1
|
Collins JD, Henley SMD, Suárez-González A. A systematic review of the prevalence of depression, anxiety, and apathy in frontotemporal dementia, atypical and young-onset Alzheimer's disease, and inherited dementia. Int Psychogeriatr 2023; 35:457-476. [PMID: 32684177 DOI: 10.1017/s1041610220001118] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Depression, anxiety, and apathy are the most commonly reported neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD). Understanding their prevalence in rarer dementias such as frontotemporal dementia (FTD), primary progressive aphasia (PPA), posterior cortical atrophy (PCA), young-onset AD (YOAD), and inherited dementias has implications for both clinical practice and research. In this study, we aimed to examine the current state of knowledge of the prevalence of these three NPS in less prevalent dementias. DESIGN We conducted a systematic review based on searches of EMBASE, PsycINFO, and PubMed up to September 2019. RESULTS 47 articles meeting inclusion criteria were identified. Depression, anxiety, and apathy were commonly reported across the phenotypes studied but their prevalence showed large variation between studies. Apathy showed the highest reported frequency in FTD (50-100% across studies), behavioral variant frontotemporal dementia (bvFTD) (73-100%), and YOAD (44-100%). Anxiety was frequently reported in FTD (0-100%) and bvFTD (19-63%). Depression showed the highest prevalence in FTD (7-69%) and YOAD (11-55%). Among the three variants of PPA, sv-PPA is the one most investigated (seven articles). Three or fewer articles were identified examining NPS in the remaining PPA variants, PCA, familial AD, and familial FTD. Inconsistency in the tools used to measure symptoms and small sample sizes were common methodological limitations. CONCLUSIONS Future studies should consider the inclusion of larger sample sizes (e.g. through multicenter collaborations) and the use of harmonized protocols that include the combination of caregiver and patient-derived measures and symptom-specific questionnaires. More research is needed on the phenotype-specific barriers and facilitators for people living with dementia to successfully engage in self-reports of NPS.
Collapse
Affiliation(s)
- Jessica D Collins
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Susie M D Henley
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Aida Suárez-González
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| |
Collapse
|
2
|
Loza MI, Hmeljak J, Bountra C, Audia JE, Chowdhury S, Weiman S, Merchant K, Blanco MJ. Collaboration and knowledge integration for successful brain therapeutics - lessons learned from the pandemic. Dis Model Mech 2022; 15:286134. [PMID: 36541917 PMCID: PMC9844134 DOI: 10.1242/dmm.049755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Brain diseases are a major cause of death and disability worldwide and contribute significantly to years of potential life lost. Although there have been considerable advances in biological mechanisms associated with brain disorders as well as drug discovery paradigms in recent years, these have not been sufficiently translated into effective treatments. This Special Article expands on Keystone Symposia's pre- and post-pandemic panel discussions on translational neuroscience research. In the article, we discuss how lessons learned from the COVID-19 pandemic can catalyze critical progress in translational research, with efficient collaboration bridging the gap between basic discovery and clinical application. To achieve this, we must place patients at the center of the research paradigm. Furthermore, we need commitment from all collaborators to jointly mitigate the risk associated with the research process. This will require support from investors, the public sector and pharmaceutical companies to translate disease mechanisms into world-class drugs. We also discuss the role of scientific publishing in supporting these models of open innovation. Open science journals can now function as hubs to accelerate progress from discovery to treatments, in neuroscience in particular, making this process less tortuous by bringing scientists together and enabling them to exchange data, tools and knowledge effectively. As stakeholders from a broad range of scientific professions, we feel an urgency to advance brain disease therapies and encourage readers to work together in tackling this challenge.
Collapse
Affiliation(s)
- Maria Isabel Loza
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Pharmacology Department, School of Pharmacy, University of Santiago de Compostela, Health Research Institute (IDIS), Kærtor Foundation, 15706 Santiago de Compostela, Spain,Authors for correspondence (; ; )
| | - Julija Hmeljak
- Disease Models & Mechanisms, The Company of Biologists, Bidder Building, Station Road, Histon, Cambridge CB24 9LF, UK
| | - Chas Bountra
- Dorothy Crowfoot Hodgkin Building, Dorothy Hodgkin Road, University of Oxford, Oxford OX1 3QU, UK
| | - James E. Audia
- Flare Therapeutics, 215 1st Street, Cambridge, MA, 02142, USA
| | - Sohini Chowdhury
- The Michael J. Fox Foundation for Parkinson's Research, 111 West 33 Street, New York, NY 10120, USA
| | - Shannon Weiman
- Keystone Symposia, 160 U.S. Highway 6, Suite 201, PO Box 1630, Silverthorne, CO 80498, USA
| | - Kalpana Merchant
- Northwestern University, 303 E Chicago Ave., Chicago, IL 60611, USA,Authors for correspondence (; ; )
| | - Maria-Jesus Blanco
- Atavistik Bio, 38 Sidney Street, Cambridge MA 02139, USA,Authors for correspondence (; ; )
| |
Collapse
|
3
|
Loi SM, Tsoukra P, Chen Z, Wibawa P, Mijuskovic T, Eratne D, Di Biase MA, Evans A, Farrand S, Kelso W, Goh AM, Walterfang M, Velakoulis D. Mortality in dementia is predicted by older age of onset and cognitive presentation. Aust N Z J Psychiatry 2022; 56:852-861. [PMID: 34420425 DOI: 10.1177/00048674211041003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Survival information in dementia is important for future planning and service provision. There have been limited Australian data investigating survival duration and risk factors associated with mortality in younger-onset dementia. METHODS This was a cross-sectional retrospective study investigating survival in inpatients with a diagnosis of dementia admitted to a tertiary neuropsychiatry service from 1991 to 2014. The Australian Institute of Health and Welfare National Death Index was used to obtain mortality information. RESULTS A total of 468 inpatients were identified, of which 75% had symptom onset at ⩽65 years of age (defined as younger-onset dementia). Dementia was categorised into four subtypes, Alzheimer's dementia, frontotemporal dementia, vascular dementia and other dementias; 72% of the patients had died. Overall median survival duration was 10.6 years with no significant differences in duration within the dementia subtypes (p = 0.174). Survival in older-onset dementia (symptom onset at >65 years of age) was about half of that in younger-onset dementia (median survival 6.3 years compared to 12.7 years, respectively). Independent predictors of mortality were having older-onset dementia (hazard ratio: 3.2) and having initial presenting symptoms being cognitive in nature (hazard ratio: 1.5). Females with an older-onset dementia had longer survival compared to males with an older-onset dementia, and this was reversed for younger-onset dementia. Older-onset dementia and younger-onset dementia conferred 3 and 6 times, respectively, increased risk of death compared to the general population. CONCLUSION This is the largest Australian study to date investigating survival and risk factors to mortality in dementia. We report important clinical information to patients with dementia and their families about prognosis which will assist with future planning. Our findings suggest that for both older-onset dementia and younger-onset dementia, 'new onset' psychiatric symptoms precede the cognitive symptoms of a neurodegenerative process. This, and sex differences in survival depending on the age of onset of the dementia warrant further investigation.
Collapse
Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Paraskevi Tsoukra
- Department of Neurology, Evangelismos General Hospital, Athens, Greece
| | - Zhiben Chen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Pierre Wibawa
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Dhamidhu Eratne
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Maria A Di Biase
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew Evans
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Anita My Goh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,National Ageing Research Institute, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
4
|
Panegyres PK. The Clinical Spectrum of Young Onset Dementia Points to Its Stochastic Origins. J Alzheimers Dis Rep 2021; 5:663-679. [PMID: 34632303 PMCID: PMC8461730 DOI: 10.3233/adr-210309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dementia is a major global health problem and the search for improved therapies is ongoing. The study of young onset dementia (YOD)-with onset prior to 65 years-represents a challenge owing to the variety of clinical presentations, pathology, and gene mutations. The advantage of the investigation of YOD is the lack of comorbidities that complicate the clinical picture in older adults. Here we explore the origins of YOD. OBJECTIVE To define the clinical diversity of YOD in terms of its demography, range of presentations, neurological examination findings, comorbidities, medical history, cognitive findings, imaging abnormalities both structural and functional, electroencephagraphic (EEG) data, neuropathology, and genetics. METHODS A prospective 20-year study of 240 community-based patients referred to specialty neurology clinics established to elucidate the nature of YOD. RESULTS Alzheimer's disease (AD; n = 139) and behavioral variant frontotemporal (bvFTD; n = 58) were the most common causes with a mean age of onset of 56.5 years for AD (±1 SD 5.45) and 57.1 years for bvFTD (±1 SD 5.66). Neuropathology showed a variety of diagnoses from multiple sclerosis, Lewy body disease, FTD-MND, TDP-43 proteinopathy, adult-onset leukoencephalopathy with axonal steroids and pigmented glia, corticobasal degeneration, unexplained small vessel disease, and autoimmune T-cell encephalitis. Non-amnestic forms of AD and alternative forms of FTD were discovered. Mutations were only found in 11 subjects (11/240 = 4.6%). APOE genotyping was not divergent between the two populations. CONCLUSION There are multiple kinds of YOD, and most are sporadic. These observations point to their stochastic origins.
Collapse
Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, West Perth, Australia
- The University of Western Australia, Nedlands, Australia
| |
Collapse
|
5
|
Loi SM, Goh AMY, Walterfang M, Velakoulis D. Clinical Application of Findings From Longitudinal Studies of Younger-Onset Dementia: Rapid Review and Recommendations. J Neuropsychiatry Clin Neurosci 2021; 32:322-333. [PMID: 32397878 DOI: 10.1176/appi.neuropsych.19110238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Younger-onset dementia (YOD) presents with heterogeneous symptoms, has a variety of etiologies, and can be difficult to diagnose. The authors conducted a rapid review of longitudinal YOD cohorts and their related substudies to evaluate current literature that may inform the clinical information provided to patients about the progression and duration of illness and to highlight areas for future research. Searches were conducted using MEDLINE, CINAHL, PubMed, PsycINFO, and Web of Science for articles published between January 1966 and June 2018. Four longitudinal YOD cohort studies and their related substudies were identified. Alzheimer's disease (AD) was reported as the most frequently occurring YOD. The age at onset reported for two cohorts ranged from 53.8 to 60.2 years, depending on the dementia type. Three cohorts yielded substudies that focused on other aspects of YOD, including caregiver outcomes, neuropsychiatric symptoms, and psychotropic drug use. There were conflicting data regarding whether AD or frontotemporal dementia had the greatest rate of cognitive decline. The authors identified a restricted amount of clinical information that may be useful for patients and their families. Limitations included relatively short follow-up periods and types of dementia included. There was also a lack of information on longitudinal changes in neuropsychiatric symptoms and their relationship to biomarkers. These aspects are important considerations for future research, because they may yield information relevant to early diagnosis and disease progression, with improved clinical care for patients with YOD and their families. Streamlining data collection may also improve the ability to generalize results.
Collapse
Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); National Ageing Research Institute, Parkville, Australia (Goh); and Florey Institute of Neuroscience and Mental Health, Parkville, Australia (Walterfang)
| | - Anita M Y Goh
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); National Ageing Research Institute, Parkville, Australia (Goh); and Florey Institute of Neuroscience and Mental Health, Parkville, Australia (Walterfang)
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); National Ageing Research Institute, Parkville, Australia (Goh); and Florey Institute of Neuroscience and Mental Health, Parkville, Australia (Walterfang)
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia (Loi, Goh, Walterfang, Velakoulis); National Ageing Research Institute, Parkville, Australia (Goh); and Florey Institute of Neuroscience and Mental Health, Parkville, Australia (Walterfang)
| |
Collapse
|
6
|
Kim J, Woo SY, Kim S, Jang H, Kim J, Kim J, Kang SH, Na DL, Chin J, Apostolova LG, Seo SW, Kim HJ. Differential effects of risk factors on the cognitive trajectory of early- and late-onset Alzheimer's disease. Alzheimers Res Ther 2021; 13:113. [PMID: 34127075 PMCID: PMC8204422 DOI: 10.1186/s13195-021-00857-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although few studies have shown that risk factors for Alzheimer's disease (AD) are associated with cognitive decline in AD, not much is known whether the impact of risk factors differs between early-onset AD (EOAD, symptom onset < 65 years of age) versus late-onset AD (LOAD). Therefore, we evaluated whether the impact of Alzheimer's disease (AD) risk factors on cognitive trajectories differ in EOAD and LOAD. METHODS We followed-up 193 EOAD and 476 LOAD patients without known autosomal dominant AD mutation for 32.3 ± 23.2 months. Mixed-effects model analyses were performed to evaluate the effects of APOE ε4, low education, hypertension, diabetes, dyslipidemia, and obesity on cognitive trajectories. RESULTS APOE ε4 carriers showed slower cognitive decline in general cognitive function, language, and memory domains than APOE ε4 carriers in EOAD but not in LOAD. Although patients with low education showed slower cognitive decline than patients with high education in both EOAD and LOAD, the effect was stronger in EOAD, specifically in frontal-executive function. Patients with hypertension showed faster cognitive decline than did patients without hypertension in frontal-executive and general cognitive function in LOAD but not in EOAD. Patients with obesity showed slower decline in general cognitive function than non-obese patients in EOAD but not in LOAD. CONCLUSIONS Known risk factors for AD were associated with slower cognitive decline in EOAD but rapid cognitive decline in LOAD.
Collapse
Affiliation(s)
- Jaeho Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sook-Young Woo
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Junpyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jisun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Juhee Chin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| |
Collapse
|
7
|
Survival and life-expectancy in a young-onset dementia cohort with six years of follow-up: the NeedYD-study. Int Psychogeriatr 2019; 31:1781-1789. [PMID: 30915930 DOI: 10.1017/s1041610219000152] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to investigate survival time and life-expectancy in people with young-onset dementia (YOD) and to examine the relationship with age, sex, dementia subtype and comorbidity. DESIGN, SETTING AND PARTICIPANTS Survival was examined in 198 participants in the Needs in Young-onset Dementia study, including participants with Alzheimer's dementia (AD), vascular dementia (VaD) and frontotemporal dementia (FTD). MEASURES The primary outcomes were survival time after symptom onset and after date of diagnosis. Cox proportional hazards models were used to explore the relationship between survival and age, sex, dementia subtype and comorbidity. Additionally, the impact on remaining life expectancy was explored. RESULTS During the six-year follow-up, 77 of the participants died (38.9%), 78 participants survived (39.4%) and 43 were lost to follow-up (21.7%). The mean survival time after symptom onset and diagnosis was 209 months (95% CI 185-233) and 120 months (95% CI 110-130) respectively. Participants with AD had a statistically significant shorter survival compared with VaD participants, both regarding survival after symptom onset (p = 0.047) as well as regarding survival after diagnosis (p = 0.049). Younger age at symptom onset or at diagnosis was associated with longer survival times. The remaining life expectancy, after diagnosis, was reduced with 51% for males and 59% for females compared to the life expectancy of the general population in the same age groups. CONCLUSION/IMPLICATIONS It is important to consider the dementia subtype when persons with YOD and their families are informed about the prognosis of survival. Our study suggests longer survival times compared to other studies on YOD, and survival is prolonged compared to studies on LOD. Younger age at symptom onset or at diagnosis was positively related to survival but diagnosis at younger ages, nevertheless, still diminishes life expectancy dramatically.
Collapse
|
8
|
The Nature and Natural History of Posterior Cortical Atrophy Syndrome. Alzheimer Dis Assoc Disord 2017; 31:295-306. [DOI: 10.1097/wad.0000000000000207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
9
|
Panegyres PK, Berry R, Burchell J. Early Dementia Screening. Diagnostics (Basel) 2016; 6:diagnostics6010006. [PMID: 26838803 PMCID: PMC4808821 DOI: 10.3390/diagnostics6010006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
Abstract
As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying Aβ1–42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history—hence the need for cost-effective screening measures for early dementia.
Collapse
Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth 6005, Western Australia, Australia.
| | - Renee Berry
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth 6005, Western Australia, Australia.
| | - Jennifer Burchell
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth 6005, Western Australia, Australia.
| |
Collapse
|
10
|
Chen HY, Panegyres PK. The Role of Ethnicity in Alzheimer's Disease: Findings From The C-PATH Online Data Repository. J Alzheimers Dis 2016; 51:515-23. [PMID: 26890783 DOI: 10.3233/jad-151089] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ethnic minorities seem to be at an increased risk of Alzheimer's disease (AD). However, little is known about ethnic differences and the risks of early onset AD (EOAD). OBJECTIVE Cognitive function changes over time and odds of EOAD by ethnicity were analyzed by the mixed model and the logistic regression. METHODS Information on demographics, self-reported co-morbidities, cognitive functions (MMSE and ADAS-COG), and ApoE genotypes were collected for 6,500 subjects with AD obtained from the placebo arm of clinical trials; this data was examined by ethnicities: Caucasian, Asian, African American, Hispanic, and other minorities--including Native Alaskans, Americans, and Hawaiians. RESULTS Of the total subjects, Caucasians accounted for 89.0% , followed by 4.7% Asians, 2.7% African Americans, 2.4% Hispanics, and 1.2% Native Americans, Alaskans, and Hawaiians. Age, gender, EOAD status, co-morbidities, family history of AD, and ApoE genotypes were significantly different by ethnicity. ApoE ɛ2 allele is possibly overrepresented in the Native Americans, Africans, Hawaiians, and African Americans. A significant interaction with time, ethnicity, and cognitive performance was found, indicating more cognitive deterioration in other minorities than Caucasians for mini-mental state (p < 0.01). After adjusting for co-morbidities and gender, the odds of EOAD among African Americans (OR: 1.6, 95% CI: 1.1-2.4) and Native Alaskans, Americans, and Hispanics (OR: 2.1, 95% CI: 1.2-3.5) were significantly higher, compared with Caucasians. CONCLUSIONS Ethnicity may impact AD through age of onset, co-morbidities, family history, ApoE gene status, and cognitive change over time. The greater odds of EOAD among African Americans, Alaskans, and Hawaiians suggest that some ethnicities may be at risk of AD at a younger age.
Collapse
|
11
|
Chakrabarty T, Sepehry AA, Jacova C, Hsiung GYR. The prevalence of depressive symptoms in frontotemporal dementia: a meta-analysis. Dement Geriatr Cogn Disord 2015; 39:257-71. [PMID: 25662033 DOI: 10.1159/000369882] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression is common in Alzheimer's and vascular dementia and is associated with poorer outcomes; however, less is known about the impact of depression on frontotemporal dementia (FTD). Here, we conducted a meta-analysis of diagnostic methods and the prevalence of depressive symptoms in FTD. METHODS PubMed, EMBASE and PsychINFO were queried for 'depression' and/or 'depressive mood' in behavioral- and language-variant FTD. The prevalence and diagnosis of depressive symptoms were extracted from relevant studies and the results pooled using a random-effects model. RESULTS We included 29 studies in this meta-analysis, with sample sizes ranging from 3 to 73 (n = 870). The omnibus estimated event rate of depressed mood was 0.334 (33%; 95% CI: 0.268-0.407). Symptoms were most commonly assessed via standardized neuropsychiatric rating scales, with other methods including subjective caregiver reports and chart reviews. The study results were heterogeneous due to the variability in diagnostic methods. CONCLUSIONS Depressive symptoms similar to those in other dementias are commonly detected in FTD. However, the diagnostic methods are heterogeneous, and symptoms of depression often overlap with manifestations of FTD. Having a standardized diagnostic approach to depression in FTD will greatly facilitate future research in this area.
Collapse
Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada
| | | | | | | |
Collapse
|
12
|
Nordström P, Michaëlsson K, Gustafson Y, Nordström A. Traumatic brain injury and young onset dementia: a nationwide cohort study. Ann Neurol 2014; 75:374-81. [PMID: 24812697 DOI: 10.1002/ana.24101] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association between traumatic brain injuries (TBIs) and the risk of young onset dementia (YOD), that is, dementia before 65 years of age. METHODS The study cohort comprised 811,622 Swedish men (mean age 5 18 years) conscripted for military service between 1969 and 1986. TBIs, dementia, and covariates were extracted from national registers. Time-dependent exposures using Cox proportional hazard regression models were evaluated. RESULTS During a median follow-up period of 33 years, there were 45,249 men with at least 1 TBI in the cohort. After adjustment for covariates, 1 mild TBI (hazard ratio [HR] 5 1.0, 95% confidence interval [CI] 5 0.5–2.0), at least 2 mild TBIs (HR 5 2.5, 95% CI 5 0.8–8.1), or 1 severe TBI (HR 5 0.7, 95% CI 5 0.1–5.2) were not associated with Alzheimer dementia (AD). Other types of dementia were strongly associated with the risk of 1 mild TBI (HR 5 3.8, 95% CI 5 2.8–5.2), at least 2 mild TBIs (HR 5 10.4, 95% CI 5 6.3–17.2), and 1 severe TBI (HR 5 11.4, 95% CI 5 7.4–17.5) in age-adjusted analysis. However, these associations were largely attenuated after adjustment for covariates (1 mild TBI: HR 5 1.7; at least 2 mild TBIs: HR 5 1.7; 1 severe TBI: HR 5 2.6; p < 0.05 for all). INTERPRETATION In the present study, we found strong associations between YOD of non-AD forms and TBIs of different severity. These associations were, however, markedly attenuated after multivariate adjustment.
Collapse
|