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Crump C, Sieh W, Vickrey BG, Edwards AC, Sundquist J, Sundquist K. Risk of depression in persons with Alzheimer's disease: A national cohort study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12584. [PMID: 38623385 PMCID: PMC11016814 DOI: 10.1002/dad2.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Depression is a risk factor and possible prodromal symptom of Alzheimer's disease (AD), but little is known about subsequent risk of developing depression in persons with AD. METHODS National matched cohort study was conducted of all 129,410 persons diagnosed with AD and 390,088 with all-cause dementia during 1998-2017 in Sweden, and 3,900,880 age- and sex-matched controls without dementia, who had no prior depression. Cox regression was used to compute hazard ratios (HRs) for major depression through 2018. RESULTS Cumulative incidence of major depression was 13% in persons with AD and 3% in controls. Adjusting for sociodemographic factors and comorbidities, risk of major depression was greater than two-fold higher in women with AD (HR, 2.21; 95% confidence interval [CI], 2.11-2.32) or men with AD (2.68; 2.52-2.85), compared with controls. Similar results were found for all-cause dementia. DISCUSSION Persons diagnosed with AD or related dementias need close follow-up for timely detection and treatment of depression. Highlights In a large cohort, women and men with AD had >2-fold subsequent risk of depression.Risks were highest in the first year (>3-fold) but remained elevated ≥3 years later.Risk of depression was highest in persons aged ≥85 years at AD diagnosis.Persons with AD need close follow-up for detection and treatment of depression.
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Affiliation(s)
- Casey Crump
- Departments of Family and Community Medicine and of EpidemiologyThe University of Texas Health Science CenterHoustonTexasUSA
| | - Weiva Sieh
- Department of EpidemiologyThe University of Texas M. D. Anderson Cancer CenterHoustonTexasUSA
| | - Barbara G. Vickrey
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alexis C. Edwards
- Department of PsychiatryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jan Sundquist
- Department of Clinical SciencesCenter for Primary Health Care ResearchLund UniversityMalmöSweden
| | - Kristina Sundquist
- Department of Clinical SciencesCenter for Primary Health Care ResearchLund UniversityMalmöSweden
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Du J, Janus SIM, de Boer M, Zuidema SU. The longitudinal patterns of psychotropic drug prescriptions for subpopulations of community-dwelling older people with dementia: electronic health records based retrospective study. BMC PRIMARY CARE 2023; 24:69. [PMID: 36907845 PMCID: PMC10009999 DOI: 10.1186/s12875-023-02021-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Studies focusing on patterns of psychotropic drug prescriptions (PDPs) for subpopulations of community-dwelling older people with dementia are lacking. OBJECTIVE The aim of this study was to identify the longitudinal patterns of PDPs in subpopulations. METHODS This retrospective study used electronic health records from general practitioners (GPs) in the Netherlands. People (N = 1278) firstly diagnosed with dementia between 2013 and 2015, aged 65 years or older, were selected and categorized into four subpopulations: community-dwelling (CD) group throughout follow-up, ultimately admitted to nursing homes (NH) group, ultimately died (DIE) group, and ultimately deregistered for unclear reasons (DeR) group. Generalised estimating equations were used to estimate the patterns of psychotropic drug prescriptions, after the diagnosis of dementia for a five-year follow-up, and 0-3 months before institutionalisation or death. RESULTS Over the five-year follow-up, antipsychotic prescriptions increased steadily in CD (OR = 1.07 [1.04-1.10]), NH (OR = 1.10 [1.04-1.15]), and DIE (OR = 1.05 [1.02-1.08]) groups. Similarly, prescriptions of antidepressants also showed upward trends in CD (OR = 1.04 [1.02-1.06]), NH (OR = 1.10 [1.02-1.18]), and DIE (OR = 1.04 [1.00-1.08]) groups. The other psychotropic drugs did not show clear changes over time in most of the subpopulations. In the three months before institutionalisation, antipsychotic prescriptions increased (OR = 2.12 [1.26-3.57]) in the NH group compared to prior periods. Likewise, before death, prescriptions of antipsychotics (OR = 1.74 [1.28-2.38]) and hypnotics and sedatives (OR = 2.11 [1.54-2.90]) increased in the DIE group, while anti-dementia drug prescriptions decreased (OR = 0.42 [0.26-0.69]). CONCLUSIONS After community-dwelling older people are diagnosed with dementia, all subpopulations' prescriptions of antipsychotics and antidepressants increase continuously during the follow-up. While we cannot judge whether these prescriptions are appropriate, GPs might consider a more reluctant use of psychotropic drugs and use alternative psychosocial interventions. Additionally, antipsychotic prescriptions rise considerably shortly before institutionalisation or death, which might reflect that older people experience more neuropsychiatric symptoms during this period.
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Affiliation(s)
- Jiamin Du
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sarah I M Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
- Alzheimer Centre Groningen, Groningen, the Netherlands.
| | - Michiel de Boer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Alzheimer Centre Groningen, Groningen, the Netherlands
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Anxiety and depression in Alzheimer's disease: a systematic review of pathogenetic mechanisms and relation to cognitive decline. Neurol Sci 2022; 43:4107-4124. [PMID: 35461471 PMCID: PMC9213384 DOI: 10.1007/s10072-022-06068-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/06/2022] [Indexed: 12/13/2022]
Abstract
Objectives To explore the pathogenetic hypothesis provided to explain the comorbidity of anxious and depressive symptomatology and AD and to assess the association between anxious and depressive symptoms and the AD-related cognitive impairment. Methods In October 2020 and March 2021, PsycINFO, Embase, Ovid, and CINAHL were searched for peer-reviewed original articles investigating anxiety and/or depression in AD. Results A total of 14,760 studies were identified and 34 papers on AD patients were included in the review. Suggested biological causes of depression and anxiety in AD include higher strychnine-sensitive glycine receptor (GlyRS) functioning and selective reduction of N-methyl-d-aspartate (NMDA) receptor NR2A density, cortical and limbic atrophy, lower resting cortical metabolism, lower CSF Aβ42 and higher t-tau and p-tau levels, and neuritic plaques. At the same time, dysthymia arises in the early stages of AD as an emotional reaction to the progressive cognitive decline and can cause it; anxiety can appear as an initial compensating behaviour; and depression might be related to AD awareness and loss of functional abilities. Affective symptoms and the expression of the depressive symptoms tend to reduce as AD progresses. Conclusion The neurodegeneration of areas and circuits dealing with emotions can elicit anxiety and depression in AD. In the early stages of the disease, anxiety and depression could arise as a psychological reaction to AD and due to coping difficulties. In late AD stages, the cognitive impairment reduces the emotional responses and their expression. Anxiety and depression are more intense in early-onset AD, due to the major impact of AD on the individual. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06068-x.
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García-Alberca JM, Gris E, de la Guía P, Mendoza S. Effects of Tianeptine Treatment on Depression and Cognitive Function in Patients with Alzheimer’s Disease: A 12-Month Retrospective Observational Study. J Alzheimers Dis 2022; 88:707-720. [PMID: 35694919 PMCID: PMC9398087 DOI: 10.3233/jad-215630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Depression is a common manifestation in Alzheimer’s disease (AD). In clinical practice, antidepressant medication is often used for depression in AD. Objective: We explore the effectiveness of the atypical antidepressant tianeptine compared with other conventional antidepressants in AD patients with depression in a real-life setting. Methods: We retrospectively identified 126 AD patients who had received antidepressant treatment for 12 months with tianeptine or other antidepressants. Subjects were divided into two groups according to the treatment they had received: tianeptine group (n = 38) or other antidepressant group (n = 88). Drug effects on depression, cognition, behavior, and functional performance were evaluated at baseline, 6, and 12 months. A Mixed Effects Model Analysis was carried out to evaluate changes in performance scores. Results: Both tianeptine and other antidepressants showed an antidepressant effect after 12 months with significant improvement on the Cornell Scale for Depression in Dementia, the Hamilton Depression Rating Scale, and the Neuropsychiatric Inventory-Depression subscale. A statistically significant improvement at 12 months was shown in the tianeptine group versus the other antidepressants group on most of the cognitive measures such as the Mini-Mental State Examination, the Letter and Category Fluency Test, the Rey Auditory Verbal Learning Test, and the Boston Naming Test. Conclusion: Our results suggest that tianeptine reduces depressive symptoms and improves cognition in AD patients. This could be considered clinically relevant and should inspire the design of future long-term randomized controlled trials that contribute to supporting the use of tianeptine for improving cognitive function in AD patients.
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Affiliation(s)
- José María García-Alberca
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Esther Gris
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Paz de la Guía
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Silvia Mendoza
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
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O’Sullivan JL, Schweighart R, Lech S, Kessler EM, Tegeler C, Teti A, Nordheim J, Gellert P. Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings. BMC Psychiatry 2022; 22:241. [PMID: 35382790 PMCID: PMC8981933 DOI: 10.1186/s12888-022-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (β = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (β = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (β = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (β = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (β = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (β = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (β = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (β = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).
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Affiliation(s)
- Julie L. O’Sullivan
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Roxana Schweighart
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany ,grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva-Marie Kessler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Christina Tegeler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Andrea Teti
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Johanna Nordheim
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Hadipour M, Bahari Z, Afarinesh MR, Jangravi Z, Shirvani H, Meftahi GH. Administering crocin ameliorates anxiety-like behaviours and reduces the inflammatory response in amyloid-beta induced neurotoxicity in rat. Clin Exp Pharmacol Physiol 2021; 48:877-889. [PMID: 33686675 DOI: 10.1111/1440-1681.13494] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
Anxiety, hippocampus synaptic plasticity deficit, as well as pro-inflammatory cytokines, are involved in Alzheimer's disease (AD). The present study is designed to evaluate the possible therapeutic effect of crocin on anxiety-like behaviours, hippocampal synaptic plasticity and neuronal shape, as well as pro-inflammatory cytokines in the hippocampus using in vivo amyloid-beta (Aβ) models of AD. The Aβ peptide (1-42) was bilaterally injected into the frontal-cortex. Five hours after the surgery, the rats were given intraperitoneal (IP) crocin (30 mg/kg) daily up to 12 days. Elevated plus maze results showed that crocin treatment after bilateral Aβ injection significantly increased the percentage of spent time into open arms, frequency of entries, and percentage of entries into open arms as compared with the Aβ group. In the open field test, the Aβ+crocin group showed a higher percentage of spent time in the centre and frequency of entries into central zone as compare with the Aβ treated animals. Administering crocin increased the number of soma, dendrites and axonal arbores in the CA1 neurons among the rats with Aβ neurotoxicity. Cresyl violet (CV) staining showed that crocin increased the number of CV-positive cells in the CA1 region of the hippocampus compared with the Aβ group. Silver-nitrate staining indicated that crocin reduced neurofibrillary tangle formation induced by Aβ. Crocin treatment attenuated the expression of TNF-α and IL-1β mRNA in the hippocampus compared with the Aβ group. Our results suggest that crocin attenuated Aβ-induced anxiety-like behaviours and neuronal damage, and synaptic plasticity loss in hippocampal CA1 neurons may via its anti-inflammatory effects.
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Affiliation(s)
| | - Zahra Bahari
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Physiology and Medical Physics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Afarinesh
- Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Zohreh Jangravi
- Department of Biochemistry, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Shirvani
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Andrews PW, Maslej MM, Thomson Jr. JA, Hollon SD. Disordered doctors or rational rats? Testing adaptationist and disorder hypotheses for melancholic depression and their relevance for clinical psychology. Clin Psychol Rev 2020; 82:101927. [DOI: 10.1016/j.cpr.2020.101927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 01/13/2023]
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Haj ME, Allain P. Self-defining Memories and their Contribution to the Sense of Self in Alzheimer's Disease. Curr Alzheimer Res 2020; 17:508-516. [PMID: 32851943 DOI: 10.2174/1567205017666200807184942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/30/2023]
Abstract
AIMS Unlike autobiographical memory (i.e., memory for personal information) in Alzheimer's Disease (AD), little is known about Self-Defining Memories (SDM) (i.e., memories of highly significant personal events) in AD. METHODS The characteristics of self-defining memories in AD were evaluated by analyzing their specificity, emotional valence, and integration, as well as their centrality and contribution to self-continuity. Results demonstrated fewer specific SDM in AD participants than in controls. RESULTS No significant differences were observed between AD participants and controls regarding the production of positive or integrated SDM. Furthermore, no significant differences were observed between AD participants and controls regarding the rating of the centrality of SDM and their contribution to self-continuity. These results demonstrate that, although AD participants produce fewer specific SDM than controls, both populations have similar levels of emotional valence, integration, centrality, and selfcontinuity of these memories. CONCLUSION It is concluded that patients with AD, at least those in the mild stages of the disease, can build on significant personal events and experiences (i.e., SDM) to reflect on how these events have changed the way they see themselves.
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Affiliation(s)
- Mohamad El Haj
- Nantes Universite, Univ Angers, Laboratoire de Psychologie des Pays de la Loire (LPPL - EA 4638), F-44000 Nantes, France
| | - Philippe Allain
- Centre National de Reference pour les Maladies Neurogenetiques de l'Adulte, Departement de Neurologie, Centre Hospitalier Universitaire d'Angers, Angers, France
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El Haj M, Kapogiannis D, Antoine P. The (fatalistic) present as experienced by individuals with Alzheimer's disease: a preliminary study. Neurol Sci 2019; 41:427-433. [PMID: 31713192 DOI: 10.1007/s10072-019-04121-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The "time perspectives theory" describes how individuals emphasize some time frames over others (e.g., present vs. future) and thus create their unique approach to time perception. Building on this theory, we investigated three time orientations in Alzheimer's disease (AD): (1) present-hedonistic orientation, which focuses on current sensations and pleasures without considering the future, (2) present-fatalistic orientation, characterized by a bias of hopelessness and helplessness toward the future, and (3) future orientation, which focuses on achieving personal goals and future consequences of present actions. METHODS Participants with mild AD (n = 30) and controls (n = 33) were assessed with a questionnaire regarding time perspectives and a questionnaire of depression. RESULTS Results demonstrated low future orientation and high present-fatalistic orientation in AD participants, whereas older adults demonstrated the reverse pattern. Depression positively correlated with fatalistic-present orientation, but negatively correlated with hedonistic-present and future orientations. DISCUSSION Although our findings are preliminary and the sample size is small, depression in mild AD seems to be related with a fatalistic orientation toward the present, as well as a hopeless and helpless perspective on the future, an orientation that results in little desire to enjoy the present.
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Affiliation(s)
- Mohamad El Haj
- Nantes Université, Univ Angers, Laboratoire de Psychologie des Pays de la Loire (LPPL - EA 4638), F-44000, Nantes, France. .,Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France. .,Institut Universitaire de France, Paris, France. .,Faculté de Psychologie, LPPL - Laboratoire de Psychologie des Pays de la Loire, Université de Nantes, Chemin de la Censive du Tertre, BP 81227, 44312, Nantes Cedex 3, France.
| | | | - Pascal Antoine
- CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Univ. Lille, F-59000, Lille, France
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Disability in older adults across the continuum of cognitive decline: unique contributions of depression, sleep disturbance, cognitive deficits and medical burden. Int Psychogeriatr 2019; 31:1611-1625. [PMID: 30714550 DOI: 10.1017/s1041610218002144] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Disability in older adults is associated with a need for support in work, education, and community activities, reduced independence, and poorer quality of life. This study examines potential determinants of disability in a clinical sample of older adults across the continuum of cognitive decline, including sociodemographic, medical, psychiatric, and cognitive factors. DESIGN This is a cross-sectional study. SETTING Participants were recruited from a specialty clinic for adults "at risk" of or with early dementia (including subjective cognitive complaints, mild cognitive impairment, and early dementia). PARTICIPANTS Four hundred forty-two older adults (mean age = 67.11, SD = 9.33) underwent comprehensive medical, neuropsychological, and mood assessments. MEASUREMENTS Disability was assessed via the self-report World Health Organization Disability Assessment Schedule 2.0. A stepwise (forward) linear regression model was computed to determine factors that contribute to disability within this group. RESULTS Depressive symptoms were the largest predictor, uniquely explaining 31.8% of the variance. Other contributing factors in the model included younger age, medical burden, and sleep quality, with all factors together accounting for a total of 50.4% of the variance in disability. Cognitive variables did not contribute to the model. CONCLUSIONS Depressive symptoms account for a significant portion of the variance in disability, but other factors such as age, medical burden and sleep quality are also important contributors in older adults across the continuum of cognitive decline. The relative association of these variables with disability appears to differ for older (≥65 years) relative to younger (<65 years) participants. Given the relationship between disability and these risk factors, an integrative and multidisciplinary approach to risk reduction will likely be most effective, with potential carry over effects for physical and mental health.
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Borsje P, Lucassen PLBJ, Bor H, Wetzels RB, Pot AM, Koopmans RTCM. The course of neuropsychiatric symptoms in patients with dementia in primary care. Fam Pract 2019; 36:437-444. [PMID: 30517631 DOI: 10.1093/fampra/cmy117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND During the course of dementia, most people develop some type of neuropsychiatric symptoms (NPS), which result in lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalization. Studies on NPS in people with dementia have been mainly conducted in clinical centres or psychiatric services. OBJECTIVES To investigate the course of NPS in people with dementia in primary care. METHODS Analysis of (cumulative) prevalence and incidence, persistence and resolution based on data collected during an assessment at home of a prospective naturalistic cohort study in primary care in a sample of 117 people with dementia and their informal caregivers. Subsyndromes of NPS were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory. Multivariate analyses were used to detect determinants for the course of NPS. RESULTS The mean age of the people with dementia was 78.6 years, and 52% were female. Mean Mini-Mental State Examination total score was 19.5, mean NPI total score 15.7. The most prevalent clinically relevant subsyndromes of the NPI were hyperactivity and mood/apathy, and the most prevalent individual NPS were aberrant motor behaviour (28%), agitation/aggression (24%) and apathy/indifference (22%). Of the people with dementia, 72.3% had one or more symptoms of the mood/apathy and 75.3% of the hyperactivity subsyndrome. CONCLUSIONS GPs should be aware of NPS in people with dementia and should actively identify them when they visit these patients or when informal caregivers consult them. Timely diagnosing facilitates adequate professional care.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Thebe, Region South-East, Goirle, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roland B Wetzels
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.,Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
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12
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Steck N, Cooper C, Orgeta V. Investigation of possible risk factors for depression in Alzheimer's disease: A systematic review of the evidence. J Affect Disord 2018; 236:149-156. [PMID: 29734098 DOI: 10.1016/j.jad.2018.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Depression is common in people with Alzheimer's disease (AD), and is associated with increased risk of institutionalization and mortality. Understanding risk factors for depression in AD is key to its development and treatment. METHODS We searched the MEDLINE, EMBASE, PsycINFO, and CINAL databases for longitudinal prospective cohort studies that evaluated risk factors for depression in people with AD. Two authors independently selected articles for inclusion and assessed quality of studies using predetermined criteria. RESULTS In seven studies that met the inclusion criteria, 2029 participants were followed up for a median of 5 years. Gender and educational attainment were not predictors of depression risk. History of a past psychiatric disorder and greater cognitive impairment predicted increased risk of depression in more than one study. In single studies, younger age, having a family history of psychiatric disorder, neuroticism, functional decline, presence of sleep disturbance and aggression, and increased cardiovascular risk predicted depression risk. Not being within 6 months of dementia onset and, counterintuitively having two comorbid disorders were protective factors in one study. LIMITATIONS A small number of studies exist overall and only a few have examined the same risk factors. Most of the studies have measured depression using scales that are not validated in AD. CONCLUSIONS These results inform a preliminary model of depression risk in people with AD. Unlike in the general population, men and women and those with higher and lower educational levels of attainment may be equally at risk of depression. Clinicians should be aware of these possible differences in the risk profile for depression in AD populations, to assist detection and enable early treatment. Interventions to delay cognitive and functional decline may reduce depression risk.
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Affiliation(s)
- Natassa Steck
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Claudia Cooper
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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13
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Pinz MP, Dos Reis AS, Vogt AG, Krüger R, Alves D, Jesse CR, Roman SS, Soares MP, Wilhelm EA, Luchese C. Current advances of pharmacological properties of 7-chloro-4-(phenylselanyl) quinoline: Prevention of cognitive deficit and anxiety in Alzheimer's disease model. Biomed Pharmacother 2018; 105:1006-1014. [PMID: 30021335 DOI: 10.1016/j.biopha.2018.06.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
This study investigated the effect of 7-chloro-4-(phenylselanyl) quinoline (4-PSQ) at a dose of 1 mg/kg in memory impairment and anxiety in an Alzheimer's disease (AD) model induced by amyloid β-peptide (Aβ) (fragment 25-35) in mice. The involvement of acetylcholinesterase (AChE) activity and lipid peroxidation in hippocampus and cerebral cortex was evaluated. Male Swiss mice were pretreated with 4-PSQ (1 mg/kg, intragastrically (i.g.), daily) for fourteen days. Thirty minutes after the first treatment with 4-PSQ, the animals received a single injection of Aβ (3 nmol/3 μl/per site, intracerebroventricular (i.c.v.)). Mice were submitted to the behavioral tasks (open-field, elevated plus maze, Barnes maze, object recognition and location, and step-down inhibitory avoidance tests) from the fifth day onwards. On the fifteenth day, blood was removed for analysis of biochemical markers (glucose, triglycerides, urea, aspartate (AST) and alanine (ALT) aminotrasferases), and cerebral cortex and hippocampus for determination of AChE activity and thiobarbituric acid reactive species (TBARS) levels. Aβ caused memory impairment, anxiogenic behavior, increased AChE activity in the cerebral structures and TBARS levels in the cerebral cortex. 4-PSQ was effective to protect against behavioral changes, AChE activity and TBARS levels. In conclusion, 4-PSQ protected against learning and memory impairment and anxiety in a mouse model of AD induced by Aβ, and anticholinesterase and antioxidant actions are involved in the pharmacological effect of the compound.
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Affiliation(s)
- Mikaela P Pinz
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Grupo de Pesquisa em Neurobiotecnologia (GPN), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), CEP 96010-900, Pelotas, RS, Brazil
| | - Angélica S Dos Reis
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Grupo de Pesquisa em Neurobiotecnologia (GPN), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), CEP 96010-900, Pelotas, RS, Brazil
| | - Ane G Vogt
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Grupo de Pesquisa em Neurobiotecnologia (GPN), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), CEP 96010-900, Pelotas, RS, Brazil
| | - Roberta Krüger
- Programa de Pós-Graduação em Química, Laboratório de Síntese Orgânica Limpa - LASOL, Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), P.O. Box 354, 96010-900, Pelotas, RS, Brazil
| | - Diego Alves
- Programa de Pós-Graduação em Química, Laboratório de Síntese Orgânica Limpa - LASOL, Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), P.O. Box 354, 96010-900, Pelotas, RS, Brazil
| | - Cristiano R Jesse
- Laboratório de Avaliações Farmacológicas e Toxicológicas Aplicadas às Moléculas Bioativas, LaftamBio Pampa, Universidade Federal do Pampa, CEP 97650-000, Itaqui, RS, Brazil
| | - Silvane S Roman
- Universidade Regional Integrada, Campus Erechim, CEP 99700-000, RS, Brazil
| | - Mauro P Soares
- Laboratório Regional de Diagnóstico Faculdade de Veterinária, Universidade Federal de Pelotas, Capão do Leão, CEP: 96010-900, RS, Brazil
| | - Ethel A Wilhelm
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Grupo de Pesquisa em Neurobiotecnologia (GPN), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), CEP 96010-900, Pelotas, RS, Brazil.
| | - Cristiane Luchese
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Grupo de Pesquisa em Neurobiotecnologia (GPN), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas (UFPel), CEP 96010-900, Pelotas, RS, Brazil.
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Tuijt R, Livingston G, Gould RL, Jones R, Verdaguer ES, Orgeta V. IDEA intervention to prevent depressive symptoms and promote well-being in early-stage dementia: protocol for a randomised controlled feasibility study. BMJ Open 2018; 8:e021074. [PMID: 29439085 PMCID: PMC5879789 DOI: 10.1136/bmjopen-2017-021074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Depressive symptoms are common among people with dementia, impacting quality of life and cognitive and functional decline. Currently, little is known about the acceptability and feasibility of psychological interventions for people with mild dementia, with recent reviews identifying the need for further evidence. Developing and evaluating psychological interventions to prevent and treat these symptoms is, therefore, an important clinical and research priority. This protocol describes a study testing the acceptability and feasibility of a manual-based behavioural activation (BA) intervention for preventing and treating depressive symptoms in people with mild dementia. The aim of this study is to explore the feasibility of conducting a pragmatic multicentre randomised controlled trial of clinical effectiveness of an eight-session intervention. The Intervention to prevent Depressive symptoms and promote well-being in EArly-stage dementia (IDEA) programme supports people with dementia and their family carers in identifying and scheduling enjoyable and meaningful activities. METHODS AND ANALYSIS Sixty people who have received a diagnosis of dementia of any type in the last 6 months will be recruited via memory clinics. Further criteria are a Mini-Mental State Examination score of ≥20, and a family carer who can assist with the intervention. Consenting participants will be randomised in a ratio of 2:1 to BA or to treatment as usual. Analyses will estimate parameters such as rates of recruitment, retention and number of sessions completed. Questionnaires measuring depressive symptoms and quality of life for both the person with dementia and their carer will be completed at baseline, 3 and 6 months. Qualitative interviews will explore acceptability of the intervention, study procedures and experiences of the sessions. ETHICS AND DISSEMINATION This study received a favourable ethical opinion from the London Camberwell St Giles Research Ethics Committee (16/LO/0540). We will disseminate findings at key conferences, the Alzheimer's Society and University College London websites and local stakeholder events. TRIAL REGISTRATION NUMBER ISRCTN75503960; Pre-results.
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Affiliation(s)
- Remco Tuijt
- Division of Psychiatry,
University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry,
University College London, London, UK
| | - Rebecca L Gould
- Division of Psychiatry,
University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry,
University College London, London, UK
| | | | - Vasiliki Orgeta
- Division of Psychiatry,
University College London, London, UK
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15
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Nie L, Wei G, Peng S, Qu Z, Yang Y, Yang Q, Huang X, Liu J, Zhuang Z, Yang X. Melatonin ameliorates anxiety and depression-like behaviors and modulates proteomic changes in triple transgenic mice of Alzheimer's disease. Biofactors 2017; 43:593-611. [PMID: 28608594 DOI: 10.1002/biof.1369] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 05/01/2017] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease accompanied by neuropsychiatric symptoms, such as anxiety and depression. The levels of melatonin decrease in brains of AD patients. The potential effect of melatonin on anxiety and depression behaviors in AD and the underlying mechanisms remain unclear. In this study, we treated 10-month-old triple transgenic mice of AD (3xTg-AD) with melatonin (10 mg/kg body weight/day) for 1 month and explored the effects of melatonin on anxiety and depression-like behaviors in 3xTg-AD mice and the protein expression of hippocampal tissues. The behavioral test showed that melatonin ameliorated anxiety and depression-like behaviors of 3xTg-AD mice as measured by open field test, elevated plus maze test, forced swimming test, and tail suspension test. By carrying out two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) coupled with mass spectrometry, we revealed a total of 46 differentially expressed proteins in hippocampus between the wild-type (WT) mice and non-treated 3xTg-AD mice. A total of 21 differentially expressed proteins were revealed in hippocampus between melatonin-treated and non-treated 3xTg-AD mice. Among these differentially expressed proteins, glutathione S-transferase P 1 (GSTP1) (an anxiety-associated protein) and complexin-1 (CPLX1) (a depression-associated protein) were significantly down-regulated in hippocampus of 3xTg-AD mice compared with the WT mice. The expression of these two proteins was modulated by melatonin treatment. Our study suggested that melatonin could be used as a potential candidate drug to improve the neuropsychiatric behaviors in AD via modulating the expression of the proteins (i.e. GSTP1 and CPLX1) involved in anxiety and depression behaviors. © 2017 BioFactors, 43(4):593-611, 2017.
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Affiliation(s)
- Lulin Nie
- College of Chemistry, Xiangtan University, Xiangtan, 411105, China
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Gang Wei
- Thyroid & Breast Surgery Department, Hubei Maternal & Children Hospital, Wuhan, 430070, China
| | - Shengming Peng
- College of Chemistry, Xiangtan University, Xiangtan, 411105, China
| | - Zhongsen Qu
- Department of Neurology, Shanghai Jiaotong University Affiliated the Sixth Hospital, Shanghai, 200233, China
| | - Ying Yang
- Department of Pathophysiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Qian Yang
- Department of cell biology and Anatomy, LSU Health Sciences Center, New Orleans, LA, 70112
| | - Xinfeng Huang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Jianjun Liu
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Zhixiong Zhuang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Xifei Yang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
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16
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The clinical importance of understanding and improving everyday cognition in older adults. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2017. [DOI: 10.1016/j.jarmac.2017.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Ryu SH, Jung HY, Lee KJ, Moon SW, Lee DW, Hong N, Kee BS, Kim DH, Han C, Lee CU. Incidence and Course of Depression in Patients with Alzheimer's Disease. Psychiatry Investig 2017; 14:271-280. [PMID: 28539945 PMCID: PMC5440429 DOI: 10.4306/pi.2017.14.3.271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/26/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Depressive symptoms are common in Alzheimer's disease (AD) and they might influence the course and prognosis of AD. Depression could appear anytime in the course of the disease, and could either last considerably long or disappear easily. This study is intended to investigate the occurrence of depression in the course of AD and the risk factors of incidence. METHODS This study targeted 1,272 AD patients without depressive symptoms at the start of this study in Korea. A total of 775 subjects completed the study, and the occurrence of depression was assessed after 12 months. Demographic information of subjects was collected and cognitive functions, overall functions, and depression severity were assessed at the start of this study and after 12 months. RESULTS Among the 775 subjects, 103 subjects (13.29%) developed depression 12 months later. The MMSE-KC scores showed significant changes in both groups that developed depression and did not. In the univariate analysis, significant differences in the incidence of depression were found in terms of gender, the administration of the antidepressant at the baseline, the SGDS-K score, and the GDS score. The multiple logistic regression analysis showed that the increase in the incidence of depression was associated with a female, in the increase in SGDS-K score and the GDS score. CONCLUSION The incidence of depression in the subjects who completed the 12-month follow-up observation was 13.29%. Moreover, in the multivariate analysis, a female gender and the severity of dementia, including the overall functions, seemed associated with the occurrence of depression.
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Affiliation(s)
- Seung-Ho Ryu
- Department of Psychiatry, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Kang Joon Lee
- Department of Psychiatry, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Seok Woo Moon
- Department of Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Dong Woo Lee
- Department of Psychiatry, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Narei Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Baik Seok Kee
- Department of Psychiatry, Chung-Ang University, College of Medicine, Seoul, Republic of Korea
| | - Do Hoon Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Neuropsychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Assessing the presence of shared genetic architecture between Alzheimer's disease and major depressive disorder using genome-wide association data. Transl Psychiatry 2017; 7:e1094. [PMID: 28418403 PMCID: PMC5416691 DOI: 10.1038/tp.2017.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 01/03/2023] Open
Abstract
Major depressive disorder (MDD) and Alzheimer's disease (AD) are both common in older age and frequently co-occur. Numerous phenotypic studies based on clinical diagnoses suggest that a history of depression increases risk of subsequent AD, although the basis of this relationship is uncertain. Both illnesses are polygenic, and shared genetic risk factors could explain some of the observed association. We used genotype data to test whether MDD and AD have an overlapping polygenic architecture in two large population-based cohorts, Generation Scotland's Scottish Family Health Study (GS:SFHS; N=19 889) and UK Biobank (N=25 118), and whether age of depression onset influences any relationship. Using two complementary techniques, we found no evidence that the disorders are influenced by common genetic variants. Using linkage disequilibrium score regression with genome-wide association study (GWAS) summary statistics from the International Genomics of Alzheimer's Project, we report no significant genetic correlation between AD and MDD (rG=-0.103, P=0.59). Polygenic risk scores (PRS) generated using summary data from International Genomics of Alzheimer's Project (IGAP) and the Psychiatric Genomics Consortium were used to assess potential pleiotropy between the disorders. PRS for MDD were nominally associated with participant-recalled AD family history in GS:SFHS, although this association did not survive multiple comparison testing. AD PRS were not associated with depression status or late-onset depression, and a survival analysis showed no association between age of depression onset and genetic risk for AD. This study found no evidence to support a common polygenic structure for AD and MDD, suggesting that the comorbidity of these disorders is not explained by common genetic variants.
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García-Alberca JM. Cognitive-behavioral treatment for depressed patients with Alzheimer's disease. An open trial. Arch Gerontol Geriatr 2017; 71:1-8. [PMID: 28237746 DOI: 10.1016/j.archger.2017.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression has a high prevalence among patients with Alzheimer's disease, and it has a significant negative impact on their functioning. However, despite its significant impact and challenge, few treatment outcomes data are available to guide clinical care of depression among this population. We developed a cognitive-behavioral intervention to persons with AD. In this paper, we describe the intervention and results of an open trial evaluating its feasibility and utility. SETTING Dementia Unit. SUBJECT Alzheimer's disease patients. METHODS The treatment was administered over a period of three months with the implication of a caregiver. Dyads were followed for an additional three months in-person sessions. A selection of skills is offered, including education and self-awareness, coping self-statements, behavioral activation, problem-solving therapy, exercise, and caregiver education. RESULTS Nine participants were enrolled. Overall, patients and caregivers were satisfied with the treatment and reported that they benefited-in terms of depression, anxiety, and caregiver distress. CONCLUSIONS These findings are preliminaries and attention now needs to be turned to futher evaluation in a randomized clinical trial.
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20
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Stern Y, Gu Y, Cosentino S, Azar M, Lawless S, Tatarina O. The Predictors study: Development and baseline characteristics of the Predictors 3 cohort. Alzheimers Dement 2017; 13:20-27. [PMID: 27219818 PMCID: PMC5118195 DOI: 10.1016/j.jalz.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/18/2016] [Accepted: 04/09/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Predictors study was designed to predict the length of time to major disease outcomes in Alzheimer's disease (AD) patients. Here, we describe the development of a new, Predictors 3, cohort. METHODS Patients with prevalent or incident AD and individuals at-risk for developing AD were selected from the North Manhattan community and followed annually with instruments comparable to those used in the original two Predictors cohorts. RESULTS The original Predictors cohorts were clinic based and racially/ethnically homogenous (94% white, 6% black; 3% Hispanic). In contrast, the 274 elders in this cohort are community-based and ethnically diverse (39% white, 40% black, 21% other; 78% Hispanic). Confirming previous observations, psychotic features were associated with poorer function and mental status and extrapyramidal signs with poorer function. DISCUSSION This new cohort will allow us to test observations made in our original clinic-based cohorts in patients that may be more representative of the general community.
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Affiliation(s)
- Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Siobhan Lawless
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Oksana Tatarina
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Puranen A, Taipale H, Koponen M, Tanskanen A, Tolppanen AM, Tiihonen J, Hartikainen S. Incidence of antidepressant use in community-dwelling persons with and without Alzheimer's disease: 13-year follow-up. Int J Geriatr Psychiatry 2017; 32:94-101. [PMID: 26924266 DOI: 10.1002/gps.4450] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/17/2015] [Accepted: 01/26/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The study aimed to investigate the incidence of antidepressant use in persons with and without Alzheimer's disease (AD) from 9 years before to 4 years after AD diagnosis and to examine the incidence of different antidepressant groups. METHODS We used register-based data from the Medication use and Alzheimer's disease cohort including all Finnish persons diagnosed with AD in 2005-2011 with their age-matched and gender-matched comparison persons without AD. In this study, 62,104 persons with AD and 62,104 comparison persons were included. Data on dispensed antidepressants during 1995-2012 were collected from the Prescription Register. A 1-year washout period was utilized to measure the rate of new antidepressant users every 6-month period starting from 9 years before and until 4 years after the AD diagnoses. The incidence rate between persons with and without AD was compared with Poisson regression. RESULTS The incidence of antidepressant use in persons with AD was higher during the whole study period compared with that in persons without AD. The incidence rate was highest at 6 months after AD diagnosis (incidence rate ratio = 5.22, 95% confidence interval 4.77-5.72). Selective serotonin reuptake inhibitors were the most frequently initiated group (61.3% of initiations in persons with AD). CONCLUSIONS The incidence of antidepressant use was higher in persons with AD than in comparison persons, and it was not explained by history of hospital-treated psychiatric disorders. Widespread use of antidepressants in persons with AD is concerning as their efficacy is controversial and their use is associated with adverse events. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Arto Puranen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti 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
| | - Anna-Maija 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
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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van der Linde RM, Dening T, Stephan BCM, Prina AM, Evans E, Brayne C. Longitudinal course of behavioural and psychological symptoms of dementia: systematic review. Br J Psychiatry 2016; 209:366-377. [PMID: 27491532 PMCID: PMC5100633 DOI: 10.1192/bjp.bp.114.148403] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 02/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND More information about the pattern of behavioural and psychological symptoms of dementia (BPSD) in the course of dementia is needed to inform patients and clinicians and to design future interventions. AIMS To determine the persistence and incidence of BPSD and their relation to cognitive function, in individuals with dementia or in cohorts investigated for dementia onset. METHOD A systematic literature review analysed the baseline prevalence, persistence and incidence of 11 symptoms. The review was conducted according to established guidelines with the exception that we could not exclude the possibilities of bias in the studies examined. RESULTS The 59 included studies showed considerable heterogeneity in their objectives and methods. The symptoms hyperactivity and apathy showed high persistence and incidence; depression and anxiety low or moderate persistence and moderate incidence; and psychotic symptoms low persistence with moderate or low incidence. CONCLUSIONS Despite heterogeneity across studies in terms of setting, focus and length of follow-up, there were clinically relevant differences in the longitudinal courses of different BPSD. Apathy was the only symptom with high baseline prevalence, persistence and incidence during the course of dementia.
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Affiliation(s)
- Rianne M. van der Linde
- Correspondence: R. van der Linde, Department of Public Health and Primary Care, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
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Siuda J, Patalong-Ogiewa M, Żmuda W, Targosz-Gajniak M, Niewiadomska E, Matuszek I, Jędrzejowska-Szypułka H, Lewin-Kowalik J, Rudzińska-Bar M. Cognitive impairment and BDNF serum levels. Neurol Neurochir Pol 2016; 51:24-32. [PMID: 28341039 DOI: 10.1016/j.pjnns.2016.10.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS To investigate the alterations of brain-derived neurotrophic factor (BNDF) serum levels in subjects with different intensity of cognitive impairment and different neurodegenerative processes. MATERIAL AND METHODS Serum BDNF levels were analyzed by ELISA kit in 378 subjects: 134 Alzheimer's disease (AD) patients, 115 amnestic mild cognitive impairment (MCI) patients, and 129 controls divided into two groups: neurodegenerative control group (ND), consisting of 49 Parkinson's disease patients without any cognitive complaints, and cognitively normal control group (CN), consisting of 80 subjects without any neurological disorders. RESULTS AD patients had significantly lower (p<0.001) BDNF serum levels compared to MCI, CN and ND controls. Age and education had significant influence on BDNF serum levels regardless the diagnosis or group assignment. We have found no influence of depression on BDNF serum levels either in our group as a whole, or in each group assessed separately. We found significant correlation between BDNF serum levels and cognitive impairments. After multiple comparisons between the groups, we found that, after adjustment for confounding factors (age, gender, education, depression, cognitive impairment), BDNF serum levels were the lowest in AD group (p=0.05). CONCLUSIONS Advanced age and low educational level are associated with decreased BDNF serum levels. Decreased BDNF serum levels correspond to the severity of cognitive impairment. There is no correlation between BDNF serum levels and depressive symptoms.
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Affiliation(s)
- Joanna Siuda
- Department of Neurology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; Department of Neurology, Central University Hospital, Katowice, Poland.
| | | | - Weronika Żmuda
- Department of Neurology, Central University Hospital, Katowice, Poland
| | | | - Ewa Niewiadomska
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - Iwona Matuszek
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Monika Rudzińska-Bar
- Department of Neurology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; Department of Neurology, Central University Hospital, Katowice, Poland
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El Haj M, Antoine P. Death Preparation and Boredom Reduction as Functions of Reminiscence in Alzheimer’s Disease. J Alzheimers Dis 2016; 54:515-23. [DOI: 10.3233/jad-160497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kosteniuk JG, Morgan DG, O'Connell ME, Kirk A, Crossley M, Stewart NJ, Karunanayake CP. Trajectories of Depressive Symptomatology in Rural Memory Clinic Patients between Baseline Diagnosis and 1-Year Follow-Up. Dement Geriatr Cogn Dis Extra 2016; 6:161-75. [PMID: 27350776 PMCID: PMC4913763 DOI: 10.1159/000444790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To investigate the prevalence and trajectories of depressive symptomatology at 1-year follow-up, and the severity of depressive symptoms, by dementia diagnostic group, as well as to determine the predictors of depressive symptomatology at 1-year follow-up. METHODS In rural and remote patients of an interdisciplinary memory clinic between 2004 and 2014, 144 patients diagnosed with no cognitive impairment (NCI), mild cognitive impairment, dementia due to Alzheimer's disease (AD), or non-AD dementia completed the Center for Epidemiologic Studies of Depression Scale to assess depressive symptomatology at both time points. RESULTS Among patients with data at both time points, persistence of depressive symptomatology at follow-up occurred in 22.2%, remission in 17.4%, incidence in 13.2%, and absence in 47.2%. The prevalence of depressive symptomatology at baseline and persistence at follow-up were significantly greater in the NCI group than in the other diagnostic groups, but there were no differences in severity. Depressive symptomatology at follow-up was independently associated with depressive symptomatology, lower independence in activities of daily living, and lower self-rating of memory at baseline, as well as with decreased independence in activities of daily living between time points. CONCLUSION Future studies should further examine short-term postdiagnostic trajectories in depressive symptomatology in multiple dementia diagnostic groups to inform prognoses and treatment decisions.
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Affiliation(s)
- Julie G Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Andrew Kirk
- Division of Neurology, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Margaret Crossley
- Department of Psychology, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Norma J Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Chandima P Karunanayake
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Sask., Canada
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El Haj M, Larøi F, Gély-Nargeot MC, Raffard S. Inhibitory deterioration may contribute to hallucinations in Alzheimer's disease. Cogn Neuropsychiatry 2016; 20:281-95. [PMID: 25788117 DOI: 10.1080/13546805.2015.1023392] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although delusions and hallucinations are relatively common symptoms in individuals with Alzheimer's disease (AD), very little is known regarding underlying mechanisms. We examined whether these manifestations could be underpinned by psychological distress and executive impairments. METHODS Thirty-one participants with probable mild AD and 33 healthy older adults were administered a neuropsychological and clinical battery assessing delusions, hallucinations, anxiety, depression, episodic memory and executive functions (shifting, updating and inhibition). RESULTS Prevalence of delusions and hallucinations were significantly higher in AD participants compared to control participants. Further, hallucinations in AD participants were significantly correlated with poor inhibition, with the latter uniquely predicting the former, as compared to other variables. In addition, hallucinations in AD participants were associated with depression, a relationship that was further mediated by inhibition. CONCLUSION Hallucinations in individuals with AD seem to be related to difficulties suppressing irrelevant thoughts, resulting in these irrelevant thoughts becoming confused with ongoing reality.
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Affiliation(s)
- Mohamad El Haj
- a Laboratoire SCALab UMR CNRS 9193 , University of Lille , Lille , France
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Litvinova SA, Klodt PM, Kudrin VS, Narkevich VB, Voronina TA. The behavior and neurotransmitter contents in brain structures of rats with Alzheimer’s disease modeled by administration of Aβ25–35. NEUROCHEM J+ 2015. [DOI: 10.1134/s1819712415010055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review. Int Psychogeriatr 2015; 27:385-405. [PMID: 25403309 DOI: 10.1017/s1041610214002282] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) often occur in patients with dementia. Understanding the course of NPS in dementia is important for healthcare professionals for psycho-educational purposes and adequate and timely interventions to prevent or diminish NPS as much as possible. METHODS We conducted a systematic literature search in several electronic databases. We combined search strings for the terms dementia, community-dwelling, cohort studies and NPS. Screening titles and abstracts, assessing the methodological quality and data-extraction were independently conducted by at least two authors. RESULTS This literature search revealed 6605 unique records of which 23 studies were included in data synthesis. In total 7184 patients participated in the included studies with a mean number of 312. Sixty percent of the participants were female and the mean age of all participants was 74.8 years. Follow-up varied between 1 and 6 years; in 17 studies loss to follow-up was less than 20% per year. NPS are highly prevalent, incident and persistent although frequency parameters vary considerably across studies. Delusions/delusional misidentification, wandering/agitation, aberrant motor behavior/motor hyperactivity and apathy are the most common NPS. For hallucinations, delusions/delusional misidentification, paranoia, aggression, wandering/agitation, aberrant motor behavior/motor hyperactivity, disinhibition, apathy, and sleep disturbance increasing trends in point prevalence rates have been found. CONCLUSIONS NPS in community-dwelling patients are frequent and persistent. The increasing trends of several NPS in the course of dementia require a preventive approach of professional caretakers. For such an approach, a timely diagnosis and adequate professional support to prevent or diminish these problems is necessary.
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Gilmartin JFM, Väätäinen S, Törmälehto S, Bell JS, Lönnroos E, Salo L, Hallikainen I, Martikainen J, Koivisto AM. Depressive symptoms are associated with analgesic use in people with Alzheimer's disease: Kuopio ALSOVA study. PLoS One 2015; 10:e0117926. [PMID: 25688858 PMCID: PMC4331553 DOI: 10.1371/journal.pone.0117926] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 01/04/2015] [Indexed: 11/18/2022] Open
Abstract
Neuropsychiatric symptoms of Alzheimer's disease (AD) such as depression may be associated with pain, which according to the literature may be inadequately recognized and managed in this population. This study aimed to identify the factors associated with analgesic use in persons with AD; in particular, how AD severity, functional status, neuropsychiatric symptoms of AD, co-morbidities and somatic symptoms are associated with analgesic use. 236 community-dwelling persons with very mild or mild AD at baseline, and their caregivers, were interviewed over five years as part of the prospective ALSOVA study. Generalized Estimating Equations (GEEs) were used to estimate unadjusted and adjusted odds ratios (ORs) for the factors associated with analgesic use over a five year follow-up. The proportion of persons with AD using any analgesic was low (13.6%) at baseline and remained relatively constant during the follow-up (15.3% at Year 5). Over time, the most prevalent analgesic changed from non-steroidal anti-inflammatories (8.1% of persons with AD at Year 1) to acetaminophen (11.1% at Year 5). Depressive symptoms (measured by the Beck Depression Inventory, BDI) were independently associated with analgesic use, after effects of age, gender, education, AD severity, comorbidities and somatic symptoms were taken into account. For every one unit increase in BDI, the odds of analgesic use increased by 4% (OR = 1.04, 95% confidence interval CI = 1.02-1.07). Caregiver depressive symptoms were not statistically significantly associated with analgesic use of the person with AD. Depressive symptoms were significantly associated with analgesic use during the five year follow-up period. Possible explanations warranting investigation are that persons with AD may express depressive symptoms as painful somatic complaints, or untreated pain may cause depressive symptoms. Greater awareness of the association between depressive symptoms and analgesic use may lead to safer and more effective prescribing for these conditions.
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Affiliation(s)
- Julia Fiona-Maree Gilmartin
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
- University College London School of Pharmacy, London, United Kingdom
- * E-mail:
| | - Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Soili Törmälehto
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland
| | - Lotta Salo
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anne M. Koivisto
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland
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Holston EC. Describing brain activity of persons with AD and depressive symptoms. Arch Psychiatr Nurs 2014; 28:413-9. [PMID: 25457693 DOI: 10.1016/j.apnu.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/30/2014] [Accepted: 09/01/2014] [Indexed: 11/18/2022]
Abstract
The purpose of this retrospective pilot study was to characterize depression of AD using electrophysiological changes in the brain activity of persons with AD and depressive symptoms. Participants had a mean age of 70.12±12.68. Participants manifested an increase in absolute/relative theta activity (p=.000) over entire brain when compared to normative population-based database. Electrophysiological changes did not differ by age or gender except for increased absolute theta activity in the right lateral frontal areas (t-test=-2.31 to -2.39, p=.04) in females. An increased theta activity suggests that depressive symptoms may be part of AD symptomatology, not a co-morbid feature.
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Affiliation(s)
- Ezra C Holston
- University of Tennessee-Knoxville College of Nursing, Knoxville, TN.
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Boockvar K. Impact of Depression and Mental Illness on Outcomes of Medical Illness in Older Adults. Clin Ther 2014; 36:1486-8. [DOI: 10.1016/j.clinthera.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Wilson RS, Capuano AW, Boyle PA, Hoganson GM, Hizel LP, Shah RC, Nag S, Schneider JA, Arnold SE, Bennett DA. Clinical-pathologic study of depressive symptoms and cognitive decline in old age. Neurology 2014; 83:702-9. [PMID: 25080520 PMCID: PMC4150132 DOI: 10.1212/wnl.0000000000000715] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To clarify the relationship between depressive symptoms and the clinical and neuropathologic manifestations of dementia. METHODS In a clinical-pathologic cohort study, 1,764 older persons without cognitive impairment at enrollment completed annual clinical evaluations for a mean of 7.8 years. The evaluations included assessment of depressive symptoms (10-item Center for Epidemiological Studies Depression Scale) and cognitive function (battery of 17 performance tests). A total of 582 individuals died during follow-up and underwent a uniform neuropathologic examination to quantify β-amyloid plaques and tau tangle density in multiple brain regions and identify neocortical Lewy bodies, hippocampal sclerosis, and gross and microscopic cerebral infarcts. RESULTS Level of depressive symptoms slightly increased during follow-up. Incident mild cognitive impairment (52.2%) was associated with higher level of depressive symptoms before the diagnosis but not with change in symptoms after the diagnosis; incident dementia (17.9%) was associated with higher symptom level before dementia onset and with more rapid decline in symptoms after dementia onset. None of the neuropathologic markers was related to level of depressive symptoms or change in symptoms over time. In a mixed-effects model adjusted for the neuropathologic markers, higher level of depressive symptoms averaged over evaluations was associated with more rapid global cognitive decline, accounting for 4.4% of the variability in decline not attributable to the neuropathologic markers. Depressive symptoms did not modify the association of the neuropathologic markers with cognitive decline. CONCLUSION In old age, depressive symptoms have an association with cognitive decline that is independent of the neuropathologic hallmarks of dementia.
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Affiliation(s)
- Robert S Wilson
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
| | - Ana W Capuano
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - Patricia A Boyle
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - George M Hoganson
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - Loren P Hizel
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - Raj C Shah
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - Sukriti Nag
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - Julie A Schneider
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - Steven E Arnold
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia
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Kosteniuk JG, Morgan DG, O'Connell ME, Crossley M, Kirk A, Stewart NJ, Karunanayake CP. Prevalence and covariates of elevated depressive symptoms in rural memory clinic patients with mild cognitive impairment or dementia. Dement Geriatr Cogn Dis Extra 2014; 4:209-20. [PMID: 25177329 PMCID: PMC4132249 DOI: 10.1159/000363226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background/Aims To estimate the prevalence, severity, and covariates of depressive symptoms in rural memory clinic patients diagnosed with either mild cognitive impairment (MCI) or dementia. Methods In a cross-sectional study of 216 rural individuals who attended an interdisciplinary memory clinic between March 2004 and July 2012, 51 patients were diagnosed with MCI and 165 with either dementia due to Alzheimer's disease (AD) or non-AD dementia. The Center for Epidemiologic Studies of Depression Scale (CES-D) was used to estimate the severity and prevalence of clinically elevated depressive symptomatology. Results The prevalence of elevated depressive symptoms was 51.0% in the MCI patients and 30.9% in the dementia patients. Depressive symptoms were more severe in the MCI patients than in the dementia patients. Elevated depressive symptoms were statistically associated with younger age for the MCI group, with lower self-rated memory for the dementia group, and with increased alcohol use and lower quality of life ratings for all patients. In the logistic regression models, elevated depressive symptoms remained negatively associated with self-rated memory and quality of life for the patients with dementia, but significant bivariate associations did not persist in the MCI group. Conclusions The high prevalence and severity of depressive symptoms among rural memory clinic patients diagnosed with either MCI or dementia warrant continued investigation.
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Affiliation(s)
- Julie G Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, Saskatoon, Sask., Canada
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, Saskatoon, Sask., Canada
| | - Megan E O'Connell
- Department of Psychology, College of Medicine, Saskatoon, Sask., Canada
| | - Margaret Crossley
- Department of Psychology, College of Medicine, Saskatoon, Sask., Canada
| | - Andrew Kirk
- Division of Neurology, College of Medicine, Saskatoon, Sask., Canada
| | - Norma J Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Chandima P Karunanayake
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, Saskatoon, Sask., Canada
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Cassimjee N. A Review of Mood and Anxiety Disturbances in Alzheimer's Disease: Implications for Treatment Outcomes. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2007.10820161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Morimoto SS, Kanellopoulos D, Alexopoulos GS. Cognitive Impairment in Depressed Older Adults: Implications for Prognosis and Treatment. Psychiatr Ann 2014; 44:138-142. [PMID: 25821256 DOI: 10.3928/00485713-20140306-05] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hayley S, Litteljohn D. Neuroplasticity and the next wave of antidepressant strategies. Front Cell Neurosci 2013; 7:218. [PMID: 24312008 PMCID: PMC3834236 DOI: 10.3389/fncel.2013.00218] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022] Open
Abstract
Depression is a common chronic psychiatric disorder that is also often co-morbid with numerous neurological and immune diseases. Accumulating evidence indicates that disturbances of neuroplasticity occur with depression, including reductions of hippocampal neurogenesis and cortical synaptogenesis. Improper trophic support stemming from stressor-induced reductions of growth factors, most notably brain derived neurotrophic factor (BDNF), likely drives such aberrant neuroplasticity. We posit that psychological and immune stressors can interact upon a vulnerable genetic background to promote depression by disturbing BDNF and neuroplastic processes. Furthermore, the chronic and commonly relapsing nature of depression is suggested to stem from "faulty wiring" of emotional circuits driven by neuroplastic aberrations. The present review considers depression in such terms and attempts to integrate the available evidence indicating that the efficacy of current and "next wave" antidepressant treatments, whether used alone or in combination, is at least partially tied to their ability to modulate neuroplasticity. We particularly focus on the N-methyl-D-aspartate (NMDA) antagonist, ketamine, which already has well documented rapid antidepressant effects, and the trophic cytokine, erythropoietin (EPO), which we propose as a potential adjunctive antidepressant agent.
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Affiliation(s)
- Shawn Hayley
- Department of Neuroscience, Carleton University Ottawa, ON, Canada
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Zahodne LB, Devanand DP, Stern Y. Coupled cognitive and functional change in Alzheimer's disease and the influence of depressive symptoms. J Alzheimers Dis 2013; 34:851-60. [PMID: 23302654 DOI: 10.3233/jad-121921] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Alzheimer's disease (AD), cognition and function are only moderately correlated in cross-sectional studies, and studies of their longitudinal association are less common. One potential non-cognitive contributor to function is depression, which has been associated with poorer clinical outcomes. The current study investigated longitudinal associations between functional abilities, cognitive status, and depressive symptoms in AD. 517 patients diagnosed with probable AD and enrolled in The Multicenter Study of Predictors of Disease Course in Alzheimer's Disease were included. Patients were followed at 6-month intervals over 5.5 years. Longitudinal changes in the Blessed Dementia Rating Scale, modified Mini-Mental State Exam, and the depression subscale of the Columbia University Scale for Psychopathology in AD were examined in a multivariate latent growth curve model that controlled for gender, age, education, and recruitment site. Results showed that cognition and function worsened over the study period, whereas depressive symptoms were largely stable. Rates of change in cognition and function were correlated across participants and coupled within participants, indicating that they travel together over time. Worse initial cognitive status was associated with faster subsequent functional decline, and vice versa. Higher level of depressive symptoms was associated with worse initial functioning and faster subsequent cognitive and functional decline. These findings highlight the importance of both cognitive and psychiatric assessment for functional prognosis. Targeting both cognitive and depressive symptoms in the clinical treatment of AD may have incremental benefit on functional abilities.
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Affiliation(s)
- Laura B Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and The Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Adwan L, Zawia NH. Epigenetics: a novel therapeutic approach for the treatment of Alzheimer's disease. Pharmacol Ther 2013; 139:41-50. [PMID: 23562602 PMCID: PMC3693222 DOI: 10.1016/j.pharmthera.2013.03.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 12/14/2022]
Abstract
Alzheimer's disease (AD) is the most common type of dementia in the elderly. It is characterized by the deposition of two forms of aggregates within the brain, the amyloid β plaques and tau neurofibrillary tangles. Currently, no disease-modifying agent is approved for the treatment of AD. Approved pharmacotherapies target the peripheral symptoms but they do not prevent or slow down the progression of the disease. Although several disease-modifying immunotherapeutic agents are in clinical development, many have failed due to the lack of efficacy or serious adverse events. Epigenetic changes including DNA methylation and histone modifications are involved in learning and memory and have been recently highlighted for holding promise as potential targets for AD therapeutics. Dynamic and latent epigenetic alterations are incorporated in AD pathological pathways and present valuable reversible targets for AD and other neurological disorders. The approval of epigenetic drugs for cancer treatment has opened the door for the development of epigenetic drugs for other disorders including neurodegenerative diseases. In particular, methyl donors and histone deacetylase inhibitors are being investigated for possible therapeutic effects to rescue memory and cognitive decline found in such disorders. This review explores the area of epigenetics for potential AD interventions and presents the most recent findings in this field.
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Affiliation(s)
- Lina Adwan
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA
| | - Nasser H. Zawia
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, USA
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Potvin O, Bergua V, Swendsen J, Meillon C, Tzourio C, Ritchie K, Dartigues JF, Amieva H. Anxiety and 10-year risk of incident and recurrent depressive symptomatology in older adults. Depress Anxiety 2013; 30:554-63. [PMID: 23532935 DOI: 10.1002/da.22101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anxiety has been shown to often precede depression in children and young adults. Only a small number of investigations have examined this form of comorbidity in older adults and the temporal relationship of these syndromes remains unclear. The objective was to verify whether trait anxiety predicts incident/recurrent depressive symptomatology in older adults independently of variables susceptible to explain this relationship in this population, such as cognitive complaints, subjective health, and baseline depressive symptoms. METHODS A random sample of 4,649 individuals aged 65 years or older from the Three-City Study, a prospective longitudinal study with a 10-year follow-up, was used. Incident and recurrent depressive symptomatology were determined by Center for Epidemiological Studies Depression Scale cutoff scores. Anxiety was measured using the trait scale of the State-Trait Anxiety Inventory. Cox proportional hazards models were used to determine the independent risk of depressive symptomatology for baseline anxiety, cognitive complaints, subjective health, and depressive symptoms, adjusting for sociodemographic, mental health, and physical health covariates. RESULTS Incident depressive symptomatology was independently predicted by baseline anxiety, depressive symptoms, cognitive complaints, and subjective health. Recurrent depressive symptomatology was independently predicted by baseline anxiety and depressive symptoms, but not by cognitive complaints and subjective health. Anxiety was associated with a higher risk of incident depressive symptomatology only in participants without a history of a major depressive episode, and with a higher risk of recurrent depressive symptomatology in men than in women. CONCLUSIONS Trait anxiety constitutes an important independent risk factor for subsequent depressive symptomatology in older adults.
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Affiliation(s)
- Olivier Potvin
- Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
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Nadia Y, El-Sousy KM, EL-Aila HJY, Mhesen F. Reaction Kinetics of the Heterogenous Decomposition of Hydrogen Peroxide in Microemulsions. TENSIDE SURFACT DET 2013. [DOI: 10.3139/113.100279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Kinetic study for the heterogeneous decomposition of hydrogen peroxide over different non-soluble metal oxides (CuO, Fe2O3 and PbO2) was taken as a model reaction, mainly in normal micellar, inverse micellar microemulsion of sodium dodecyl sulfate (SDS). Other micellar phases of different surfactants [sodium dioctylsulfosuccinate (AOT), cetyle trimethyl ammonium bromide (CTAB) and triton X100] have been studied. Different organic solvents have been investigated. A promotional effect was generally observed. The reaction rate determining step was estimated. Reaction rate constants and thermodynamic parameters (ΔG*, ΔH* and ΔS*) were calculated. It was found that the highest promotional influence was observed in the case of (SDS/Fe3O4) in micellar and inverse micellar micro-emulsion media.
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Affiliation(s)
- Yousef Nadia
- Department of Chemistry, Ain Shams Women's College, Cairo, Egypt
| | | | | | - Fatheya Mhesen
- Department of Chemistry, Al-Aqsa University, Gaza, PNA Via Israel
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Dawson NT, Powers SM, Krestar M, Yarry SJ, Judge KS. Predictors of self-reported psychosocial outcomes in individuals with dementia. THE GERONTOLOGIST 2012; 53:748-59. [PMID: 23107792 DOI: 10.1093/geront/gns137] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Little is known about the illness experience from the perspective of individuals with dementia (IWDs), as most quantitative research has focused on IWDs' psychosocial issues from proxy reports. The primary aim of this study was to better understand the impact of the illness experience on well-being from the perspective of the IWD through the framework of the Stress Process Model for Individuals with Dementia (SPM for IWDs). DESIGN AND METHODS Guided by the SPM for IWDs, self-report data were collected from IWDs (N = 131) about their illness experience, including primary objective and subjective stressors, secondary role and intrapsychic strains, and well-being outcomes. Using multiple linear regression, primary stressors, secondary strains, and background and context characteristics were entered into 3 prediction models for each outcome: anxiety, depression, and quality of life (QoL). RESULTS Three distinct prediction patterns emerged for each of the outcome measures. Embarrassment about memory loss was the unique predictor of anxiety, whereas physical health strain and role captivity uniquely predicted depression. Unique predictors for QoL included lower perceived instrumental activities of daily living (IADL) difficulty and higher self-efficacy. IMPLICATIONS This study provided valuable insight into the illness experience from the perspective of the IWD and identified key areas amenable to interventions, such as managing embarrassment about memory problems as well as improving self-efficacy and inner strength. Moreover, this study provided additional support for the inclusion of IWDs in the research process and highlighted the need for further research regarding clinical application of findings, testing of hypotheses, and analyzing efficacy of interventions.
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Affiliation(s)
- Nicole T Dawson
- Address correspondence to Katherine S. Judge, Department of Psychology, Cleveland State University, 2121 Euclid Avenue, CB 109, Cleveland, OH 44115. E-mail:
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Holtzer R, Zweig RA, Siegel LJ. Learning From The Past and Planning For The Future: The Challenges Of And Solutions For Integrating Aging Into Doctoral Psychology Training. TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY 2012; 6:142-150. [PMID: 23483705 PMCID: PMC3590915 DOI: 10.1037/a0029365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The long forecast "elder boom" has begun. Beginning in 2011, ten thousand members of the "baby boom" generation began turning 65 each day. This demographic shift in our society mandates that pre-doctoral programs in clinical psychology incorporate aging as an integral component of their core and elective training. While fully supporting the concept of broad and general training for predoctoral professional psychology programs, we maintain that the infusion of aging into doctoral psychology training curricula has been inadequate. In this manuscript we provide an overview of geropsychology training models and discuss the challenges involved in incorporating aging to the curriculum of pre-doctoral training in clinical psychology. Potential solutions and examples for accelerating infusion of aging knowledge base are discussed in the context of different geropsychology training models. We conclude that providing services to this rapidly growing segment of our population presents both an employment opportunity to broaden the reach of our profession as well as an ethical responsibility to train future professionals who will practice within their area of knowledge and expertise.
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Affiliation(s)
- Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University
- Department of Neurology, Albert Einstein College of Medicine, Yeshiva University
| | - Richard A. Zweig
- Ferkauf Graduate School of Psychology, Yeshiva University
- Department of Psychiatry, Albert Einstein College of Medicine, Yeshiva University
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Wilson R, Rochon E, Mihailidis A, Leonard C. Examining success of communication strategies used by formal caregivers assisting individuals with Alzheimer's disease during an activity of daily living. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2012; 55:328-341. [PMID: 22199204 DOI: 10.1044/1092-4388(2011/10-0206)] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To examine how formal (i.e., employed) caregivers' use verbal and nonverbal communication strategies while assisting individuals with moderate to severe Alzheimer's disease (AD) during the successful completion of an activity of daily living (ADL). Based on the literature, the authors hypothesized that caregivers' use of 1 proposition, closed-ended questions, and repetition would be of most benefit. METHOD Twelve caregiver-AD dyads participated in this observational study. Each dyad was videorecorded on 6 separate occasions while completing handwashing. Handwashing sessions were transcribed and systematically coded for the use of communication strategies during completion of the ADL. RESULTS Caregiver-AD dyads successfully completed 90% of all handwashing sessions, and caregivers employed a variety of communication strategies. Consistent with our hypotheses, during successful task completion, caregivers most frequently provided individuals with AD with 1 direction or idea (i.e., proposition) at a time, closed-ended questions, and paraphrased repetition. Caregivers also frequently used encouraging comments and the resident's name during the task; however, use of these strategies was not correlated to task success rate. CONCLUSION This study adds to the limited body of evidence supporting the use of specific communication strategies by caregivers assisting individuals with moderate to severe AD during successful completion of ADLs.
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Slaughter SE, Estabrooks CA, Jones CA, Wagg AS. Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities. BMC Geriatr 2011; 11:84. [PMID: 22176583 PMCID: PMC3264506 DOI: 10.1186/1471-2318-11-84] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 12/16/2011] [Indexed: 11/17/2022] Open
Abstract
Background Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. Methods/Design This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease. Discussion There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population. Trial Registration This clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).
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Utilization of antihypertensives, antidepressants, antipsychotics, and hormones in Alzheimer disease. Alzheimer Dis Assoc Disord 2011; 25:144-8. [PMID: 20975515 DOI: 10.1097/wad.0b013e3181fcba68] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study explores the longitudinal relationship between patient characteristics and use of 4 drug classes (antihypertensives, antidepressants, antipsychotics, and hormones) that showed significant changes in use rates over time in patients with Alzheimer disease. Patient/caregiver-reported prescription medication usage was categorized by drug class for 201 patients from the Predictors Study. Patient characteristics included use of cholinesterase inhibitors and/or memantine, function, cognition, living situation, baseline age, and sex. Assessment interval, year of study entry, and site were controlled for. Before adjusting for covariates, useage increased for antihypertensives (47.8% to 62.2%), antipsychotics (3.5% to 27.0%), and antidepressants (32.3% to 40.5%); use of hormones decreased (19.4% to 5.4%). After controlling for patient characteristics, effects of time on the use of antidepressants were no longer significant. Antihypertensive use was associated with poorer functioning, concurrent use of memantine, and older age. Antipsychotic use was associated with poorer functioning and poorer cognition. Antidepressant use was associated with younger age, poorer functioning, and concurrent use of cholinesterase inhibitors and memantine. Hormone use was associated with being female and younger age. Findings suggest accurate modeling of the Alzheimer disease treatment paradigm for certain subgroups of patients should include antihypertensives and antipsychotics in addition to cholinesterase inhibitors and memantine.
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Arbus C, Gardette V, Cantet CE, Andrieu S, Nourhashémi F, Schmitt L, Vellas B. Incidence and predictive factors of depressive symptoms in Alzheimer's disease: the REAL.FR study. J Nutr Health Aging 2011; 15:609-17. [PMID: 21968854 DOI: 10.1007/s12603-011-0061-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many patients develop psychiatric and behavioral disturbances in the course of Alzheimer's disease (AD). Among these disturbances, depressive symptoms are frequent and affect nearly 40% of patients. The natural history and course of such symptoms in AD, and in particular the predictive factors, are little known. We studied the incidence and risk factors for the development of the first depressive symptoms in AD. DESIGN Multicenter prospective study. PARTICIPANTS Three hundred twelve AD patients from the French Network on AD (REAL.FR) without depression and without antidepressant treatment at baseline were followed up and assessed every 6 months for 4 years. During follow-up, all events occurring between two visits were carefully recorded. MEASUREMENTS We used the Neuropsychiatric Inventory (NPI) for comprehensive evaluation of behavioral and psychological symptoms and depressive symptoms in particular. A multivariate analysis was performed using a backward stepwise Cox proportional hazards model. RESULTS The incidence of depressive symptoms was 17.45% person/years, 95%CI (13.88-21.02). Among non-time dependent variables, duration of disease (RR=0.51; 95%CI: 0.30-0.85, p=0.0102) and the number of comorbid conditions (RR=0.45; 95%CI: 0.24-0.83, p=0.0115) were protective factors against the development of depressive symptoms. Agitation/aggression (RR=1.96; 95%CI: 1.19-3.23, p=0.0078) and sleep disturbances (RR=2.65; 95%CI: 1.40-5.00, p=0.0026) were time-dependent variables predictive of depressive symptoms. CONCLUSION Better knowledge of predictive factors of mood disturbances in AD will enable clinicians to set up appropriate management of their patients. As published longitudinal studies are few, further works should be carried out to improve knowledge of the pattern and course of depression and depressive symptoms in AD.
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Affiliation(s)
- C Arbus
- Toulouse University, UPS, Traumatic Stress Laboratory-LST (Je2511), Hopital Casselardit, 170 av. de Casselardit, TSA 40031, 31059 Toulouse Cedex 9, France.
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Verkaik R, Francke AL, van Meijel B, Spreeuwenberg PMM, Ribbe MW, Bensing JM. The effects of a nursing guideline on depression in psychogeriatric nursing home residents with dementia. Int J Geriatr Psychiatry 2011; 26:723-32. [PMID: 21495077 DOI: 10.1002/gps.2586] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 06/03/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the effects of introducing a nursing guideline on depression in residents with dementia of psychogeriatric nursing home wards. METHODS A multi-center controlled clinical trial with randomization at ward level was used to study the effects of the guideline introduction. Nursing teams were trained in applying the guideline to their own residents diagnosed with depression in dementia. Key elements of the nursing guideline are increasing individualized pleasant activities and decreasing unpleasant events. Participating residents were 97 residents diagnosed with dementia and comorbid depression, from 18 psychogeriatric nursing home wards, in 9 Dutch nursing homes. Measurements took place at pre-test, post-test and follow-up. Primary outcome was severity of depression measured with the MDS/RAI-Depression Rating Scale (DRS) and the Cornell Scale for Depression in Dementia. Secondary outcome is mood as measured by the FACE-observation scale. RESULTS Compliance with the nursing guideline was moderate. Despite this, residents on the experimental wards showed a significant reduction in depression on the DRS. With the Cornell scale a reduction of depression was found as well, although not significantly different from that in the control group. No effects on observed mood were found. CONCLUSION This study shows significant reductions in depression severity by introducing a nursing guideline on psychogeriatric nursing home wards. Better compliance with the guideline could probably enlarge the effects. Some ways to achieve enhanced compliance are: (1) additionally train non-certified nurse assistants, and (2) emphasize necessary conditions for successful introduction of the guideline to nursing team managers.
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Affiliation(s)
- Renate Verkaik
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
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Abstract
OBJECTIVES The aim of this study was to investigate the prevalence of depression among very old individuals with dementia compared to those without dementia and to examine if there were any differences regarding associated factors between people with or without depression in these conditions. METHODS In a population-based study in Sweden, 363 participants aged 85 years and above, were evaluated for depression and dementia. RESULTS The prevalence of depression was significantly higher among the people with dementia than without dementia, 43% vs. 24% (p < 0.001). Approximately 2/3 of the depressed in both groups used antidepressants and of those, approximately 50% had responded. Depression in the group without dementia was, among other factors, associated with higher total number of medication, the use of significant more analgesics and benzodiazepines, loneliness, inability of going outside and recent loss of child. The loss of a child was the only factor that was independently associated with depression in those with dementia. CONCLUSIONS The present study confirms that in the very old, depression is more common among people with dementia than without dementia. A large proportion, both with and without dementia, are under-diagnosed and untreated, and in addition many subjects in both groups studied were non-responders to treatment. Many of the factors associated with depression among people without dementia in this study were not associated with depression among those with dementia, thus supporting the theory that the spectrum of associated factors for depression in dementia seems to be different from that for depression in people without dementia.
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Abstract
OBJECTIVE There is evidence that major depression increases the risk for dementia, but there is conflicting evidence as to whether depression may accelerate cognitive decline in dementia. The authors tested the hypothesis that decline in cognitive function over time is more pronounced in patients with dementia with comorbid depression, when compared with patients with dementia without depression history. DESIGN Prospective, longitudinal cohort study of aging. SETTING Nursing home. PARTICIPANTS Three hundred thirteen elderly nursing home residents (mean age at baseline: 86.99 years, standard deviation = 6.7; 83.1% women). At baseline, 192 residents were diagnosed with dementia, and another 27 developed dementia during follow-up. Thirty residents suffered from major depression at any point during the study, and 48 residents had a history of depression. MEASUREMENTS The authors measured cognitive decline using change in Mini-Mental State Examination (MMSE) scores over up to 36 months. The authors calculated multilevel regression models to estimate the effects of age, gender, education, dementia status, depression, depression history, and an interaction between dementia and depression, on change in MMSE scores over time. RESULTS Beyond the effects of age, gender, and education, residents showed steeper cognitive decline in the presence of dementia (β = -13.69, standard error = 1.38) and depression (β = -4.16, SE = 1.2), which was further accelerated by the presence of both depression and dementia (β = -2.72, SE = 0.65). CONCLUSIONS In dementia, the presence of depression corresponds to accelerated cognitive decline beyond gender and level of education, suggesting a unique influence of depression on the rate of cognitive decline in dementia.
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