 0.727, p = 0.045), and memory performance (HR = 0.387, p < 0.001) were significantly associated with dementia. CONCLUSIONS NPS may inform dementia risk assessment in conjunction with cognitive testing and imaging and laboratory AD biomarkers. NPS is independently associated with the risk of MCI-dementia progression, over and beyond the contributions of CSF biomarkers.
Collapse
Affiliation(s)
- Maria Vittoria Spampinato
- Radiology and Radiological Science Department, Medical University of South Carolina, Charleston, SC, USA
| | - Jenny L Ulber
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Habiba Fayyaz
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Allison Sullivan
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Heather R Collins
- Radiology and Radiological Science Department, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
9
|
Sulkava S, Haukka J, Sulkava R, Laatikainen T, Paunio T. Association Between Psychological Distress and Incident Dementia in a Population-Based Cohort in Finland. JAMA Netw Open 2022; 5:e2247115. [PMID: 36520436 PMCID: PMC9856411 DOI: 10.1001/jamanetworkopen.2022.47115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Symptoms of psychological distress have shown association with subsequent dementia, but the nature of association remains unclear. OBJECTIVE To examine the association of psychological distress with etiological risk of dementia and incidence of dementia in presence of competing risk of death. DESIGN, SETTING, AND PARTICIPANTS This cohort study consisted of population-based cross-sectional National FINRISK Study surveys collected in 1972, 1977, 1982, 1987, 1992, 1997, 2002, and 2007 in Finland with register-based follow-up; and the cohort was linked to Finnish Health Register data for dementia and mortality for each participant until December 31, 2017. Participants included individuals without dementia who had complete exposure data. Data were analyzed from May 2019 to April 2022. EXPOSURES Self-reported symptoms of psychological distress: stress (more than other people), depressive mood, exhaustion, and nervousness (often, sometimes, never). MAIN OUTCOMES AND MEASURES Incident all-cause dementia, ascertained through linkage to national health registers. Poisson cause-specific hazard model (emphasizing etiological risk) and Fine-Gray subdistribution hazard model (emphasizing effect on incidence) considering dementia and death without dementia as competing risks. Covariates of age, sex, baseline year, follow-up time, educational level, body mass index, smoking, diabetes, systolic blood pressure, cholesterol, and physical activity. Sensitivity analysis was performed to reduce reverse causation bias by excluding individuals with follow-up less than 10 years. RESULTS Among 67 688 participants (34 968 [51.7%] women; age range, 25 to 74 years; mean [SD] age, 45.4 years), 7935 received a diagnosis of dementia over a mean follow-up of 25.4 years (range, 10 to 45 years). Psychological distress was significantly associated with all-cause dementia in a multivariable Poisson model, with incidence rate ratios from 1.17 (95% CI, 1.08-1.26) for exhaustion to 1.24 (95% CI, 1.11-1.38) for stress, and remained significant in sensitivity analyses. A Fine-Gray model showed significant associations (with hazard ratios from 1.08 [95% CI, 1.01-1.17] for exhaustion to 1.12 [95% CI, 1.00-1.25] for stress) for symptoms other than depressive mood (hazard ratio, 1.08 [95% CI, 0.98-1.20]). All the symptoms showed significant associations with competing risk of death in both models. CONCLUSIONS AND RELEVANCE In this cohort study, psychological distress symptoms were significantly associated with increased risk of all-cause dementia in the model emphasizing etiological risk. Associations with real incidence of dementia were diminished by the competing risk of death.
Collapse
Affiliation(s)
- Sonja Sulkava
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry and SleepWell Research Programme, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Genetics, Helsinki University Hospital, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Raimo Sulkava
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Amia Memory Clinics, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Tiina Paunio
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry and SleepWell Research Programme, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
10
|
Cao QL, Sun Y, Hu H, Wang ZT, Tan L, Yu JT. Association of Cerebral Small Vessel Disease Burden with Neuropsychiatric Symptoms in Non-Demented Elderly: A Longitudinal Study. J Alzheimers Dis 2022; 89:583-592. [PMID: 35912738 DOI: 10.3233/jad-220128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The links between cerebral small vessel disease (CSVD) burden and neuropsychiatric symptoms (NPS) have not been fully studied. OBJECTIVE We aimed to explore the associations of the CSVD burden with Neuropsychiatric Inventory (NPI) total scores and its subsyndromes in the elderly without dementia. METHODS We investigated 630 non-demented participants from the Alzheimer's Disease Neuroimaging Initiative. All of them had NPI assessments and 3 Tesla MRI scans at baseline and 616 had longitudinal NPI assessments during the follow-up. Linear mixed-effects models were used to investigate the cross-sectional and longitudinal associations of CSVD burden with NPI total scores and its subsyndromes. RESULTS Higher CSVD burden longitudinally predicted more serious neuropsychiatric symptoms, including NPS (p = 0.0001), hyperactivity (p = 0.0007), affective symptoms (p = 0.0096), and apathy (p < 0.0001) in the total participants. Lacunar infarcts (LIs), white matter hyperactivities (WMHs), and cerebral microbleeds (CMBs) might play important roles in the occurrence of NPS, since they were longitudinally associated with specific neuropsychiatric subsyndromes. LIs contributed to hyperactivity (p = 0.0094), psychosis (p = 0.0392), affective symptoms (p = 0.0156), and apathy (p < 0.0001). WMHs were associated with hyperactivity (p = 0.0408) and apathy (p = 0.0343). However, CMBs were only related to apathy (p = 0.0148). CONCLUSION CSVD burden was associated with multiple neuropsychiatric symptoms, suggesting the importance of monitoring and controlling vascular risk factors. Different markers of CSVD were associated with specific subsyndromes of NPS, suggesting that different markers tended to occur in different encephalic regions.
Collapse
Affiliation(s)
- Qiao-Ling Cao
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | | |
Collapse
|
11
|
Zhao Q, Xiang H, Cai Y, Meng SS, Zhang Y, Qiu P. Systematic evaluation of the associations between mental disorders and dementia: An umbrella review of systematic reviews and meta-analyses. J Affect Disord 2022; 307:301-309. [PMID: 35283178 DOI: 10.1016/j.jad.2022.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Increasing evidence support the correlation between mental disorders and the likelihood of developing dementia. We aim to conduct an umbrella review to assess the risk of dementia in patients with eight mental disorders. METHODS We searched PubMed, Embase, Web of science, CNKI, VIP, and Wanfang databases from inception to October 29, 2021. For each included meta-analysis, the effect size with a 95% confidence interval was estimated using either a random effect model or a fixed effect model, and between-study heterogeneity was expressed by I2 and Cochran's Q test. The ROBIS tool was used to assess the risk of bias. RESULTS A total of ten systematic reviews were included. Among these studies, we identified seven risk factors, including anxiety disorder, bipolar disorder, depression, late-life depression, post-traumatic stress disorder, schizophrenia, and sleep disorder. Light to moderate alcohol drinking was identified as a protective factor. The evaluation results of the ROBIS tool showed that nine systematic reviews had high risk of bias and one had low risk of bias. The strength of evidence supporting the associations between late-life depression and all-cause dementia, Alzheimer's disease, and vascular dementia was high; the strength of evidence supporting the association between depression and all-cause dementia was moderate. LIMITATIONS Most associations had low strength of evidence and high risk of bias. CONCLUSIONS This umbrella review shows that high and moderate evidence supports the associations between some mental disorders and dementia. More cohort studies are needed to support the associations between mental disorders and dementia.
Collapse
Affiliation(s)
- Qin Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hongyu Xiang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Steven Siyao Meng
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Yunyang Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peiyuan Qiu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
12
|
Inamura K, Shinagawa S, Nagata T, Tagai K, Nukariya K, Shigeta M. Education level is associated with neuropsychiatric symptoms in patients with amnestic-mild cognitive impairment. Psychogeriatrics 2022; 22:343-352. [PMID: 35181960 DOI: 10.1111/psyg.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined differences in the severity of neuropsychiatric symptom (NPS) subsyndromes according to education level among patients with amnestic-mild cognitive impairment (a-MCI) with the aim of identifying patient demographics related to NPS subsyndromes. METHODS Overall, 140 patients with a-MCI were included. We divided the patients into three groups according to their educational level (primary education, middle education, and high education) and compared their demographics. To explore the severity of NPS subsyndromes according to educational level, we used the Neuropsychiatric Inventory (NPI) after adjustments for the Mini-Mental State Examination (MMSE) score. Finally, NPS subsyndromes that were identified as being related to educational level were further explored using a general linear model (GLM). RESULTS Significant differences in several demographics were observed among the three groups. Among the NPS subsyndromes, the scores for aggressiveness were significantly higher in the primary and high education groups than in the middle education group, while the apathy/eating problem scores were significantly higher in the primary education group than in the other groups. The GLM analyses showed that aggressiveness was related to marital status and the Zarit Caregiver Burden Interview (ZBI-J) score, while apathy/eating problems were related to the instrumental activities of daily living (IADL) percentage, the ZBI-J score, and the education level in years. CONCLUSIONS Among NPS subsyndromes, aggressiveness and apathy/eating problems differed according to education level in patients with a-MCI. A GLM analysis suggested that not only education level, but also various other factors should be considered when determining the need for NPS interventions.
Collapse
Affiliation(s)
- Keisuke Inamura
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
13
|
RETRACTED - Risk factors for mild behavioral impairment in non-demented geriatrics: a population-based survey in Taiwan. Int Psychogeriatr 2022; 34:191-199. [PMID: 33966688 DOI: 10.1017/s1041610221000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate potential risk factors for mild behavioral impairment (MBI) among non-demented geriatrics. DESIGN Population-based, cross-sectional survey. SETTING Taiwan Alzheimer Disease Association (TADA) Database. PARTICIPANTS Participants were selected by multistage random sampling of all Taiwan counties. They received in-person interviews between December 2011 and March 2013. MEASUREMENTS Demographic data, lifestyle and habits, medical comorbidities, cognitive status measured by the Taiwanese Mini-Mental Status Examination (TMSE) and presence of MCI of the participants were collected. Subjects were distributed to the MBI and non-MBI groups. These factors had been evaluated for their effects on MBI in the univariate and multivariable logistic regression models. RESULTS In total, 6,196 non-demented participants aged 65 years or older, including 409 MBI and 5,787 non-MBI participants, were recruited. After adjustment for age, sex, education, body mass index, lifestyle and habits, medical comorbidities, and MCI, good sleep was associated with lower risk of MBI (OR 0.09, 95% CI 0.07 - 0.12). Low body weight (OR 2.01, 95% CI 1.21-3.33), low-to-medium education (OR 1.40, 95%CI 1.06-1.85; OR 2.32, 95% CI 1.67-3.21), medical comorbidities of hypertension (OR 1.56, 95% CI 1.25-1.95), hyperlipidemia (OR 1.29, 95% CI 1.00-1.67), cancer (OR 2.05, 95% CI 1.37-3.06) were significantly associated with increased MBI risk. MCI neither increased nor decreased risk of MBI (OR 1.00, 95% CI 0.76-1.32). CONCLUSIONS Good sleep was associated with lower MBI risk. Underweight, lower education, medical comorbidities of cancer, hypertension, hyperlipidemia were predictive of MBI.
Collapse
|
14
|
Stella F, Pais MV, Loureiro JC, Radanovic M, Forlenza OV. Neuropsychiatric symptoms and cerebrovascular risk in non-demented elders: cross-sectional study using the mild behavioural impairment checklist (MBI-C). Psychogeriatrics 2022; 22:55-66. [PMID: 34704636 DOI: 10.1111/psyg.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) may represent early clinical manifestations of evolving brain diseases. Studies underpin the occurrence of NPS in the context of mild cognitive impairment (MCI) and prodromal Alzheimer's disease, where symptoms referred to as 'mild behavioural impairment' (MBI) have been shown to predict conversion to dementia and to hasten cognitive/functional decline. However, the association between NPS and cerebrovascular risk factors has been poorly investigated, despite the high prevalence of the latter among individuals with MCI. The aim of the present study was to investigate the association between MBI and cerebrovascular risk in a clinical sample of non-demented elders. METHODS Sixty-five MCI and 15 cognitively unimpaired older adults were cross-sectionally assessed with the Mild Behavioural Impairment Checklist (MBI-C), using the cut-off score > 6.5 to define positive screening. Participants were submitted to the Hachinski Ischaemic Score (HIS) to account for cerebrovascular symptoms, vascular risk, and related comorbidities. Neuroimaging scans (magnetic resonance imaging and/or 18F-fluorodeoxyglucose-positron emission tomography) and apolipoprotein E genotype were obtained. RESULTS Positive associations were found between total MBI-C scores and increasing number of comorbidities present (0-2 comorbidities), but not with three comorbidities. Two domains of the MBI-C-impulse dyscontrol and social inappropriateness-followed the same trend of the MBI-C total score, with higher scores with the increasing numbers of comorbidities. No significant associations were found between MBI symptoms and HIS or cerebrovascular burden in neuroimaging assessment. CONCLUSION We found weak associations between MBI-C total score and the presence of comorbidities with cerebrovascular risk, but not with structural or functional neuroimaging abnormalities or HIS. This finding may represent that the presence of comorbidities adds limited risk to the occurrence of MBI in this sample of non-demented elders.
Collapse
Affiliation(s)
- Florindo Stella
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil.,UNESP-Universidade Estadual Paulista, Instituto de Biociências, Sao Paulo, Brazil
| | - Marcos V Pais
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Júlia C Loureiro
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| |
Collapse
|
15
|
Novotný JS, Gonzalez‐Rivas JP, Medina‐Inojosa JR, Lopez‐Jimenez F, Geda YE, Stokin GB. Investigating cognition in midlife. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12234. [PMID: 35005209 PMCID: PMC8719351 DOI: 10.1002/trc2.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022]
Abstract
We here posit that measurements of midlife cognition can be instructive in understanding cognitive disorders. Even though molecular events signal possible onset of cognitive disorders decades prior to their clinical diagnoses, cognition and its possible early changes in midlife remain poorly understood. We characterize midlife cognition in a cognitively healthy population-based sample using the Cogstate Brief Battery and test for associations with cardiovascular, adiposity-related, lifestyle-associated, and psychosocial variables. Learning and working memory showed significant variability and vulnerability to psychosocial influences in midlife. Furthermore, midlife aging significantly and progressively increased prevalence of suboptimal cognitive performance. Our findings suggest that physiological changes in cognition, measured with simple tests suitable for use in everyday clinical setting, may signal already in midlife the first clinical manifestations of the presymptomatic biologically defined cognitive disorders. This pilot study calls for longitudinal studies investigating midlife cognition to identify clinical correlates of biologically defined cognitive disorders.
Collapse
Affiliation(s)
- Jan S. Novotný
- Translational Aging and Neuroscience Program, Centre for Translational Medicine, International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Juan P. Gonzalez‐Rivas
- Kardiovize Study, International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
| | - Jose R. Medina‐Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo ClinicRochesterMinnesotaUSA
| | - Francisco Lopez‐Jimenez
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo ClinicRochesterMinnesotaUSA
| | - Yonas E. Geda
- Division of Alzheimer's Disease and Memory Disorders ProgramDepartment of NeurologyBarrow Neurological InstitutePhoenixArizonaUSA
| | - Gorazd B. Stokin
- Translational Aging and Neuroscience Program, Centre for Translational Medicine, International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
- Translational Aging and Neuroscience ProgramMayo ClinicRochesterMinnesotaUSA
- Division of NeurologyUniversity Medical CentreLjubljanaSlovenia
| |
Collapse
|
16
|
Pentkowski NS, Rogge-Obando KK, Donaldson TN, Bouquin SJ, Clark BJ. Anxiety and Alzheimer's disease: Behavioral analysis and neural basis in rodent models of Alzheimer's-related neuropathology. Neurosci Biobehav Rev 2021; 127:647-658. [PMID: 33979573 DOI: 10.1016/j.neubiorev.2021.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
Alzheimer's disease (AD) pathology is commonly associated with cognitive decline but is also composed of neuropsychiatric symptoms including psychological distress and alterations in mood, including anxiety and depression. Emotional dysfunction in AD is frequently modeled using tests of anxiety-like behavior in transgenic rodents. These tests often include the elevated plus-maze, light/dark test and open field test. In this review, we describe prototypical behavioral paradigms used to examine emotional dysfunction in transgenic models of AD, specifically anxiety-like behavior. Next, we summarize the results of studies examining anxiety-like behavior in transgenic rodents, noting that the behavioral outcomes using these paradigms have produced inconsistent results. We suggest that future research will benefit from using a battery of tests to examine emotional behavior in transgenic AD models. We conclude by discussing putative, overlapping neurobiological mechanisms underlying AD-related neuropathology, stress and anxiety-like behavior reported in AD models.
Collapse
Affiliation(s)
- Nathan S Pentkowski
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87109, Mexico.
| | | | - Tia N Donaldson
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87109, Mexico
| | - Samuel J Bouquin
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87109, Mexico
| | - Benjamin J Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87109, Mexico.
| |
Collapse
|
17
|
Abstract
Although Alzheimer’s disease (AD) is primarily a neurocognitive disorder, it also results in prominent neuropsychiatric symptoms (NPS). Much literature has investigated the NPS of apathy and depression in association with AD, but relatively less is known regarding anxiety, the third most common NPS in this disorder. The prevalence of anxiety symptoms in AD is about 40%, and it can be a prelude of AD. Anxiety can be especially present among patients with mild cognitive impairment, mild dementia, or early-onset forms of the disease, and can promote progression or conversion to Alzheimer’s clinical syndrome. A number of studies have established that anxiety is associated with positive amyloid scans, mesial temporal changes with atrophy and hypometabolism in the entorhinal region, and neurofibrillary tangles present on pathological examination of this region. In addition to psychosocial factors, proposed neurobiological mechanisms for increased anxiety in AD include decreased sensorimotor gating, relatively increased activation of amygdalae or the Salience Network, and the presence of comorbid pathology, particularly Lewy bodies. Having management strategies for anxiety in patients with AD is important as anxiety can worsen cognitive deficits. Interventions involve psychological support, behavioral management, and the judicious use of the psychiatric armamentarium of medications.
Collapse
Affiliation(s)
- Mario F Mendez
- Department of Neurology, Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA); Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
18
|
Mendez MF. Degenerative dementias: Alterations of emotions and mood disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:261-281. [PMID: 34389121 DOI: 10.1016/b978-0-12-822290-4.00012-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Degenerative dementias such as Alzheimer's disease and frontotemporal dementia result in distinct alterations in emotional processing, emotional experiences, and mood. The neuropathology of these dementias extends to structures involved in emotional processing, including the basolateral limbic network (orbitofrontal cortex, anterior temporal lobe, amygdala, and thalamus), the insula, and ventromedial frontal lobe. Depression is the most common emotion and mood disorder affecting patients with Alzheimer's disease. The onset of depression can be a prodromal sign of this dementia. Anxiety can also be present early in the course of Alzheimer's disease and especially among patients with early-onset forms of the disease. In contrast, patients with behavioral variant frontotemporal dementia demonstrate hypoemotionality, deficits in the recognition of emotion, and decreased psychophysiological reactivity to emotional stimuli. They typically have a disproportionate impairment in emotional and cognitive empathy. One other unique feature of behavioral variant frontotemporal dementia is the frequent occurrence of bipolar disorder. The management strategies for these alterations of emotion and mood in degenerative dementias primarily involve the judicious use of the psychiatric armamentarium of medications.
Collapse
Affiliation(s)
- Mario F Mendez
- Behavioral Neurology Program, Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States; Neurology Service, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
| |
Collapse
|
19
|
Moriarty F, Savva GM, Grossi CM, Bennett K, Fox C, Maidment I, Loke YK, Steel N, Kenny RA, Richardson K. Cognitive decline associated with anticholinergics, benzodiazepines and Z-drugs: Findings from The Irish Longitudinal Study on Ageing (TILDA). Br J Clin Pharmacol 2020; 87:2818-2829. [PMID: 33270264 DOI: 10.1111/bcp.14687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/16/2020] [Accepted: 11/29/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS To estimate the association between patterns of anticholinergic, benzodiazepine and Z-drug medication use and change in cognitive function in middle-aged and older adults. METHODS This prospective cohort study used data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), including community-dwelling adults aged ≥50 years followed for up to 4 years (n = 7027). Cognitive function was assessed using the Mini Mental State Examination, animal naming test and word recall tests. Regular medication use was self-reported at baseline and follow-up interviews at 2 and 4 years. Pharmacy dispensing claims for a subset (n = 2905) allowed assessment of medication use between interviews and cumulative dosage. Medication use at consecutive waves of TILDA was analysed in relation to change in cognitive function between waves. RESULTS Strongly anticholinergic medications (Anticholinergic Cognitive Burden scale 3), benzodiazepines and Z-drugs were reported by 7.3%, 5.8% and 5.1% of participants, respectively, at any time during the study. Adjusting for potential confounders, new anticholinergic use between interviews was associated with change in recall score (-1.09, 95% confidence interval -1.64, -0.53) over 2 years compared to non-use, but not with MMSE (0.07; 95% CI -0.21, 0.34) or animal naming (-0.70; 95% CI -1.43, 0.03). The pharmacy claims analysis was consistent with this finding. Other hypothesised associations were not supported. CONCLUSIONS Except for new use of anticholinergic medications, no other findings supported a risk of cognitive decline over 2-year periods in this middle-aged and older cohort. Patients and prescribers should weigh this potential risk against potential benefits of commencing anticholinergic medications.
Collapse
Affiliation(s)
- Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - George M Savva
- Quadram Institute Bioscience, Norwich Research Park, Norwich, United Kingdom.,School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Carlota M Grossi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kathryn Richardson
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| |
Collapse
|
20
|
Kuring JK, Mathias JL, Ward L. Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis. J Affect Disord 2020; 274:247-261. [PMID: 32469813 DOI: 10.1016/j.jad.2020.05.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression, anxiety and PTSD appear to be linked to dementia, but it is unclear whether they are risk factors (causal or prodromal) for, comorbid with, or sequelae to (secondary effect of) dementia. Existing meta-analyses have examined depression or anxiety in all-cause dementia, Alzheimer's disease (AD) and vascular dementia (VaD), but have not considered post-traumatic stress disorder (PTSD), dementia with Lewy bodies (DLB), or frontotemporal dementia (FTD). The current meta-analysis examined the risk of developing dementia (AD, VaD, DLB, FTD, all-cause) in people with and without a history of clinically-significant depression, anxiety or PTSD in order to better understand the link between mental illness and dementia (PROSPERO number: CRD42018099872). METHODS PubMed, EMBASE, PsycINFO and CINAHL searches identified 36 eligible studies. RESULTS There is a higher risk of developing all-cause dementia and AD in people with previous depression, and a higher risk of all-cause dementia in people with prior anxiety, than in persons without this history. Prior PTSD was not associated with a higher risk of later being diagnosed with dementia. LIMITATIONS The data for anxiety, PTSD, DLB and FTD were limited. CONCLUSIONS Depression and anxiety appear to be risk factors for dementia, but longitudinal studies across adulthood (young adult/mid-life/older adult) are needed to evaluate the likely causal or prodromal nature of this risk. The link between PTSD and dementia remains unclear. Regular screening for new onset mental illness and for cognitive changes in older adults with a history of mental illness may assist with earlier identification of dementia.
Collapse
Affiliation(s)
- J K Kuring
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J L Mathias
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - L Ward
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| |
Collapse
|
21
|
Ai PH, Chen S, Liu XD, Zhu XN, Pan YB, Feng DF, Chen S, Xu NJ, Sun S. Paroxetine ameliorates prodromal emotional dysfunction and late-onset memory deficit in Alzheimer's disease mice. Transl Neurodegener 2020; 9:18. [PMID: 32398165 PMCID: PMC7216685 DOI: 10.1186/s40035-020-00194-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Neuropsychiatric symptoms (NPS) such as depression, anxiety, apathy, and irritability occur in prodromal phases of clinical Alzheimer’s disease (AD), which might be an increased risk for later developing AD. Here we treated young APP/PS1 AD model mice prophylactically with serotonin-selective re-uptake inhibitor (SSRI) paroxetine and investigated the protective role of anti-depressant agent in emotional abnormalities and cognitive defects during disease progress. Methods To investigate the protective role of paroxetine in emotional abnormalities and cognitive defects during disease progress, we performed emotional behaviors of 3 months old APP/PS1 mouse following oral administration of paroxetine prophylactically starting at 1 month of age. Next, we tested the cognitive, biochemical and pathological, effects of long term administration of paroxetine at 6 months old. Results Our results showed that AD mice displayed emotional dysfunction in the early stage. Prophylactic administration of paroxetine ameliorated the initial emotional abnormalities and preserved the eventual memory function in AD mice. Conclusion Our data indicate that prophylactic administration of paroxetine ameliorates the emotional dysfunction and memory deficit in AD mice. These neuroprotective effects are attributable to functional restoration of glutamate receptor (GluN2A) in AD mice.
Collapse
Affiliation(s)
- Peng-Hui Ai
- Department of Neurology and Institute of Neurology, Rui-jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Si Chen
- Collaborative Innovation Center for Brain Science, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xian-Dong Liu
- Department of Neurology and Institute of Neurology, Rui-jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiao-Na Zhu
- Collaborative Innovation Center for Brain Science, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yuan-Bo Pan
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Dong-Fu Feng
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Rui-jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Nan-Jie Xu
- Collaborative Innovation Center for Brain Science, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Shanghai Key Laboratory of Reproductive Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Suya Sun
- Department of Neurology and Institute of Neurology, Rui-jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| |
Collapse
|
22
|
Baek YH, Lee H, Kim WJ, Chung JE, Pratt N, Kalisch Ellett L, Shin JY. Uncertain Association Between Benzodiazepine Use and the Risk of Dementia: A Cohort Study. J Am Med Dir Assoc 2020; 21:201-211.e2. [DOI: 10.1016/j.jamda.2019.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 01/26/2023]
|
23
|
Frontal-executive dysfunction affects dementia conversion in patients with amnestic mild cognitive impairment. Sci Rep 2020; 10:772. [PMID: 31964931 PMCID: PMC6972894 DOI: 10.1038/s41598-020-57525-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 01/03/2020] [Indexed: 11/08/2022] Open
Abstract
Among mild cognitive impairment (MCI) patients, those with memory impairment (amnestic MCI, aMCI) are at a high risk of dementia. However, the precise cognitive domain, beside memory, that predicts dementia conversion is unclear. Therefore, we investigated the cognitive domain that predicts dementia conversion in a longitudinal aMCI cohort. We collected data of 482 aMCI patients who underwent neuropsychological tests and magnetic resonance imaging at baseline and were followed for at least 1 year. The patients were categorized according to number (1-4) and type of impaired cognitive domains (memory, language, visuospatial, and frontal-executive function). We evaluated dementia conversion risk in each group when compared to single-domain aMCI after controlling for age, education, diabetes and dyslipidemia. Baseline cortical thickness of each group was compared to that of 410 cognitively normal controls (NCs) after controlling for age, intracranial volume, diabetes and dyslipidemia. Compared to single-domain aMCI, aMCI patients with frontal-executive dysfunction at baseline had a higher risk of dementia conversion than aMCI patients with visuospatial or language dysfunction. Compared to NCs, aMCI patients with frontal-executive dysfunction had overall cortical thinning including frontal areas. Our findings suggest that aMCI patients with frontal-executive dysfunction have poor prognosis and,thus, should be considered for intervention therapy with a higher priority among aMCI patients.
Collapse
|
24
|
Pennington C, Ball H, Swirski M. Functional Cognitive Disorder: Diagnostic Challenges and Future Directions. Diagnostics (Basel) 2019; 9:diagnostics9040131. [PMID: 31569352 PMCID: PMC6963804 DOI: 10.3390/diagnostics9040131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 01/01/2023] Open
Abstract
Functional cognitive disorder describes patients with persistent, troublesome subjective cognitive complaints that are inconsistent with a recognized disease process, and where significant discrepancies are found between subjective and objectively observed cognitive functioning. The etiology is heterogeneous and potentially related to underlying psychological factors. Making a diagnosis of functional cognitive disorder can be challenging and there is the potential for misdiagnosis of early-stage neurodegeneration. We compared neuropsychological findings in three groups: functional cognitive disorder (FCD), mild cognitive impairment (MCI), and healthy controls. Participants were recruited from the ReMemBr Group Clinic, North Bristol NHS Trust, and via Join Dementia Research. Both the FCD and MCI groups showed elevated prospective and retrospective memory symptom scores. Performance on the Montreal cognitive assessment was equivalent in the FCD and MCI groups, both being impaired compared with the controls. The FCD group was younger than those with MCI. We discuss challenges and controversies in the diagnosis of functional cognitive disorder, alongside illustrative cases and proposals for areas of research priority.
Collapse
Affiliation(s)
- Catherine Pennington
- ReMemBr Group, University of Bristol, Bristol Brain Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
- Centre for Dementia Prevention, University of Edinburgh, 9A Bioquarter, 9 Little France Road, Edinburgh EH16 4UX, UK.
| | - Harriet Ball
- ReMemBr Group, University of Bristol, Bristol Brain Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
| | - Marta Swirski
- ReMemBr Group, University of Bristol, Bristol Brain Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
| |
Collapse
|
25
|
Tiel C, Sudo FK, Calmon AB. Neuropsychiatric symptoms and executive function impairments in Alzheimer's disease and vascular dementia: The role of subcortical circuits. Dement Neuropsychol 2019; 13:293-298. [PMID: 31555401 PMCID: PMC6753905 DOI: 10.1590/1980-57642018dn13-030005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) in dementia are prevalent, under-recognized and little studied regarding their pathophysiological aspects. The pathophysiological mechanism, as well as the possible role of vascular lesions in the genesis of these symptoms, are still matters of debate. OBJECTIVE to describe and compare the prevalence and severity of NPS in subjects with Alzheimer's disease (AD) and vascular dementia (VaD). METHODS a cross-sectional study involving 82 outpatients, divided into two groups (AD × VaD), was conducted. Patients were submitted to the Cambridge Cognitive Test (CAMCOG), the Clock Drawing Test (CLOX 1 and 2), the Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating (CDR) scale. Neuroimaging was scored using the de Leon and Fazekas scales. RESULTS 90.8% of the patients had at least one neuropsychiatric symptom. There were statistical differences on the CLOX test and in the apathy symptoms between AD and VaD groups. Apathy and disinhibition proved more prevalent in patients with higher vascular load. CONCLUSION apathy and impaired executive function may reflect vascular damage in subcortical circuits in dementia patients.
Collapse
Affiliation(s)
- Chan Tiel
- Universidade de VassourasMedical SchoolVassourasRJBrazilUniversidade de Vassouras (UV), Medical School, Vassouras, Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de JaneiroDepartment of NeurologyRio de JaneiroRJBrazilDepartment of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
| | - Felipe Kenji Sudo
- Instituto D’Or de Ensino e PesquisaMemory ClinicRio de JaneiroRJBrazilMemory Clinic, Instituto D’Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil.
| | - Ana Beatriz Calmon
- Universidade de VassourasMedical SchoolVassourasRJBrazilUniversidade de Vassouras (UV), Medical School, Vassouras, Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de JaneiroDepartment of NeurologyRio de JaneiroRJBrazilDepartment of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
26
|
Hoostal S, Atkinson DM. The Challenges of Diagnosing Psychotic Depression in Older Patients. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190510-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
27
|
Valente ES, Caramelli P, Gambogi LB, Mariano LI, Guimarães HC, Teixeira AL, de Souza LC. Phenocopy syndrome of behavioral variant frontotemporal dementia: a systematic review. ALZHEIMERS RESEARCH & THERAPY 2019; 11:30. [PMID: 30935398 PMCID: PMC6444822 DOI: 10.1186/s13195-019-0483-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The phenocopy syndrome of behavioral variant of frontotemporal dementia (phFTD) refers to patients presenting with neuropsychiatric symptoms mimicking the behavioral variant frontotemporal dementia (bvFTD), but lacking frontotemporal atrophy/hypometabolism on neuroimaging and not evolving to dementia during the follow-up. It is important to recognize phFTD for clinical and research purposes. Objective The aim of this study was to perform a systematic review of the available literature on phFTD taking into account its clinical, cognitive, imaging, genetic, and pathological features. Methods and results We searched for the following terms in two electronic databases (PubMed and Scopus): “frontotemporal dementia and slowly progressive,” “frontotemporal dementia and phenocopy,” “frontotemporal dementia and non-progressive,” “frontotemporal dementia and benign progression,” and “frontotemporal dementia and benign.” We did not include review articles. Papers had to be written in English, French, Portuguese, or Spanish. Overall, 235 studies were retrieved in the initial search. A total of 31 studies composed the final selection, comprising 292 patients. Patients with phFTD are predominantly male and have no major cognitive deficits, with globally preserved executive functions and episodic memory. Some cases (n = 7) of slowly progressive FTD have been associated with C9orf72 genetic expansion. There are only four reports of phFTD neuropathological data, with two patients with no neurodegenerative findings and two with frontotemporal lobar degeneration with ubiquitin-positive inclusions. Conclusion The neurobiological underpinnings of phFTD remain unknown. It is controversial whether phFTD belongs to the FTD spectrum. Studies with biomarkers and pathological data are needed to solve the phFTD conundrum.
Collapse
Affiliation(s)
- Elizabeth Sakamoto Valente
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (sala 100, Bloco M1), Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-010, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (sala 100, Bloco M1), Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-010, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190/sl 243, Belo Horizonte, MG, 30130-100, Brazil
| | - Leandro Boson Gambogi
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (sala 100, Bloco M1), Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-010, Brazil
| | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (sala 100, Bloco M1), Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-010, Brazil
| | - Henrique Cerqueira Guimarães
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (sala 100, Bloco M1), Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-010, Brazil
| | - Antônio Lúcio Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, Houston, TX, 77054, USA
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas (sala 100, Bloco M1), Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-010, Brazil. .,Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190/sl 243, Belo Horizonte, MG, 30130-100, Brazil.
| |
Collapse
|
28
|
Social brain, social dysfunction and social withdrawal. Neurosci Biobehav Rev 2019; 97:10-33. [DOI: 10.1016/j.neubiorev.2018.09.012] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/31/2018] [Accepted: 09/17/2018] [Indexed: 01/07/2023]
|
29
|
James SN, Davis D, O'Hare C, Sharma N, John A, Gaysina D, Hardy R, Kuh D, Richards M. Lifetime affective problems and later-life cognitive state: Over 50 years of follow-up in a British birth cohort study. J Affect Disord 2018; 241:348-355. [PMID: 30144717 PMCID: PMC6137547 DOI: 10.1016/j.jad.2018.07.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Affective problems increase the risk of dementia and cognitive impairment, yet the life course dimension of this association is not clearly understood. We aimed to investigate how affective problems across the life course relate to later-life cognitive state. METHODS Data from 1269 participants from the Medical Research Council National Survey of Health and Development (NSHD, the British 1946 birth cohort) were used. Prospectively-assessed measures of affective symptoms spanning ages 13-69 and categorised into case-level thresholds. Outcomes consisted of a comprehensive measure of cognitive state (Addenbrooke's Cognitive Examination (ACE-III)), verbal memory, and letter search speed and accuracy at age 69. RESULTS Complementary life course models demonstrated that having 2 or more case-level problems across the life course was most strongly associated with poorer cognitive outcomes, before and after adjusting for sex, childhood cognition, childhood and midlife occupational position and education. LIMITATIONS A disproportionate loss to follow-up of those who had lower childhood cognitive scores may have led to underestimation of the strength of associations. DISCUSSION Using a population-based prospective study we provide evidence that recurrent lifetime affective problems predicts poorer later-life cognitive state, and this risk can be already manifest in early old age (age 69). Our findings raise the possibility that effective management to minimise affective problems reoccurring across the life course may reduce the associated risk of cognitive impairment and decline.
Collapse
Affiliation(s)
- Sarah-Naomi James
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Celia O'Hare
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Nikhil Sharma
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Amber John
- EDGE Lab, School of Psychology, University of Sussex, BN1 9RH, Brighton, United Kingdom
| | - Darya Gaysina
- EDGE Lab, School of Psychology, University of Sussex, BN1 9RH, Brighton, United Kingdom
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Diana Kuh
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom.
| |
Collapse
|
30
|
Levada OA, Troyan AS, Cherednichenko NV. Specific Cognitive-Psychopathological Phenotypes in Patients With Early Stages of Subcortical Vascular Neurocognitive Disorders: A Hospital-Based Case-Control Study. J Geriatr Psychiatry Neurol 2018; 31:256-264. [PMID: 30037284 DOI: 10.1177/0891988718790418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of subcortical vascular neurocognitive disorders' (ScVNCDs) is currently based on neuropsychological and neuroimaging approaches; nevertheless, clinical features, apart from cognitive impairments (CI), may provide additional information about ScVNCD phenotypes. We aimed to determine whether CI and neuropsychiatric symptoms (NPS) form such clinical phenotypes in the mild and early stage of major ScVNCD. METHODS Our sample included 88 cognitively normal elderly individuals, 100 patients with mild ScVNCD, and 60 patients with early major ScVNCD. All participants had neuropsychological, neuropsychiatric, neurological, and functional evaluations. The prevalence of NPS was based on the neuropsychiatric inventory. The statistical analyses included parametric and nonparametric tests and multivariate regression. RESULTS The severity of executive dysfunction increased through stages of ScVNCD progression ( P < .0001). The NPS with significant predictive value for mild ScVNCD membership was depression (odds ratio [OR] = 7.4), whereas for early major ScVNCD were depression (OR = 5.5) and apathy (OR = 7.6). Those distinguishing NPS and impairments of executive tests' performance significantly correlated ( P < .05) in patients with mild/major ScVNCD. CONCLUSION Significant correlation between pathognomonic cognitive and NPS in compared groups suggest that dysexecutive-depressive syndrome can be the main phenotype in mild ScVNCD, while dysexecutive-depressive-apathetic syndrome in the early stage of major ScVNCD. Obtained cognitive-psychopathological phenotypes may allow a better comprehension of the ScVNCD pathophysiology and improve the diagnostic and therapeutic approach.
Collapse
Affiliation(s)
- Oleg A Levada
- 1 State Institution, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
| | - Alexandra S Troyan
- 1 State Institution, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
| | - Nataliya V Cherednichenko
- 1 State Institution, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
| |
Collapse
|
31
|
Tapiainen V, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. The risk of Alzheimer's disease associated with benzodiazepines and related drugs: a nested case-control study. Acta Psychiatr Scand 2018; 138:91-100. [PMID: 29851063 DOI: 10.1111/acps.12909] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the association between benzodiazepine and related drug (BZDR) use and risk of Alzheimer's disease (AD) with cumulative consumption and duration of use based models. METHOD A nationwide nested case-control study of all Finnish community-dwelling persons who received clinically verified AD diagnosis in 2005-2011 (N = 70 719) and their matched controls (N = 282 862). AD diagnosis was based on DSM-IV and NINCDS-ADRDA criteria. BZDR purchases were extracted from the Prescription Register since 1995. The association between BZDR use and AD was assessed using conditional logistic regression with 5-year lag time between exposure and outcome. RESULTS Benzodiazepine and related drug use was associated with modestly increased risk of AD (adjusted OR 1.06, 95% CI 1.04-1.08). A dose-response relationship was observed with both cumulative consumption and duration. Adjustment for other psychotropics removed the cumulative dose-response relationship by attenuating the ORs in the highest dose category. CONCLUSION Benzodiazepine and related drug use in general was associated with modestly increased risk of AD. No major differences were observed between different subcategories of BZDRs (i.e. benzodiazepines, Z drugs, short-/medium-acting or long-acting BZDRs). As dose-response relationship abolished after adjustment for other psychotropics, it is possible that the association may partially be due to antidepressants and/or antipsychotics, or concomitant use of these medications.
Collapse
Affiliation(s)
- V Tapiainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - H Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - J Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - S Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - A-M Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
32
|
Jenkins C, Feldman G. Recognition of preclinical signs of dementia: A qualitative study exploring the experiences of family carers and professional care assistants. J Clin Nurs 2018; 27:1931-1940. [PMID: 29495091 DOI: 10.1111/jocn.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To identify preclinical signs of dementia by exploring the experiences of family caregivers and professional care assistants. BACKGROUND Dementia results in disability, emotional strain and financial loss for people with dementia, family members and nations. Informal identification of social and behavioural risk signifiers could facilitate timely interventions with potential to delay onset of serious disability. DESIGN A retrospective qualitative approach using a naturalistic interpretive design was used. Focus groups enabled in-depth understanding of the participants' experiences of life or work with people who subsequently developed dementia. METHODS Purposive sampling was used to recruit family carers and professional carers who had cared for people who later developed dementia. The data from focus groups were fully transcribed and anonymised, and transcripts were analysed by two researchers. These researchers coded and analysed the transcripts independently; subsequently, overlapping and similar themes were identified and consensus reached on final themes. A third researcher was invited to review the analysis and ensure trustworthiness of the study findings. RESULTS Findings revealed that preclinical signs of dementia were identifiable in retrospect Participants' accounts resulted in four themes, "Lowered Threshold of Frustration", "Insight and Coping Strategies," "Early signs of poor memory" and "Alarming Events." CONCLUSIONS Earlier recognition of preclinical signs of dementia would allow affected individuals to follow health promotion advice and plan for the future. Identification of social exclusion prior to diagnosis has implications for antistigma campaigns and development of "dementia-friendly communities." RELEVANCE TO CLINICAL PRACTICE Healthcare professionals could work with those at risk, facilitating lifestyle changes to postpone symptoms and advance planning for improved autonomy. Predementia should be viewed as a disability for which reasonable adjustments can be made at a community level, to enhance and extend emotional well-being and social inclusion.
Collapse
|
33
|
Nyunt MSZ, Soh CY, Gao Q, Gwee X, Ling ASL, Lim WS, Lee TS, Yap PLK, Yap KB, Ng TP. Characterisation of Physical Frailty and Associated Physical and Functional Impairments in Mild Cognitive Impairment. Front Med (Lausanne) 2017; 4:230. [PMID: 29326936 PMCID: PMC5741611 DOI: 10.3389/fmed.2017.00230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/01/2017] [Indexed: 01/20/2023] Open
Abstract
Objective To characterize the physical frailty phenotype and its associated physical and functional impairments in mild cognitive impairment (MCI). Method Participants with MCI (N = 119), normal low cognition (NLC, N = 138), and normal high cognition (NHC, N = 1,681) in the Singapore Longitudinal Ageing Studies (SLAS-2) were compared on the prevalence of physical frailty, low lean body mass, weakness, slow gait, exhaustion and low physical activity, and POMA balance and gait impairment and fall risk. Results There were significantly higher prevalence of frailty in MCI (18.5%), than in NLC (8.0%) and NHC (3.9%), and pre-frailty in MCI (54.6%), NLC (52.9%) than in NHC (48.0%). Age, sex, and ethnicity-adjusted OR (95% CI) of association with MCI (versus NHC) for frailty were 4.65 (2.40–9.04) and for pre-frailty, 1.67 (1.07–2.61). Similar significantly elevated prevalence and adjusted ORs of association with MCI were observed for frailty-associated physical and functional impairments. Further adjustment for education, marital status, living status, comorbidities, and GDS significantly reduced the OR estimates. However, the OR estimates remained elevated for frailty: 3.86 (1.83–8.17), low body mass: 1.70 (1.08–2.67), slow gait: 1.84 (1.17–2.89), impaired gait: 4.17 (1.98–8.81), and elevated fall risk 3.42 (1.22–9.53). Conclusion Two-thirds of MCI were physically frail or pre-frail, most uniquely due to low lean muscle mass, slow gait speed, or balance and gait impairment. The close associations of frailty and physical and functional impairment with MCI have important implications for improving diagnostic acuity of MCI and targetting interventions among cognitively frail individuals to prevent dementia and disability.
Collapse
Affiliation(s)
- Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Chang Yuan Soh
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyi Gwee
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Audrey S L Ling
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tih Shih Lee
- Duke Medical School, National University of Singapore, Singapore, Singapore
| | - Philip L K Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng Bee Yap
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
34
|
Wen MC, Chan LL, Tan LC, Tan EK. Mild cognitive impairment in Parkinson's disease: a distinct clinical entity? Transl Neurodegener 2017; 6:24. [PMID: 28919975 PMCID: PMC5596909 DOI: 10.1186/s40035-017-0094-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/30/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mild cognitive impairment in Parkinson's disease (PD-MCI) is a common clinical condition. Understanding its pathology and clinical features is important for early intervention before the onset of dementia. In the past, variable definitions and differences in neuropsychological batteries generated divergent results of the affected cognitive patterns. MAIN BODY The introduction of PD-MCI criteria by the Movement Disorders Society (MDS) Task Force provides a more uniform system for defining and measuring PD-MCI and may improve the validity of future research. PD-MCI is likely to be heterogeneous since it can coexist with Alzheimer's disease and/ or Lewy body pathologies in PD. Pathogeneses of neuropsychiatric disturbances, such as depression, anxiety and apathy, are associated with PD with or without MCI. In addition, cognitive reserve formed by patients' unique life experiences may influence the outward cognitive performance despite the presence of the aforementioned pathogeneses and hence alter the diagnosis of MCI. CONCLUSION The overlap of cognitive impairment across different neurodegenerative diseases suggests that PD-MCI is likely to result from a mixture of complex pathophysiologies, rather than being a distinct pathologic entity. Differentiating MCI from other organic symptoms in PD would facilitate novel therapeutic strategies.
Collapse
Affiliation(s)
- Ming-Ching Wen
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Ling Ling Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Louis C.S. Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eng King Tan
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
35
|
Pantzar A, Atti AR, Fratiglioni L, Fastbom J, Bäckman L, Laukka EJ. Cognitive performance in unipolar old-age depression: a longitudinal study. Int J Geriatr Psychiatry 2017; 32:675-684. [PMID: 27246314 DOI: 10.1002/gps.4510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/02/2016] [Accepted: 04/22/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Previous studies on cognitive deficits in acute and remitted states of old-age depression have shown mixed findings. The episodic nature of depression makes repeated assessment of cognitive performance important in order to address reversibility and stability of cognitive deficits. METHODS Dementia-free older participants (≥60 years) from the population-based Swedish National Study on Aging and Care in Kungsholmen who completed neuropsychological testing at baseline (T1) and follow-up (T2) formed the basis of the study sample. Participants were grouped according to depression status at T1 and T2: depressed-remitted (n = 32), remitted-depressed (n = 45), and nondepressed-depressed (n = 29). These groups were compared with a group of randomly selected and matched (age, gender, education, and follow-up time) healthy controls (n = 106) over a period of maximum 6 years. RESULTS Mixed ANCOVAs, controlling for age and gender, revealed depression-related deficits for processing speed, attention, executive function, and category fluency. In remitted states, only processing speed and attention were affected. However, these deficits were attenuated after exclusion of persons using benzodiazepine medications. A general pattern of cognitive decline was observed across all groups for processing speed, executive function, category fluency, and episodic and semantic memory; persons transitioning from a nondepressed to depressed state tended to show exacerbated cognitive decline. CONCLUSIONS The results support the notion that cognitive deficits in depression may be more transient than stable. Consequently, cognitive deficits in depression might be regarded as potential treatment targets rather than stable vulnerabilities. As such, repeated assessment of cognitive functioning may provide an additional marker of treatment response.
Collapse
Affiliation(s)
- Alexandra Pantzar
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna Rita Atti
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Bologna University, Bologna, Italy
| | - Laura Fratiglioni
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| |
Collapse
|
36
|
Biétry FA, Pfeil AM, Reich O, Schwenkglenks M, Meier CR. Benzodiazepine Use and Risk of Developing Alzheimer's Disease: A Case-Control Study Based on Swiss Claims Data. CNS Drugs 2017; 31:245-251. [PMID: 28078633 DOI: 10.1007/s40263-016-0404-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A possible association between benzodiazepine use and Alzheimer's disease (AD) has been hypothesized in previous studies. OBJECTIVES Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between previous benzodiazepine use and the risk of AD. METHODS We conducted a matched case-control study and identified 1438 incident AD cases between 2013 and 2014 based on recorded first-time use of drugs used to treat AD [i.e., acetylcholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and the N-methyl-D-aspartate receptor antagonist memantine] and matched one control to each case on age, sex, index date, and residence (canton). Because the initiation of benzodiazepine use shortly before the AD diagnosis date may occur as a result of symptomatic treatment of prodromal symptoms of early major neurocognitive disorder, we introduced an induction period of 2 years before the AD diagnosis date. Additionally, we categorized medication use by duration of use prior to the index date using prescriptions. We applied conditional logistic regression analyses to calculate odds ratios with 95% confidence intervals and adjusted for use of antidepressants. RESULTS The crude odds ratio (95% confidence interval) of developing AD for patients starting benzodiazepine treatment was 1.71 (1.17-2.99) in the year before diagnosis and 1.19 (0.82-1.72) in the third year before diagnosis. After accounting for benzodiazepine use initiated during the prodromal phase, benzodiazepine use was not associated with an increased risk of developing AD; long-term benzodiazepine use (≥30 prescriptions) yielded an adjusted odds ratio of 0.78 (0.53-1.14). CONCLUSIONS After taking into consideration a possible protopathic bias in the 2 years preceding the AD diagnosis date, benzodiazepine use was not associated with an increased risk of developing AD.
Collapse
Affiliation(s)
- Fabienne A Biétry
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Alena M Pfeil
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | | | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
37
|
Levada OA, Cherednichenko NV, Troyan AS. Neuropsychiatric Symptoms in Patients with the Main Etiological Types of Mild Neurocognitive Disorders: A Hospital-Based Case-Control Study. Front Psychiatry 2017; 8:75. [PMID: 28522977 PMCID: PMC5415620 DOI: 10.3389/fpsyt.2017.00075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The diagnostic construct of mild neurocognitive disorders (MNCDs) is substantially congruent with previously proposed criteria for mild cognitive impairment (MCI). MNCD/MCI is associated with neuropsychiatric symptoms (NPS). Previous studies have examined the prevalence of NPS in amnestic and non-amnestic MCI subtypes; however, no studies exist for etiological types of MNCD. We aimed to estimate the prevalence of NPS in patients with MNCD due to Alzheimer's disease (MNCD-AD) and subcortical vascular MNCD (ScVMNCD) and to determine whether NPS would expand these MNCD phenotypes. METHODS The sample comprised 70 patients with MNCD-AD, 70 patients with ScVMNCD, and 55 cognitively normal elderly persons (CNEP). The diagnosis of MNCD-AD was made according to DSM-5 criteria for possible MNCD-AD. ScVMNCD patients fulfilled the DSM-5 criteria of the probable vascular MNCD and the diagnostic criteria for subcortical vascular MCI according to Frisoni et al. (1). The prevalence of NPS was based on the neuropsychiatric inventory. The statistical analyses included parametric and non-parametric tests, multivariate regression, and Spearman's correlation coefficient. RESULTS About 69.1% of CNEP, 97.1% of MNCD-AD, and 100% of ScVMNCD patients had one or more NPS. The prevalence of NPS in both MNCD groups was significantly higher than that in CNEP. The most prevalent NPS that had significant differential diagnostic value in separating MNCD-AD from ScVMNCD, as well as MNCD from CNEP, were anxiety (81.43%) and irritability (67.14%) in MNCD-AD and depression (81.43%) in ScVMNCD. In both MNCD groups, we observed significant (p < 0.05) correlations between all distinguishing NPS and the differential cognitive disturbances: the amnestic syndrome in MNCD-AD and executive dysfunction in ScVMNCD. CONCLUSION NPS occur in the majority of persons with MNCD-AD and ScVMNCD. Anxiety and irritability are the most prevalent NPS in MNCD-AD, as well as depression in ScVMNCD. The amnestic-anxious-irritable syndrome can be the main phenotype in MNCD-AD, on the other hand, the dysexecutive-depressive syndrome can be considered as the most prevalent clinical manifestation in ScVMNCD. Obtained data may be used for clinical differentiation of MNCD-AD and ScVMNCD patients.
Collapse
Affiliation(s)
- Oleg A Levada
- State Institution "Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine", Zaporizhzhia, Ukraine
| | - Nataliya V Cherednichenko
- State Institution "Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine", Zaporizhzhia, Ukraine
| | - Alexandra S Troyan
- State Institution "Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine", Zaporizhzhia, Ukraine
| |
Collapse
|
38
|
Karve SJ, Jimenez E, Mendez MF. Initial Heart Rate Reactivity to Socioemotional Pictures in Early-Onset Alzheimer's Disease. J Alzheimers Dis 2017; 60:1325-1332. [PMID: 29036817 DOI: 10.3233/jad-170319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with Alzheimer's disease (AD) often have generalized anxiety, particularly in early-onset AD (EOAD) or the first stages of their disease. This increased anxiety could be associated with decreased sensorimotor gating with increased attention to significant stimuli from AD pathology in the entorhinal cortex. We investigated whether widening initial attention to socioemotional stimuli was association with anxiety among 16 patients with first stage EOAD compared to 19 normal controls (NCs). The participants underwent assessment of their initial heart rate deceleration ("orienting response"; OR), a measure of attentional refocusing, to pictures (International Affective Picture Stimuli) varying in pleasant-unpleasant valence and social-nonsocial content. The results showed group differences; the EOAD patients had significantly larger ORs than the NCs across conditions, with larger ORs in each valence and social condition. In addition, the EOAD patients, but not the NCs, showed ORs to normally less threatening stimuli, particularly pleasant, but also less significantly, social stimuli. On the Neuropsychiatric Inventory, the ORs among the EOAD patients significantly correlated with anxiety scores. Together, these findings suggest that anxiety in mild EOAD may be associated with widening attentional refocusing to socioemotional stimuli, possibly reflecting decreased sensorimotor gating in the entorhinal cortex. This finding could be a potential biomarker for the first stages of AD.
Collapse
Affiliation(s)
- Simantini J Karve
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Elvira Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
39
|
Xu XY, Deng CQ, Wang J, Deng XJ, Xiao Q, Li Y, He Q, Fan WH, Quan FY, Zhu YP, Cheng P, Chen GJ. Plasma levels of soluble receptor for advanced glycation end products in Alzheimer's disease. Int J Neurosci 2016; 127:454-458. [PMID: 27323891 DOI: 10.1080/00207454.2016.1193861] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A decreased plasma level of soluble form of the receptor for advanced glycation end products (sRAGE) in patients with Alzheimer's disease (AD) has been reported. However, no evidence has shown whether the sRAGE plasma level of AD patients may differentiate from other types of dementia. METHODS Our study assessed sRAGE concentrations in the following 121 individuals in Chongqing area: 36 patients with AD, 12 with vascular dementia (VaD), 14 with mixed dementia (MD), 24 with other dementia (OD) including Parkinson's disease dementia, frontotemporal dementia, paralytic dementia and 35 cognitively normal controls. The total plasma level of sRAGE was determined using sandwich ELISA method. RESULTS sRAGE concentration in AD is significantly decreased compared with healthy controls. However, the receiver operating characteristic curve analysis of sRAGE between the AD and the control shows a low diagnostic accuracy. CONCLUSIONS Our results demonstrate that sRAGE may assist the diagnosis of AD from normal individuals, but cannot differentiate AD from VaD, MD or OD.
Collapse
Affiliation(s)
- Xiao-Yan Xu
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Chang-Qing Deng
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jian Wang
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Xiao-Juan Deng
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Qian Xiao
- b 2 Department of Gerontology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yuan Li
- c 3 Department of Geriatrics, Chongqing Mental Health Center , GeLeShan Branch, Chongqing , China
| | - Qi He
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Wen-Hui Fan
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Feng-Ying Quan
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yao-Ping Zhu
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Ping Cheng
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Guo-Jun Chen
- a 1 Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| |
Collapse
|
40
|
Gray SL, Dublin S, Yu O, Walker R, Anderson M, Hubbard RA, Crane PK, Larson EB. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ 2016; 352:i90. [PMID: 26837813 PMCID: PMC4737849 DOI: 10.1136/bmj.i90] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline. DESIGN Prospective population based cohort. SETTING Integrated healthcare delivery system, Seattle, Washington. PARTICIPANTS 3434 participants aged ≥ 65 without dementia at study entry. There were two rounds of recruitment (1994-96 and 2000-03) followed by continuous enrollment beginning in 2004. MAIN OUTCOMES MEASURES The cognitive abilities screening instrument (CASI) was administered every two years to screen for dementia and was used to examine cognitive trajectory. Incident dementia and Alzheimer's disease were determined with standard diagnostic criteria. Benzodiazepine exposure was defined from computerized pharmacy data and consisted of the total standardized daily doses (TSDDs) dispensed over a 10 year period (a rolling window that moved forward in time during follow-up). The most recent year was excluded because of possible use for prodromal symptoms. Multivariable Cox proportional hazard models were used to examine time varying use of benzodiazepine and dementia risk. Analyses of cognitive trajectory used linear regression models with generalized estimating equations. RESULTS Over a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia, of whom 637 developed Alzheimer's disease. For dementia, the adjusted hazard ratios associated with cumulative benzodiazepine use compared with non-use were 1.25 (95% confidence interval 1.03 to 1.51) for 1-30 TSDDs; 1.31 (1.00 to 1.71) for 31-120 TSDDs; and 1.07 (0.82 to 1.39) for ≥ 121 TSDDs. Results were similar for Alzheimer's disease. Higher benzodiazepine use was not associated with more rapid cognitive decline. CONCLUSION The risk of dementia is slightly higher in people with minimal exposure to benzodiazepines but not with the highest level of exposure. These results do not support a causal association between benzodiazepine use and dementia.
Collapse
Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, WA 98195-7630, US
| | - Sascha Dublin
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Onchee Yu
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Rod Walker
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Melissa Anderson
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, US
| | - Paul K Crane
- University of Washington Department of Medicine, Division of General Internal Medicine, Seattle, WA, US
| | - Eric B Larson
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| |
Collapse
|
41
|
David ND, Lin F, Porsteinsson AP. Trajectories of Neuropsychiatric Symptoms and Cognitive Decline in Mild Cognitive Impairment. Am J Geriatr Psychiatry 2016; 24:70-80. [PMID: 26525995 PMCID: PMC4691566 DOI: 10.1016/j.jagp.2015.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize the course of neuropsychiatric symptoms (NPS) in adults with mild cognitive impairment (MCI), and to examine baseline individual-level predictors and associated cognitive and functional outcomes. DESIGN A 2-year prospective cohort study. SETTING Multicenter clinical settings. PARTICIPANTS Five hundred sixty individuals with MCI at baseline. MEASUREMENTS NPS severity (measured using Neuropsychiatric Inventory Questionnaire) and cognitive and functional outcomes were assessed at baseline and every 6 months thereafter. Potential individual-level predictors were collected at baseline. RESULTS Three latent classes of NPS courses were identified using growth mixture modeling: a stable class in which a low NPS burden remained relatively unchanged over time (N = 503, 89.8%); a worsened class in which an initially moderate NPS burden increased (N = 39, 7.0%); and an improved class in which an initially high NPS burden decreased (N = 18, 3.2%). There were no associations between class membership and baseline individual characteristics. Members of the worsened class were 1.74 times more likely to be diagnosed with incident Alzheimer disease (AD) than members of the stable class (95% confidence interval: 1.07-2.84). The worsened class also showed significantly more rapid declines in cognitive and functional outcomes than the stable class. Class membership did not predict rate of brain atrophy. CONCLUSIONS Patients with MCI may experience different trajectories of NPS over time. Patients with worsening NPS may be at greater risk of developing AD and severe cognitive and functional impairment.
Collapse
Affiliation(s)
| | - Feng Lin
- University of Rochester School of Medicine and Dentistry,University of Rochester School of Nursing
| | - Anton P. Porsteinsson
- University of Rochester School of Medicine and Dentistry,Corresponding author: Anton P. Porsteinsson, M.D., Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 435 East Henrietta Road, Rochester, NY 14620, Telephone: 585-760-6550, Fax: 585-760-6572,
| | | |
Collapse
|
42
|
Waggel SE, Lipnicki DM, Delbaere K, Kochan NA, Draper B, Andrews G, Sachdev PS, Brodaty H. Neuroticism scores increase with late-life cognitive decline. Int J Geriatr Psychiatry 2015; 30:985-93. [PMID: 25581393 DOI: 10.1002/gps.4251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neuroticism has been reported as both a risk factor for cognitive decline and a characteristic that increases in parallel with the development of mild cognitive impairment (MCI) and dementia. However, the evidence for these associations is inconclusive, and whether effects are stronger for particular cognitive domains is unknown. We investigated these issues and determined if associations differ among different components of neuroticism. METHODS A neuroticism scale (NEO-FFI) and neuropsychological test battery were administered to 603 older adults without dementia, with 493 of these reassessed two years later. Diagnoses of MCI and dementia (at follow-up) were made, and global cognition and performance in six cognitive domains quantified. The neuroticism components were negative affect, self-reproach, and proneness to psychological distress. RESULTS For the whole sample, neuroticism scores remained stable between baseline (15.3 ± 7.0) and follow-up (15.5 ± 7.0), as did all neuroticism component scores. However, there were declines in global cognition (p < 0.05) and particular cognitive domains (p < 0.001). Higher neuroticism was associated with poorer cognition cross-sectionally (p < 0.01), but did not predict cognitive decline. For 43 participants who developed incident MCI or dementia, there were increases in neuroticism (15.3 ± 6.4 to 17.1 ± 8.3, p < 0.05) and negative affect (p < 0.05). Declines in all cognitive measures except executive function were associated with increases in neuroticism and component scores (p < 0.05). CONCLUSIONS Late-life cognitive decline is associated with an increase in neuroticism scores. However, associations vary between different cognitive domains and components of neuroticism. An increase in neuroticism or negative affect scores may be a sign of MCI or dementia.
Collapse
Affiliation(s)
- Stephanie E Waggel
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW, Australia
| | - Kim Delbaere
- Falls and Balance Research Group, Neuroscience Research Australia, UNSW, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, New South Wales, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW, Australia.,Primary Dementia Collaborative Research Centre, School of Psychiatry, UNSW, Australia.,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, New South Wales, Australia
| | | | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, New South Wales, Australia.,Primary Dementia Collaborative Research Centre, School of Psychiatry, UNSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW, Australia.,Primary Dementia Collaborative Research Centre, School of Psychiatry, UNSW, Australia.,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, New South Wales, Australia
| |
Collapse
|
43
|
Imfeld P, Bodmer M, Jick SS, Meier CR. Benzodiazepine Use and Risk of Developing Alzheimer’s Disease or Vascular Dementia: A Case–Control Analysis. Drug Saf 2015; 38:909-19. [DOI: 10.1007/s40264-015-0319-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
44
|
Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, Yu O, Crane PK, Larson EB. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 2015; 175:401-7. [PMID: 25621434 PMCID: PMC4358759 DOI: 10.1001/jamainternmed.2014.7663] [Citation(s) in RCA: 634] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Many medications have anticholinergic effects. In general, anticholinergic-induced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy. However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia. OBJECTIVE To examine whether cumulative anticholinergic use is associated with a higher risk for incident dementia. DESIGN, SETTING, AND PARTICIPANTS Prospective population-based cohort study using data from the Adult Changes in Thought study in Group Health, an integrated health care delivery system in Seattle, Washington. We included 3434 participants 65 years or older with no dementia at study entry. Initial recruitment occurred from 1994 through 1996 and from 2000 through 2003. Beginning in 2004, continuous replacement for deaths occurred. All participants were followed up every 2 years. Data through September 30, 2012, were included in these analyses. EXPOSURES Computerized pharmacy dispensing data were used to ascertain cumulative anticholinergic exposure, which was defined as the total standardized daily doses (TSDDs) dispensed in the past 10 years. The most recent 12 months of use was excluded to avoid use related to prodromal symptoms. Cumulative exposure was updated as participants were followed up over time. MAIN OUTCOMES AND MEASURES Incident dementia and Alzheimer disease using standard diagnostic criteria. Statistical analysis used Cox proportional hazards regression models adjusted for demographic characteristics, health behaviors, and health status, including comorbidities. RESULTS The most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics. During a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia (637 of these [79.9%] developed Alzheimer disease). A 10-year cumulative dose-response relationship was observed for dementia and Alzheimer disease (test for trend, P < .001). For dementia, adjusted hazard ratios for cumulative anticholinergic use compared with nonuse were 0.92 (95% CI, 0.74-1.16) for TSDDs of 1 to 90; 1.19 (95% CI, 0.94-1.51) for TSDDs of 91 to 365; 1.23 (95% CI, 0.94-1.62) for TSDDs of 366 to 1095; and 1.54 (95% CI, 1.21-1.96) for TSDDs greater than 1095. A similar pattern of results was noted for Alzheimer disease. Results were robust in secondary, sensitivity, and post hoc analyses. CONCLUSIONS AND RELEVANCE Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.
Collapse
Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle
| | | | - Sascha Dublin
- Group Health Research Institute, Seattle, Washington3Department of Epidemiology, University of Washington, Seattle
| | - Joseph T Hanlon
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca Hubbard
- Group Health Research Institute, Seattle, Washington5Department of Biostatistics, University of Washington, Seattle6currently with the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rod Walker
- Group Health Research Institute, Seattle, Washington
| | - Onchee Yu
- Group Health Research Institute, Seattle, Washington
| | - Paul K Crane
- Division of General Internal Medicine, University of Washington, Seattle
| | - Eric B Larson
- Group Health Research Institute, Seattle, Washington7Division of General Internal Medicine, University of Washington, Seattle
| |
Collapse
|