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Cheng YT, Xin GK, Wang YL, Tan FY, Yuan L, Zhang Y, Liu Y, Ni CP. The current status of apathy in patients with dementia and its factors: A systematic review. Geriatr Nurs 2024; 58:290-297. [PMID: 38848610 DOI: 10.1016/j.gerinurse.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To systematically evaluate the current status of apathy in dementia patients and its associated factors. METHODS We searched Chinese and English databases to collect studies on the associated factors of apathy in patients with dementia from inception to March 14, 2023. Two researchers independently screened the literature, evaluated the quality, and extracted the data RESULTS: A total of 20 studies were included, and the incidence of apathy in patients with dementia ranged from 21 % to 90 %. According to the model of apathy proposed by Massimo in 2018, the associated factors were divided into individual factors for dementia patients, caregiver factors, and environmental factors. The individual factors of apathy in patients with dementia mainly include demographic characteristics, the severity of cognitive impairment, a combination of other behavioral and psychological symptoms of dementia, acute medical problems or adverse drug reactions, unmet needs, and malnutrition. Caregiver factors mainly include emotional expressions of hostility or criticism towards dementia patients and caregivers' expectations for a better life in the future. Environmental factors mainly include too high or too low stimulation and a lack of daytime activities CONCLUSIONS: Existing studies have shown that the incidence of apathy in dementia patients is high and is affected by multi-dimensional factors. There are more studies on individual factors in dementia patients and fewer studies on caregivers and environmental factors. In the future, a large number of high-quality studies are needed to demonstrate the mechanism of apathy in dementia patients and to find more related factors.
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Affiliation(s)
- Yue-Tong Cheng
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Gong-Kai Xin
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Ye-Lv Wang
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Feng-Ying Tan
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Lei Yuan
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Yu Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China; Department of Nephrology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Cui-Ping Ni
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
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2
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Dero K, van Alphen SPJ, Hoogenhout E, Rossi G. The role of maladaptive personality in behavioural and psychological symptoms in dementia. Int J Geriatr Psychiatry 2023; 38:e5971. [PMID: 37462412 DOI: 10.1002/gps.5971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although research demonstrated a significant link between premorbid normative personality traits and the severity of behavioural and psychological symptoms in dementia (BPSD) and associated emotional distress of the caregiver, little is known about the relationship of BPSD symptoms and associated distress with maladaptive traits. METHOD Informants (N = 182) of Dutch nursing home residents with dementia aged 65+, completed the Neuropsychiatric Inventory Questionnaire to assess the severity of BPSD and associated emotional distress. Premorbid maladaptive personality traits were evaluated using informant versions of a brief version of the Personality Inventory for Diagnostic and Statistical manual of Mental Disorders-5 (PID-5-BF), and two age-specific personality measures, the Informant Personality Questionnaire (HAP), and Gerontological Personality disorder Scale. Relationships between premorbid personality and BPSD were investigated with correlational and ordinal regression analyses. RESULTS BPSD severity and distress were associated with medium sized correlations to Negative Affectivity, Antagonism and indications of personality disorder presence. The emotional distress also correlated with a medium effect with Detachment. Higher scores on maladaptive personality traits increased the odds of higher BPSD severity and distress. CONCLUSION Results found with age-specific personality measures were in line with results found with other measures of (mal)adaptive traits. Several maladaptive personality traits had a significant relationship with the BPSD severity and associated emotional distress. We therefore encourage to implement personality assessment within BPSD treatment strategies. This way care becomes more person-focused and more tailored to the specific needs of patients and caregivers.
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Affiliation(s)
- Kato Dero
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen-Maastricht, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | | | - Gina Rossi
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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3
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Ekiz E, Videler AC, van Alphen SPJ. Feasibility of the Cognitive Model for Behavioral Interventions in Older Adults with Behavioral and Psychological Symptoms of Dementia. Clin Gerontol 2022; 45:903-914. [PMID: 32286161 DOI: 10.1080/07317115.2020.1740904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: The purpose of this study was to develop an individually tailored, non-pharmacological treatment model, the Cognitive Model for Behavioral Interventions (CoMBI), for patients with Behavioral and Psychological Symptoms of Dementia (BPSD) and comorbid maladaptive personality traits (CMPT), and to explore its feasibility and effectiveness.Methods: CoMBI was developed and implemented in two geriatric psychiatric inpatient wards in the Netherlands. In this single-group pretest-posttest, feasibility study, 40 patients with BPSD and CMPT (M = 73.8, SD = 8.5) were treated with CoMBI. BPSD and CMPT were assessed using informant-based questionnaires. Wilcoxon signed-rank tests and effect size calculations were conducted to determine differences.Results: Wilcoxon signed-rank tests demonstrated a significant decrease of BPSD with medium (r = 0.45) to large (r = 0.56) effect sizes. CoMBI demonstrated high acceptability and compliance by health-care professionals and family members.Conclusions: CoMBI is a feasible treatment model for challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease in challenging behaviors regardless of etiology.Clinical implications: Focusing on personality and associated core needs could have a key role in the non-pharmacological treatment of the elderly with BPSD.
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Affiliation(s)
- Erol Ekiz
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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4
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Fukunaga H, Sugawara H, Koyama A, Okamoto K, Fukui T, Ishikawa T, Takebayashi M, Sekiyama K, Hashimoto M. Relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients: focus on personality and coping process. Psychogeriatrics 2022; 22:453-459. [PMID: 35504791 DOI: 10.1111/psyg.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative delirium is associated with increased mortality. Therefore, it is important to manage delirium during the entire perioperative period. Preoperative anxiety is associated with poor prognosis in postoperative patients who have undergone cardiovascular surgery. This study aims to investigate the relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients (aged 65 years or older), considering the individual psychological characteristics, such as personality and stress coping skills in response to anxiety, as confounding factors. METHODS This prospective study included patients aged >65 years in a preoperative state before undergoing cardiovascular surgery. Subjects were divided into two groups based on whether they experienced postoperative delirium, or not. We compared clinical and demographic factors, preoperative psychiatric and psychological factors, and intraoperative and perioperative physical factors between the control and delirium groups. Multiple imputations were used to account for missing data. RESULTS Out of 168 subjects enrolled in this study, 26 (15.5%) developed postoperative delirium. Univariate analysis showed significant differences in age (P = 0.027), cognitive function (P = 0.007), agreeableness (P = 0.029), and the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score (P = 0.023) between the delirium and control groups. Multiple logistic regression analysis did not identify a significant association between preoperative anxiety and the onset of postoperative delirium. However, age (odds ratio (OR) = 1.114, P = 0.018), agreeableness (OR = 0.555, P = 0.008), and the APACHE-II score (OR = 1.227, P = 0.008) were identified as risk factors for postoperative delirium. CONCLUSION Agreeableness, one of the personality traits associated with preoperative anxiety, appears to be involved in the development of postoperative delirium as an independent psychological factor, regardless of age or physical factors.
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Affiliation(s)
- Hiroe Fukunaga
- Department of Nursing, Kumamoto School of Nursing, Kumamoto, Japan
| | - Hiroko Sugawara
- Department of Psychiatry, Kansai Rosai Hospital, Amagasaki, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ken Okamoto
- Department of Cardiovascular Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kaoru Sekiyama
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University, Kyoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
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5
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Fukuda C, Higami Y, Shigenobu K, Kanemoto H, Yamakawa M. Using a Non-Wearable Actigraphy in Nursing Care for Dementia With Lewy Bodies. Am J Alzheimers Dis Other Demen 2022; 37:15333175221082747. [PMID: 35343815 PMCID: PMC10581098 DOI: 10.1177/15333175221082747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People who have dementia with Lewy bodies often have sleep disorders. We used non-wearable devices to record and categorize the sleep patterns of patients with Lewy body dementia. Individual sleep data at a dementia-care unit in Japan were recorded using non-wearables. One week's worth of data from 18 patients was analyzed. Median metrics for all participants were the following: sleep efficiency, 68% (23-89); sleep duration at night, 6.8 hours (1.6-11.1); times getting out of bed at night, 3.5 (0-13). We identified three types of abnormal sleep: extremely short sleep duration, excessive sleep duration at night, and excessive number of times getting out of bed at night. Sleep disturbances in Lewy body dementia patients are treated using various practices; staff must choose the most effective plan for each patient's situation. Monitoring patient sleep using non-wearable provides more objective data that can help staff better personalize nursing care.
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Affiliation(s)
- Chiaki Fukuda
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoko Higami
- Faculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazue Shigenobu
- Asakayama General Hospital, Sakai, Japan
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Miyae Yamakawa
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
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6
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Rouch I, Dorey JM, Padovan C, Trombert-Paviot B, Benoit M, Laurent B, Boublay N, Krolak-Salmon P. Does Personality Predict Behavioral and Psychological Symptoms of Dementia? Results from PACO Prospective Study. J Alzheimers Dis 2020; 69:1099-1108. [PMID: 31156171 DOI: 10.3233/jad-190183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Premorbid personality could play a role in the onset of behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) but prospective studies are lacking. OBJECTIVE The present study aimed at prospectively assessing the influence of premorbid personality traits on BPS evolution in a population of patients with prodromal or mild AD. METHODS We used a multicenter prospective cohort study of 237 patients followed-up for 18 months. The influence of personality traits on BPS evolution, measured with Neuropsychiatric Inventory (NPI), was assessed using linear mixed-effect models. RESULTS A principal components analysis of the 12 NPI behavioral domains yielded five factors labelled as psychotic symptoms, affective symptoms, behavioral dyscontrol, apathy/appetite symptoms, and sleep disorders. During the follow-up, higher neuroticism was significantly associated with a higher progression of affective symptoms (p < 0.0001), apathy/appetite symptoms (p = 0.002), sleep disorders (p = 0.001) as well as global NPI scores (p < 0.0001). Greater conscientiousness was related to a lower evolution of psychotic (p = 0.002), affective (p = 0.02) and apathy/appetite symptoms (p = 0.02), and global NPI score (p < 0.0001). Higher openness was associated with lower affective symptoms evolution (p = 0.01). A significant relationship was found between higher extraversion, lower affective symptoms (p = 0.02), and higher behavioral dyscontrol (p = 0.04). CONCLUSION The present analysis suggests that premorbid personality may influence the evolution of BPS in prodromal or mild AD. Given these results, it seems important to give more importance to personality assessment in early AD, in order to better identify and manage patients at risk of adverse behavioral changes.
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Affiliation(s)
- Isabelle Rouch
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint-Etienne, France.,Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France
| | - Jean-Michel Dorey
- Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France.,Aging Psychiatry Unit, University Hospital Le Vinatier, Bron, France.,Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Catherine Padovan
- Aging Psychiatry Unit, University Hospital Le Vinatier, Bron, France
| | - Béatrice Trombert-Paviot
- Public Health and Medical Information Unit, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Michel Benoit
- Psychiatry Unit, Hôpital Pasteur, University Hospital of Nice, Nice, France
| | - Bernard Laurent
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint-Etienne, France
| | | | - Nawèle Boublay
- Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France
| | - Pierre Krolak-Salmon
- Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France.,Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
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7
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Abstract
Research into irritability has focused largely on its developmental and child-adolescent manifestations. Although irritability appears to be as elemental an experience as anxiety or depression, diagnoses highlighting irritability as the focal ingredient have yet to be delineated for adults. Instead, irritability-related diagnoses in adults have largely emphasized externalizing behaviors, depressed mood, and personality. Consequently, patients complaining of irritability are sometimes shoehorned into diagnostic categories that they do not experience as authentic representations of their lived experiences. This article proposes that the symptom of irritability might be productively reenvisioned as a focal point, analogous to anxiety and depression, around which irritability-related syndromes and disorders in adults might coalesce. If anxiety, depressive, insomnia, and pain disorders, why not irritability disorders? Both state and trait characteristics of irritability can lend themselves to DSM diagnostic frames. Based on clinical observations, specific irritability disorders in adults can be envisioned, modeled as Irritability Disorder of Adulthood, Irritability Disorder Secondary to Another Medical Condition, Substance-Induced Irritability Disorder, Adjustment Disorder With Irritable Mood, and the like. Further delineation of irritability phenomena, syndromes, and possible disorders in adults is warranted to advance investigation, guide assessment, and improve treatment.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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8
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Dorey JM, Rouch I, Padovan C, Boublay N, Pongan E, Laurent B, von Gunten A, Krolak-Salmon P. Neuroticism-Withdrawal and Neuroticism-Volatility Differently Influence the Risk of Neuropsychiatric Symptoms in Alzheimer's Disease. J Alzheimers Dis 2020; 74:79-89. [PMID: 31985463 DOI: 10.3233/jad-190884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neuroticism is recognized as the personality domain that is most strongly associated with behavioral and psychological symptoms (BPS) of Alzheimer's disease (AD). Two sub-components of neuroticism have been recently isolated. Neuroticism-withdrawal (N-withdrawal) refers to the tendency to internalize negative emotion, whereas neuroticism-volatility (N-volatility) reflect the predisposition to externalize negative emotions. OBJECTIVE The objective of the current study was to investigate the specific influence of these two sub-components of neuroticism on BPS. METHODS One hundred eighty-seven patients with prodromal or mild AD were drawn from the PACO study (Personalité Alzheimer COmportement). Neuroticism and its facets were assessed at baseline using the NEO-PI-R inventory. N-withdrawal and N-volatility were isolated using a principal component analysis led on the six facets composing neuroticism. BPS were measured with the short version of Neuropsychiatric Inventory (NPI-Q) and collected at baseline, then every 6 months over an 18-month follow-up. Linear mixed-effect analyses were conducted to investigate the association between N-withdrawal, N-volatility, and the severity of BPS over the follow-up. RESULTS Mean age of the participant was 79.2±6.5; 59% were female; mean MMSE was 24.5±2.5. Both N-volatility and N-withdrawal were related with the NPI-Q (p < 0.001; p = 0,004). N-withdrawal was positively associated with anxiety (p = 0.001) and depression (p = 0.002), while N-volatility was positively related to delusions (p = 0.004), agitation/aggression (p < 0.001), irritability/volatility (p = 0.037), and apathy (p = 0.021). CONCLUSION The present study demonstrates that N-volatility and N-withdrawal influence the risk of developing BPS in a different way. These results highlight the relevance of considering sub-components of neuroticism when studying links between personality and BPS.
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Affiliation(s)
- Jean-Michel Dorey
- Aging Psychiatry Unit, University Hospital Le Vinatier, Bron, France.,Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM, CNRS UMR, Lyon, France.,Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France.,Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Isabelle Rouch
- Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France.,Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology unit, university hospital of Saint Etienne, Saint-Etienne, France
| | - Catherine Padovan
- Aging Psychiatry Unit, University Hospital Le Vinatier, Bron, France.,Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM, CNRS UMR, Lyon, France
| | - Nawèle Boublay
- Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM, CNRS UMR, Lyon, France
| | - Elodie Pongan
- Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France
| | - Bernard Laurent
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology unit, university hospital of Saint Etienne, Saint-Etienne, France
| | | | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre Krolak-Salmon
- Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM, CNRS UMR, Lyon, France.,Memory Clinical and Research Center of Lyon (CMRR), Aging Institute I-Vie, University Hospital of Lyon, Villeurbanne, France
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9
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Young JJ, Balachandran S, Garg G, Balasubramaniam M, Gupta A, Tampi DJ, Tampi RR. Personality and the risk factors for developing behavioral and psychological symptoms of dementia: a narrative review. Neurodegener Dis Manag 2019; 9:107-118. [PMID: 30998118 DOI: 10.2217/nmt-2018-0044] [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] [Indexed: 11/21/2022] Open
Abstract
Premorbid personality traits have been implicated as risk factors for the development of behavioral and psychological symptoms of dementia (BPSD), although there is a paucity of studies investigating this relationship. In this narrative review, a number of studies found that premorbid neuroticism has consistently been observed to have a significant association with the development of BPSD symptoms while premorbid conscientiousness, extraversion, openness and agreeableness may be protective factors against future BPSD symptoms. In conclusion, premorbid personality traits appear to affect the risk of BPSD symptoms among individuals with dementia.
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Affiliation(s)
- Juan J Young
- Department of Psychiatry, Case Western Reserve University School of Medicine, MetroHealth, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Silpa Balachandran
- Department of Psychiatry, Case Western Reserve University School of Medicine, MetroHealth, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Garima Garg
- Department of Psychiatry, Case Western Reserve University School of Medicine, MetroHealth, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Meera Balasubramaniam
- Department of Psychiatry, New York University School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Aarti Gupta
- Department of Psychiatry, Yale School of Medicine, 300 George St. #901, New Haven, CT 06511, USA
| | - Deena J Tampi
- Diamond Healthcare, 701 E. Byrd Street, 15th Floor, Richmond, VA 23219, USA
| | - Rajesh R Tampi
- Department of Psychiatry, Yale School of Medicine, 300 George St. #901, New Haven, CT 06511, USA.,Department of Psychiatry and Psychology, Cleveland Clinic Akron General, Akron, OH 44037, USA.,Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
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10
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Sao T, Yoshino Y, Yamazaki K, Ozaki Y, Mori Y, Ochi S, Yoshida T, Mori T, Iga JI, Ueno SI. MEF2C mRNA expression and cognitive function in Japanese patients with Alzheimer's disease. Psychiatry Clin Neurosci 2018; 72:160-167. [PMID: 29112298 DOI: 10.1111/pcn.12618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 12/15/2022]
Abstract
AIM Despite continuing research into Alzheimer's disease (AD), its pathological mechanisms and modulating factors remain unknown. Several genes influence AD pathogenesis by affecting inflammatory pathways. Myocyte-enhancer factor 2C (MEF2C) is one such candidate gene for AD. METHODS We examined MEF2C mRNA expression levels and methylation rates of CpG on its promoter region in peripheral leukocytes from Japanese AD patients compared with age- and sex-matched control subjects. RESULTS In peripheral leukocytes, MEF2C mRNA expression levels in AD subjects were significantly lower than those in control subjects (0.86 ± 0.25 vs 0.99 ± 0.27, respectively, P = 0.007) and were correlated with the Alzheimer's Disease Assessment Scale (r = -0.345, P = 0.049) and the Mini Mental State Examination (r = 0.324, P = 0.02). No significant differences were found in methylation rates between AD and control subjects. CONCLUSION MEF2C mRNA expression in leukocytes may be a biological marker for cognitive decline in AD.
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Affiliation(s)
- Tomoko Sao
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuta Yoshino
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kiyohiro Yamazaki
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuki Ozaki
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoko Mori
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Taku Yoshida
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takaaki Mori
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shu-Ichi Ueno
- Department of Neuropsychiatry, Molecules, and Function, Ehime University Graduate School of Medicine, Toon, Japan
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11
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Sutin AR, Stephan Y, Luchetti M, Terracciano A. Self-reported personality traits are prospectively associated with proxy-reported behavioral and psychological symptoms of dementia at the end of life. Int J Geriatr Psychiatry 2018; 33:489-494. [PMID: 28869657 PMCID: PMC5807122 DOI: 10.1002/gps.4782] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/27/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of Alzheimer disease for patients and their families. Previous studies have found associations between informant-reported retrospective personality and BPSD; we test whether prospective, self-reported personality predicts who will experience these symptoms. METHODS Deceased participants from the Health and Retirement Study who had evidence of cognitive impairment at the end of life (N = 1988) were selected to examine whether self-reported five-factor model personality traits, measured up to 8 years before death, were associated with proxy-reported BPSD. RESULTS Neuroticism was associated with increased risk of the 7 BPSD: got lost in familiar places, wandered off, were not able to be left alone, experienced hallucinations, suffered from depression, had periodic confusion, and an uncontrolled temper. These associations were not moderated by age, gender, race, or education. Conscientiousness was associated with fewer symptoms overall and especially with lower risk of getting lost in familiar places and not being able to be left alone. CONCLUSIONS The present research indicates that self-reported personality, particularly Neuroticism, is associated prospectively with risk for a wide range of behavioral symptoms for individuals who had cognitive impairment at the end of life. The use of self-reported personality traits can help aid in identifying who is most at risk for behavioral symptoms. Such information may be useful for nonpharmacological interventions tailored to the individual's personality to reduce the prevalence and burden of these BPSD.
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