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Dorey JM, Pongan E, Padovan C, Chaillet A, Herrmann M, Krolak-Salmon P, Rouch I. Prodromal or mild Alzheimer's disease: Influence of neuropsychiatric symptoms and premordid personality on caregivers' burden. Int J Geriatr Psychiatry 2024; 39:e6114. [PMID: 38858800 DOI: 10.1002/gps.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE In Alzheimer's disease (AD), the burden on caregivers is influenced by various factors, including the stage of disease progression and neuropsychiatric symptoms (NPS). To date, there has been limited research examining how patient's premorbid personality could affect this burden. The objective of this study was to investigate the impact of both premorbid personality and NPS in individuals with prodromal to mild AD on their caregivers' burden. METHOD One hundred eighty participants with prodromal or mild AD drown from the PACO (in French: Personnalité Alzheimer COmportement) cohort were included. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R). Neuropsychiatric symptoms were measured with the short version of the Neuropsychiatric Inventory (NPI-Q), and caregiver burden was evaluated with the Zarit burden scale. Relationships between personality, Neuro-Psychiatric Inventory (NPI) scores, and caregiver burden were determined using multivariate linear regressions controlled for age, sex, educational level, and Mini Mental State Examination. RESULTS The total NPI score was related to increased burden (beta = 0.45; p < 0.001). High level of neuroticism (beta = 0.254; p = 0.003) et low level of conscientiousness (beta = - 0.233; p = 0.005) were associated higher burden. Extraversion (beta = -0.185; p = 0.027) and conscientiousness (beta = -0.35; p = 0.006) were negatively associated with burden. In contrast, neuroticism, openness and agreeableness were not correlated with burden. When adjusted on total NPI score, the relationship between extraversion and conscientiousness didn't persist. CONCLUSION Our results suggest that premorbid personality of patients with prodromal to mild Alzheimer influence caregivers's burden, with a protective effect of a high level of extraversion and conscientiousness.
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Affiliation(s)
- J M Dorey
- Department of Aging Psychiatry, Hospital Le Vinatier, Bron, France
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, Hôpital des Charpennes, Villeurbanne, France
- Lyon Neuroscience Research Center, Centre Hospitalier Le Vinatier - Neurocampus, INSERM U1028 - CNRS UMR5292 - PsyR2 - Lyon 1 University, Bron Cedex, France
| | - E Pongan
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, Hôpital des Charpennes, Villeurbanne, France
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, Hospital of Saint Etienne, Saint Etienne, France
| | - C Padovan
- Department of Aging Psychiatry, Hospital Le Vinatier, Bron, France
| | - A Chaillet
- Department of Aging Psychiatry, Hospital Le Vinatier, Bron, France
| | - M Herrmann
- Department of Aging Psychiatry, Hospital Le Vinatier, Bron, France
| | - P Krolak-Salmon
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, Hôpital des Charpennes, Villeurbanne, France
| | - I Rouch
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, Hospital of Saint Etienne, Saint Etienne, France
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
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Montesinos R, Custodio B, Malaga M, Chambergo-Michilot D, Verastegui-Aranda G, Agüero K, Alejos-Zirena J, Andamayo-Villalba L, Seminario G W, Custodio N. Influence of Behavioral and Psychological Symptoms on Caregiver Burden for Different Types of Dementia: Clinical Experience in Lima, Peru. Dement Geriatr Cogn Disord 2024:1-8. [PMID: 38768581 DOI: 10.1159/000539335] [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: 02/16/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION People caring for patients with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries, there is a lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia and to compare the effects of BPSD on caregiver burden across different types of dementia. METHODS A cross-sectional study was conducted on 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB), and vascular dementia (VD) and their caregivers who attended a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory. We used analysis of variance to compare the AD, bvFTD, DLB, and VD groups. Correlations between Zarit Burden Inventory and NPI subscale scores were assessed with Spearman's correlation. RESULTS DLB caregivers had significantly higher levels of burden than the other patient groups (p < 0.05) and higher total NPI scores than caregivers for other patient groups (p < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (p < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively. CONCLUSION Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden.
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Affiliation(s)
- Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Belen Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Marco Malaga
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de Investigación Neurociencia Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Graciet Verastegui-Aranda
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Katherine Agüero
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | | | | | - Wendy Seminario G
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Hospital IV EsSalud Augusto Hernández Mendoza, Ica, Peru
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
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Tan YL, Lo YKJ, Ho CSH. Psychological and social impacts of frontotemporal dementia on caregivers and family members - A systematic review. Gen Hosp Psychiatry 2024; 86:33-49. [PMID: 38064912 DOI: 10.1016/j.genhosppsych.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) may impose substantial psychological and social burdens on caregivers and family members that are unique from other forms of dementia due to its distinctive clinical characteristics. This systematic review investigated these impacts on caregivers and family members. METHODS A systematic search was conducted in the PubMed, Cochrane Library and Embase databases for relevant articles published from database inception to 23 March 2023. The methodological quality of the articles was evaluated using a checklist. RESULTS Thirty-six articles (six qualitative and thirty quantitative), including 5129 participants, were included in this review. Like other forms of dementia, FTD caregivers had significant caregiver burden levels and psychological impacts. Caregiver burden was associated with behavioural symptoms (e.g., apathy and disinhibition) and motor symptoms. The costs of caring for a patient with FTD were found to be higher than those for Alzheimer's disease. FTD patients often face challenges in obtaining a correct diagnosis and experience significant delays and multiple misdiagnoses. Healthcare professionals may also be less familiar with FTD than with Alzheimer's, leading to delayed diagnosis. This can cause considerable stress and deprive patients and caregivers of early intervention. CONCLUSION FTD is associated with significant costs and caregiver burden levels, and the difficulties faced by caregivers and family members can be unique and challenging in different aspects when compared to other forms of dementia. Better education about FTD for family members and healthcare professionals is required to improve the quality of life for both patients and caregivers, and more support needs to be provided at all stages of the disease.
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Affiliation(s)
- Ying Li Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Yee Kai Jeffrey Lo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore.
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Panzavolta A, Cerami C, Marcone A, Zamboni M, Iannaccone S, Dodich A. Diagnostic Performance of Socio-Emotional Informant-Based Questionnaires for the Clinical Detection of the Behavioral Variant of Frontotemporal Dementia. J Alzheimers Dis 2024; 97:1249-1260. [PMID: 38277289 DOI: 10.3233/jad-230591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Although social cognitive dysfunction is a major feature of the behavioral variant of frontotemporal dementia (bvFTD), quantitative measurement of social behavior changes is poorly available in clinical settings. OBJECTIVE The aim of the study is to evaluate diagnostic accuracy of social-emotional questionnaires in distinguishing bvFTD from healthy control (HC) subjects and Alzheimer's disease (AD) patients. METHODS We enrolled 29 bvFTD, 24 AD, and 18 HC subjects matched for age, sex, and education. Two informant-based measures of socio-emotional sensitivity and empathy (i.e., revised Self-Monitoring Scale (rSMS) and Interpersonal Reactivity Index (IRI)) were administered. One-way ANOVA was performed to compare groups, whereas Receiver Operating Characteristics (ROC) curve analysis tested questionnaire ability in distinguishing groups. A short version of IRI (sIRI) was obtained by excluding the non-contributing subscale (i.e., personal distress). RESULTS Compared to HC and AD, bvFTD showed significantly lower scores in rSMS and IRI scores, except for IRI personal distress subscale. The sIRI showed an excellent performance in early diagnosis (bvFTD versus HC = AUC 0.95). Both sIRI and rSMS showed good performance in distinguishing bvFTD from AD (AUC 0.83). CONCLUSIONS ROC analyses support the usefulness of informant social questionnaires in memory clinics and their potential value in screening procedures for research eligibility in forthcoming trials. In the timely diagnosis of bvFTD patients, IRI and rSMS may supply crucial information for the early detection of signs and symptoms affecting social-emotional skills, which might otherwise be underrecognized.
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Affiliation(s)
- Andrea Panzavolta
- IUSS Cognitive Neuroscience ICoN Center, Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
| | - Chiara Cerami
- IUSS Cognitive Neuroscience ICoN Center, Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Marcone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Michele Zamboni
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Alessandra Dodich
- Center for Neurocognitive Rehabilitation - CIMeC, University of Trento, Rovereto (TN), Italy
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Demirbas M, Hahn-Pedersen JH, Jørgensen HL. Comparison Between Burden of Care Partners of Individuals with Alzheimer's Disease Versus Individuals with Other Chronic Diseases. Neurol Ther 2023; 12:1051-1068. [PMID: 37222859 PMCID: PMC10310688 DOI: 10.1007/s40120-023-00493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Caregiving in Alzheimer's disease (AD) is often provided by informal care partners, who spend more hours per week on average than care partners of individuals with conditions other than AD. However, the burden of care in partners of individuals with AD has not been systematically compared to that of other chronic diseases. OBJECTIVE The current study therefore aims to compare the care partner burden of AD to that of other chronic diseases through a systematic literature review. METHODS Data was collected from journal articles published in the last 10 years, using two unique search strings in PubMed and analysed using pre-defined patient-reported outcome measures (PROMs) including the EQ-5D-5L, GAD-7, GHQ-12, PHQ-9, WPAI and the ZBI. The data was grouped according to the included PROMs and the diseases studied. The number of participants in the studies reporting burden of caregiving in AD was adjusted to reflect the number of participants in studies reporting care partner burden in other chronic diseases. RESULTS All results in this study are reported as a mean value and standard deviation (SD). The ZBI measurement was the most frequently used PROM to collect care partner burden (15 studies) and showed a moderate burden (mean 36.80, SD 18.35) on care partners of individuals with AD, higher than most of the other included diseases except for those characterized by psychiatric symptoms (mean scores 55.92 and 59.11). Other PROMs such as PHQ-9 (six studies) and GHQ-12 (four studies) showed a greater burden on care partners of individuals with other chronic diseases such as heart failure, haematopoietic cell transplantations, cancer and depression compared to AD. Likewise, GAD-7 and EQ-5D-5L measurements showed a lesser burden on care partners of individuals with AD compared to care partners of individuals with anxiety, cancer, asthma and chronic obstructive pulmonary disease. The current study suggests that care partners of individuals with AD experience a moderate burden, but with some variations depending on the PROMs used. CONCLUSION The results of this study were mixed with some PROMs indicating a greater burden for care partners of individuals with AD versus other chronic diseases, and other PROMs showing a greater burden for care partners of individuals with other chronic diseases. Psychiatric disorders imposed a greater burden on care partners compared to AD, while somatic diseases in the musculoskeletal system resulted in a significantly smaller burden on care partners compared to AD.
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Affiliation(s)
- Murat Demirbas
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Henrik L Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Sejourne C, Dworkin JD, Barker MS, Manoochehri M, Gottesman RT, Wassermann EM, Tierney MC, Huey ED, Grafman J. Demographic and Symptom Correlates of Initial Idiopathic Psychiatric Diagnosis in Frontotemporal Dementia. J Geriatr Psychiatry Neurol 2023; 36:193-200. [PMID: 36342454 PMCID: PMC11279523 DOI: 10.1177/08919887221130267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study aims to measure frequency and correlates of initial idiopathic psychiatric diagnosis in a cohort of 147 patients with Frontotemporal Dementia (FTD)-spectrum disorders. METHODS Participants were evaluated at the National Institutes of Health in Bethesda, Maryland. Initial participant diagnoses were determined by chart review and patient and informant interviews. Logistic regression was used to assess the relationships between diagnosis and age of symptom onset, gender, education, family history of psychiatric illness, and family history of dementia. Additional exploratory analyses investigated patients' first symptom type. RESULTS 25% (n=43) of all the patients reviewed were initially misdiagnosed with an idiopathic psychiatric illness, which is less than half the commonly cited 50% rate.3 Depression was the most common misdiagnosis (46.5%). Family history of dementia, family history of mental illness and an exploratory analysis of behavioral first symptoms suggested significant association with a greater likelihood of initial idiopathic psychiatric diagnosis in FTD patients. DISCUSSION This data confirms patterns of initial idiopathic psychiatric diagnosis in FTD and elucidates potential factors underlying misdiagnosis. Potential implications for patient outcomes, caregiver burden and healthcare costs are discussed.
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Affiliation(s)
- Corinne Sejourne
- Taub Institute for Research in Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, NY, USA
| | | | - Megan S Barker
- Taub Institute for Research in Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Masood Manoochehri
- Taub Institute for Research in Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Reena T Gottesman
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, ML, USA
| | - Michael C Tierney
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, ML, USA
| | - Edward D Huey
- Taub Institute for Research in Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jordan Grafman
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
- Brain Injury Research Program, Shirley Ryan AbilityLab, Chicago, IL, USA
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Lwi SJ, Ford BQ, Levenson RW. Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers. Clin Gerontol 2023; 46:207-222. [PMID: 36309843 PMCID: PMC9928887 DOI: 10.1080/07317115.2022.2137448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia. METHODS We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72). RESULTS Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia. CONCLUSIONS These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers. CLINICAL IMPLICATIONS Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.
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Affiliation(s)
- Sandy J Lwi
- VA Northern California Health Care System, Martinez, California, USA
| | - Brett Q Ford
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, California, USA
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Addition of the FTD Module to the Neuropsychiatric Inventory improves classification of frontotemporal dementia spectrum disorders. J Neurol 2023; 270:2674-2687. [PMID: 36811680 PMCID: PMC10129920 DOI: 10.1007/s00415-023-11596-3] [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: 12/19/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
Most neuropsychiatric symptoms (NPS) common in frontotemporal dementia (FTD) are currently not part of the Neuropsychiatric Inventory (NPI). We piloted an FTD Module that included eight extra items to be used in conjunction with the NPI. Caregivers of patients with behavioural variant FTD (n = 49), primary progressive aphasia (PPA; n = 52), Alzheimer's dementia (AD; n = 41), psychiatric disorders (n = 18), presymptomatic mutation carriers (n = 58) and controls (n = 58) completed the NPI and FTD Module. We investigated (concurrent and construct) validity, factor structure and internal consistency of the NPI and FTD Module. We performed group comparisons on item prevalence, mean item and total NPI and NPI with FTD Module scores, and multinomial logistic regression to determine its classification abilities. We extracted four components, together explaining 64.1% of the total variance, of which the largest indicated the underlying dimension 'frontal-behavioural symptoms'. Whilst apathy (original NPI) occurred most frequently in AD, logopenic and non-fluent variant PPA, the most common NPS in behavioural variant FTD and semantic variant PPA were loss of sympathy/empathy and poor response to social/emotional cues (part of FTD Module). Patients with primary psychiatric disorders and behavioural variant FTD showed the most severe behavioural problems on both the NPI as well as the NPI with FTD Module. The NPI with FTD Module correctly classified more FTD patients than the NPI alone. By quantifying common NPS in FTD the NPI with FTD Module has large diagnostic potential. Future studies should investigate whether it can also prove a useful addition to the NPI in therapeutic trials.
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Chatzidimitriou E, Ioannidis P, Moraitou D, Konstantinopoulou E, Aretouli E. The cognitive and behavioral correlates of functional status in patients with frontotemporal dementia: A pilot study. Front Hum Neurosci 2023; 17:1087765. [PMID: 36923586 PMCID: PMC10009888 DOI: 10.3389/fnhum.2023.1087765] [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: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Objective: Frontotemporal dementia (FTD) impinges significantly on cognition, behavior, and everyday functioning. Goal of the present study is the detailed description of behavioral disturbances and functional limitations, as well as the investigation of associations between cognition, behavior, and functional impairment among FTD patients. Given the importance of maintaining a satisfying functional status as long as possible, this study also aims to identify the cognitive correlates of compensatory strategy use in this clinical group. Methods: A total of 13 patients diagnosed with FTD (behavioral variant FTD = 9, non-fluent variant primary progressive aphasia = 3, semantic dementia = 1) were administrated a broad range of neuropsychological tests for the assessment of different cognitive abilities. Behavioral symptomatology and performance on everyday activities were rated with informant-based measures. Descriptive statistics were used for the delineation of behavioral and functional patterns, whereas stepwise multiple regression analyses were performed to identify associations between cognition, behavior, and functional status. Results: Negative symptoms, especially apathy, were found to predominate in the behavior of FTD patients. Instrumental tasks, such as housework and leisure activities, appeared to be the most impaired functional domains. Working memory was the strongest cognitive correlate of performance across various domains of everyday functioning, whereas working memory along with short-term verbal memory accounted for a great proportion of variance in compensatory strategy use. Behavioral disturbances and especially negative symptoms were also found to contribute significantly to functional impairment in FTD. Conclusions: Executive dysfunction, as well as behavioral disturbances contribute significantly to functional disability in FTD. Early interventions tailored at these domains may have the potential to improve functional outcomes and delay the rate of functional decline among FTD patients.
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Affiliation(s)
- Electra Chatzidimitriou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Ioannidis
- B Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Konstantinopoulou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Aretouli
- School of Psychology, University of Ioannina, Ioannina, Greece
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Caramelli P, Marinho V, Laks J, Coletta MVD, Stella F, Camargos EF, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Chaves MLF, Brucki SMD, Nitrini R, Durgante HB, Bertolucci PHF. Treatment of dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s106en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT There is currently no cure for neurodegenerative or vascular dementias, but some pharmacological and non-pharmacological interventions may contribute to alleviate symptoms, slow disease progression and improve quality of life. Current treatment approaches are based on etiology, symptom profile and stage of dementia. This manuscript presents recommendations on pharmacological and non-pharmacological treatments of dementia due to Alzheimer’s disease, vascular cognitive impairment, frontotemporal dementia, Parkinson’s disease dementia, and dementia with Lewy bodies.
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Affiliation(s)
| | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Florindo Stella
- Universidade Estadual Paulista, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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11
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Caramelli P, Marinho V, Laks J, Coletta MVD, Stella F, Camargos EF, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Chaves MLF, Brucki SMD, Nitrini R, Durgante HB, Bertolucci PHF. Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:88-100. [DOI: 10.1590/1980-5764-dn-2022-s106pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
RESUMO Atualmente não há tratamento curativo para as demências neurodegenerativas ou para a demência vascular, mas algumas intervenções farmacológicas e não farmacológicas podem contribuir para aliviar os sintomas, retardar a progressão da doença e melhorar a qualidade de vida. As abordagens terapêuticas atuais são baseadas na etiologia, no perfil dos sintomas e no estágio da demência. Neste artigo apresentamos recomendações sobre os tratamentos farmacológicos e não farmacológicos da demência devida à doença de Alzheimer, comprometimento cognitivo vascular, demência frontotemporal, demência da doença de Parkinson e demência com corpos de Lewy.
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Affiliation(s)
| | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Florindo Stella
- Universidade Estadual Paulista, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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12
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Laganà V, Bruno F, Altomari N, Bruni G, Smirne N, Curcio S, Mirabelli M, Colao R, Puccio G, Frangipane F, Cupidi C, Torchia G, Muraca G, Malvaso A, Addesi D, Montesanto A, Di Lorenzo R, Bruni AC, Maletta R. Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer's Disease and Frontotemporal Dementia. Front Neurol 2022; 13:832199. [PMID: 35812082 PMCID: PMC9263122 DOI: 10.3389/fneur.2022.832199] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Neuropsychiatric or behavioral and psychological symptoms of dementia (BPSD) represent a heterogeneous group of non-cognitive symptoms that are virtually present in all patients during the course of their disease. The aim of this study is to examine the prevalence and natural history of BPSD in a large cohort of patients with behavioral variant of frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) in three stages: (i) pre-T0 (before the onset of the disease); (ii) T0 or manifested disease (from the onset to 5 years); (iii) T1 or advanced (from 5 years onwards). Six hundred seventy-four clinical records of patients with bvFTD and 1925 with AD, from 2006 to 2018, were studied. Symptoms have been extracted from Neuropsychiatric Inventory (NPI) and from a checklist of BPSD for all periods observed. In our population, BPSD affect up to 90% of all dementia subjects over the course of their illness. BPSD profiles of the two dementia groups were similar but not identical. The most represented symptoms were apathy, irritability/affective lability, and agitation/aggression. Considering the order of appearance of neuropsychiatric symptoms in AD and bvFTD, mood disorders (depression, anxiety) come first than the other BPSD, with the same prevalence. This means that they could be an important “red flag” in detection of dementia. With the increase of disease severity, aberrant motor behavior and wandering were significantly more present in both groups. Differences between BPSD in AD and bvFTD resulted only in prevalence: Systematically, in bvFTD, all the symptoms were more represented than in AD, except for hallucinations, depression, anxiety, and irritability. Given their high frequency and impact on management and overall health care resources, BPSD should not be underestimated and considered as an additional important diagnostic and therapeutic target both in patients with AD and bvFTD.
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Affiliation(s)
- Valentina Laganà
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- *Correspondence: Valentina Laganà
| | - Francesco Bruno
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
- Francesco Bruno
| | - Natalia Altomari
- Department of Mathematics and Computer Science, University of Calabria, Rende, Italy
| | - Giulia Bruni
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
| | - Nicoletta Smirne
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Sabrina Curcio
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
| | - Maria Mirabelli
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Rosanna Colao
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
| | | | | | - Chiara Cupidi
- Neurology Unit, Fondazione Istituto Giglio, Cefalù, Italy
| | - Giusy Torchia
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Gabriella Muraca
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Antonio Malvaso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Desirèe Addesi
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- Department of Internal Medicine, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | - Raffaele Di Lorenzo
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
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13
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Dementia caregiving across Latin America and the Caribbean and brain health diplomacy. LANCET HEALTHY LONGEVITY 2021; 2:e222-e231. [PMID: 34790905 PMCID: PMC8594860 DOI: 10.1016/s2666-7568(21)00031-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of dementia in Latin America and the Caribbean is growing rapidly, increasing the burden placed on caregivers. Exacerbated by fragile health-care systems, unstable economies, and extensive inequalities, caregiver burden in this region is among the highest in the world. We reviewed the major challenges to caregiving in Latin America and the Caribbean, and we propose regional and coordinated actions to drive future change. Current challenges include the scarcity of formal long-term care, socioeconomic and social determinants of health disparities, gender-biased burdens, growing dementia prevalence, and the effect of the current COVID-19 pandemic on families affected by dementia. Firstly, we propose local and regional short-term strategic recommendations, including systematic identification of specific caregiver needs, testing of evidence-based local interventions, contextual adaptation of strategies to different settings and cultures, countering gender bias, strengthening community support, provision of basic technology, and better use of available information and communications technology. Additionally, we propose brain health diplomacy (ie, global actions aimed to overcome the systemic challenges to brain health by bridging disciplines and sectors) and convergence science as frameworks for long-term coordinated responses, integrating tools, knowledge, and strategies to expand access to digital technology and develop collaborative models of care. Addressing the vast inequalities in dementia caregiving across Latin America and the Caribbean requires innovative, evidence-based solutions coordinated with the strengthening of public policies.
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14
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Zapata-Restrepo L, Rivas J, Miranda C, Miller BL, Ibanez A, Allen IE, Possin K. The Psychiatric Misdiagnosis of Behavioral Variant Frontotemporal Dementia in a Colombian Sample. Front Neurol 2021; 12:729381. [PMID: 34867716 PMCID: PMC8634474 DOI: 10.3389/fneur.2021.729381] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: To describe the demographic characteristics, initial psychiatric diagnoses, and the time to reach a diagnosis of probable behavioral variant frontotemporal dementia (bvFTD) in a public psychiatric hospital in Cali, Colombia. Methods: We retrospectively reviewed the medical records of 28 patients who were diagnosed with probable bvFTD based on a multidisciplinary evaluation that included a structural MRI, neuropsychological testing, functional assessment, and neurological exam. Prior to this evaluation, all patients were evaluated by a psychiatrist as part of their initial consultation at the hospital. The initial consultation included the Neuropsychiatric Inventory and diagnoses based on the DSM-V. Demographics, clinical features, and initial psychiatric misdiagnoses were extracted from clinical records and summarized in the full sample and by gender. Results: The study sample had a mean education of 10.0 years (SD = 4.9) and 68.0% were female. In the full sample, 28.6% were initially diagnosed with dementia, and 71.4% with a psychiatric disorder. The psychiatric diagnosis at initial consultation differed by gender. Women were most likely to be diagnosed with depression (26.3%) or bipolar disorder (26.3%), while the men were most likely to be diagnosed with anxiety (33.3%) or a psychotic disorder (22.2%). Psychotic symptoms were common (delusions, 60.7% and hallucinations, 39.3%), and the pattern of neuropsychiatric symptoms did not differ by gender. Conclusions: This is one of few case series of bvFTD in a Colombian population, where bvFTD is a recognizable and prevalent disorder. In this psychiatric hospital, the majority of patients with bvFTD were initially diagnosed with a primary psychiatric condition. There was a gender difference in psychiatric diagnosis, but not in neuropsychiatric symptoms. In this sample, the rate of psychiatric misdiagnosis, as well as the psychotic symptoms, were higher compared to rates described in other countries. These results highlight the need for interventions to improve bvFTD diagnosis in under-represented populations.
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Affiliation(s)
- Lina Zapata-Restrepo
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
| | - Juan Rivas
- Hospital Departamental Psiquiátrico, Universitario del Valle, Cali, Colombia
- Department of Psychiatry, Universidad del Valle, Cali, Colombia
- Department of Psychiatry, Fundación Valle del Lili, Cali, Colombia
- Department of Psychiatry, Universidad ICESI, Cali, Colombia
| | - Carlos Miranda
- Hospital Departamental Psiquiátrico, Universitario del Valle, Cali, Colombia
- Department of Psychiatry, Universidad del Valle, Cali, Colombia
| | - Bruce L. Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
- The Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Agustín Ibanez
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Isabel E. Allen
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
- The Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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15
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Da Silva TBL, Ordonez TN, Bregola AG, Bahia VS, Cecchini MA, Guimarães HC, Gambogi LB, Caramelli P, Balthazar MLF, Damasceno BP, Brucki SMD, de Souza LC, Nitrini R, Yassuda MS. Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease: A 12-Month Follow-Up Study. Front Neurol 2021; 12:728108. [PMID: 34659093 PMCID: PMC8515178 DOI: 10.3389/fneur.2021.728108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Neuropsychiatric symptoms in patients with frontotemporal dementia (FTD) are highly prevalent and may complicate clinical managements. Objective: To test whether the Neuropsychiatry Inventory (NPI) could detect change in neuropsychiatric symptoms and caregiver's distress in patients diagnosed with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) from baseline to a 12-month follow-up and to investigate possible predictors of change in NPI scores. Methods: The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), the INECO Frontal Screening (IFS), the Frontal Assessment Battery (FAB), the Executive Interview (EXIT-25) and the NPI were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (χ2) test and Linear Regression Analysis were used. Results: NPI total and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. MMSE, ACE-R scores significantly declined and NPI Total and Distress scores significantly increased in both groups. In the bvFTD group, age was the only independent predictor variable for the NPI total score at follow up. In the AD group, ACE-R and EXIT-25, conjunctively, were associated with the NPI total score at follow up. Conclusions: In 12 months, cognition declined and neuropsychiatric symptoms increased in bvFTD and AD groups. In the AD group only, cognitive impairment was a significant predictor of change in neuropsychiatric symptoms.
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Affiliation(s)
- Thais Bento Lima Da Silva
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Gerontology, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
| | - Tiago Nascimento Ordonez
- Gerontology, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil.,Graduate Program in Applied Statistics, University Center of United Metropolitan Colleges, São Paulo, Brazil
| | - Allan Gustavo Bregola
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Valéria Santoro Bahia
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mário Amore Cecchini
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Leandro Boson Gambogi
- Neurology Division, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Neurology Division, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Leonardo Cruz de Souza
- Neurology Division, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Monica Sanches Yassuda
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Gerontology, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
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16
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Sato S, Hashimoto M, Yoshiyama K, Kanemoto H, Hotta M, Azuma S, Suehiro T, Kakeda K, Nakatani Y, Umeda S, Fukuhara R, Takebayashi M, Ikeda M. Characteristics of behavioral symptoms in right-sided predominant semantic dementia and their impact on caregiver burden: a cross-sectional study. ALZHEIMERS RESEARCH & THERAPY 2021; 13:166. [PMID: 34627361 PMCID: PMC8502362 DOI: 10.1186/s13195-021-00908-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/28/2021] [Indexed: 01/01/2023]
Abstract
Background This study aimed to clarify the neuropsychiatric symptoms of right-sided predominant semantic dementia (SD-R) by comparing them with those of behavioral variant frontotemporal dementia (bvFTD), left-sided predominant SD (SD-L), and Alzheimer’s disease (AD). This study also aimed to identify clinical factors related to caregiver burden for bvFTD, SD-R, and SD-L. Methods The neuropsychiatric symptoms of 28 patients with bvFTD, 14 patients with SD-R, 24 patients with SD-L, and 43 patients with AD were evaluated using the Neuropsychiatric Inventory (NPI) and the Stereotypy Rating Inventory (SRI). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Dementia severity was assessed using the Clinical Dementia Rating. Activities of daily living were assessed using the Lawton Instrument Activities of Daily Living (IADL) scale and the Physical Self-Maintenance Scale. We compared the NPI and SRI scores among the four groups using the Kruskal-Wallis test. In addition, clinical factors related to caregiver burden, represented by the Japanese version of the Zarit Burden Interview (J-ZBI), were analyzed using multiple regression analysis in the bvFTD, SD-R, and SD-L groups. Results The NPI total score and the NPI subscale scores of apathy and disinhibition were significantly higher in the bvFTD group than in the SD-L and AD groups. The SD-R group scores were closer to those of the bvFTD group than the SD-L group. The SRI total score and SRI subscale scores for eating and cooking and speaking were significantly higher in the bvFTD, SD-R, and SD-L groups than in the AD group. The NPI total score was significantly associated with the J-ZBI score in the bvFTD group. The NPI total score and Lawton IADL scale score were independently associated with the J-ZBI score in the SD-R group. Furthermore, the NPI total score and MMSE score were independently associated with the J-ZBI score in the SD-L group. Conclusions SD-R seemed to be a similar condition to bvFTD rather than SD-L regarding behavioral symptoms. Our results suggest that each frontotemporal dementia subgroup requires different approaches to reduce the caregiver burden.
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Affiliation(s)
- Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan. .,Department of Psychiatry, Osaka General Medical Center, Osaka, Japan.
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan
| | - Maki Hotta
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan.,Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shingo Azuma
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan.,Department of Psychiatry, Mizuma Hospital, Kaizuka, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan
| | - Kyosuke Kakeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan
| | - Yoshitaka Nakatani
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan.,Department of Psychiatry, Osaka Psychiatric Medical Center, Osaka, Japan
| | - Sumiyo Umeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan.,Department of Psychiatry, Daini Osaka Police Hospital, Osaka, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.,Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2 Yamadaoka,, Suita City,, Osaka, 565-0871, Japan
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17
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Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is the second-most common cause of young-onset dementia. Personality and behavior changes lead to high caregiver stress and burden, but little support is available. Our aim is to present the evidence on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions. METHODS We conducted a scoping review on caregiver burden using PubMed, Web of Science and ScienceDirect. A total of 69 articles were considered eligible and were analyzed in the present study. RESULTS Through the analysis of 69 empirical articles, our results show that caregivers of patients with FTLD are often younger in age, have children and find behavioral disturbances to be the most burdensome. Nine studies assessed the needs of and support for caregivers. Ten studies compared the burden in different forms of FTLD, 19 compared FTLD to other types of dementia, and one compared the caregiver burden between two countries. Eight studies reported on interventions for caregivers or interventions taking burden into account. One study assessed the support structure for caregivers of FTLD patients. Five case reports, eight research overviews and three reviews addressed specific needs and challenges. CONCLUSIONS Further research should reproduce and validate efficacious interventions and focus on underage children of FTLD patients and findings from non-Western countries. Additionally, support structures for FTLD caregivers should be assessed and extended. Awareness both in the wider population and among healthcare professionals is an urgent need for the future.
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18
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Piña-Escudero SD, Aguirre GA, Javandel S, Longoria-Ibarrola EM. Caregiving for Patients With Frontotemporal Dementia in Latin America. Front Neurol 2021; 12:665694. [PMID: 34305781 PMCID: PMC8292669 DOI: 10.3389/fneur.2021.665694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Latin America is a vast heterogeneous territory where chronic diseases such as mild cognitive impairment or dementia are becoming higher. Frontotemporal dementia (FTD) prevalence in this region is estimated to be around 12-18 cases per thousand persons. However, this prevalence is underestimated given the lack of awareness of FTD even among healthcare professionals. Family members are responsible for the care of patients with FTD at home. These caregivers deliver care despite being ill-equipped and living in the context of austerity policies and social inequities. They often face unsurmountable financial and social burdens that are specific to the region. The most important step to support caregivers in Latin America is to increase awareness of the disease at all levels. Healthcare diplomacy is fundamental to create joint efforts that push policies forward to protect caregivers of FTD patients.
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Affiliation(s)
- Stefanie Danielle Piña-Escudero
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Gloria Annette Aguirre
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Shireen Javandel
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Erika Mariana Longoria-Ibarrola
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Instituto Nacional de Neurología y Neurocirugía José Velazco Suárez, Mexico City, Mexico
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19
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Poptsi E, Tsolaki M, Bergh S, Cesana BM, Ciccone A, Fabbo A, Frisoni GB, Frölich L, Lavolpe S, Guazzarini AG, Hugon J, Fascendini S, Defanti CA. Rationale, Design, and Methodology of a Prospective Cohort Study for Coping with Behavioral and Psychological Symptoms of Dementia: The RECage Project. J Alzheimers Dis 2021; 80:1613-1627. [PMID: 33720887 PMCID: PMC8203243 DOI: 10.3233/jad-201215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are quite challenging problems during the dementia course. Special Care Units for people with dementia (PwD) and BPSD (SCU-B) are residential medical structures, where BPSD patients are temporarily admitted, in case of unmanageable behavioral disturbances at home. OBJECTIVE RECage (REspectful Caring for AGitated Elderly) aspires to assess the short and long-term effectiveness of SCU-Bs toward alleviating BPSD and improving the quality of life (QoL) of PwD and their caregivers. METHODS RECage is a three-year, prospective study enrolling 500 PwD. Particularly, 250 community-dwelling PwDs presenting with severe BPSD will be recruited by five clinical centers across Europe, endowed with a SCU-B, for a short period of time; a second similar group of 250 PwD will be followed by six other no-SCU-B centers solely via outpatient visits. RECage's endpoints include short and long-term SCU-B clinical efficacy, QoL of patients and caregivers, cost-effectiveness of the SCU-B, psychotropic drug consumption, caregivers' attitude toward dementia, and time to nursing home placement. RESULTS PwD admitted in SCU-Bs are expected to have diminished rates of BPSD and better QoL and their caregivers are also expected to have better QoL and improved attitude towards dementia, compared to those followed in no-SCU-Bs. Also, the cost of care and the psychotropic drug consumption are expected to be lower. Finally, PwD followed in no-SCU-Bs are expected to have earlier admission to nursing homes. CONCLUSION The cohort study results will refine the SCU-B model, issuing recommendations for implementation of SCU-Bs in the countries where they are scarce or non-existent.
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Affiliation(s)
- Eleni Poptsi
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), Macedonia, Hellas.,Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas.,1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Macedonia, Hellas
| | - Sverre Bergh
- Research centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics"Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Alfonso Ciccone
- Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, Mantua, Italy
| | - Andrea Fabbo
- Direttore UOC di Geriatria-Disturbi Cognitivi e Demenze, Dipartimento Cure Primarie AUSL, Modena, Italy
| | - Giovanni B Frisoni
- Memory Clinic, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sara Lavolpe
- Department of Neurology and CDCD Centre Humanitas Gavazzeni, Bergamo, Italy
| | - Anna Giulia Guazzarini
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Italy
| | - Jacques Hugon
- Center of Cognitive Neurology Université de Paris, Paris, France
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20
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Regier NG, Taylor JL, Szanton SL, Parmelee PA, Perrin N, Liu M, Jenkins E, Hodgson NA, Gitlin LN. Pain in persons with dementia and the direct and indirect impacts on caregiver burden. Geriatr Nurs 2021; 42:366-371. [PMID: 33571930 PMCID: PMC8832466 DOI: 10.1016/j.gerinurse.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Unresolved pain is related to neuropsychiatric symptoms (NPS) in persons living with dementia (PLWD), and an increase in NPS is distressing for PLWD and their caregivers. Hence, we examined whether pain in PLWD was related to caregiver burden and whether caregiver upset with NPS mediated this relationship. METHOD We examined, cross-sectionally, the relationships among pain in PLWD, caregiver burden, and upset with NPS. Data from 272 PLWD and their caregivers who participated in the Advancing Caregiver Training (ACT) trial were analyzed using structural equation modeling (SEM). RESULTS Model fit was satisfactory, and caregiver upset with NPS fully mediated the association between pain in PLWD and caregiver burden. CONCLUSION Caregiver upset with NPS helps explain the relationship between pain in PLWD and burden in their caregivers. Pain and NPS are amenable to modification, as is caregiver burden, suggesting great opportunity to impact the lives of PLWD and their caregivers.
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Affiliation(s)
- Natalie G Regier
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA.
| | - Janiece L Taylor
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia A Parmelee
- The University of Alabama, Alabama Research Institute on Aging, Tuscaloosa, AL, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Minhui Liu
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Emerald Jenkins
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Laura N Gitlin
- Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA; Drexel College of Nursing and Health Professions, Philadelphia, PA, USA
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21
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Amato C, Burridge G, Basic D, Huynh D, Gibbons E, Ní Chróinín D, Liu KPY. Assistance provided in daily tasks and difficulty experienced by caregivers for people living with dementia. Aust Occup Ther J 2021; 68:236-245. [PMID: 33533025 DOI: 10.1111/1440-1630.12720] [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] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION There is a growing body of research that addresses caregivers for people living with dementia. However, there is limited research looking at the perceptions of caregivers in specific daily tasks. To address this gap, this study investigated the assistance caregivers provided and the difficulty they faced when completing daily tasks for people with dementia and, additionally, how these experiences might relate to their perceived burden. METHODS Sixty-two caregivers for people living with dementia completed the study. Data were collected, through a survey, on the level of assistance caregivers provided, and the difficulties they experienced. The Zarit Burden Scale was used to measure the level of perceived burden. Descriptive statistics and Spearman's correlation coefficient were used to report the results and the relationship between the perceived burden, the level of assistance provided, and the difficulty experienced. RESULTS The activities of daily living that caregivers provided the most assistance for was dressing and showering. Most instrumental activities of daily living required maximal to total assistance. Overall, the caregivers did not experience a high level of difficulty with assisting with these daily tasks in comparison to the level of assistance provided. The caregiver burden was associated significantly with the difficulties experienced in dressing, toileting, and showering (rho = 0.30-0.75), most instrumental activities of daily living (rho = 0.29-0.47), but not with the level of assistance provided. CONCLUSION Caregivers are assisting in many daily tasks. Their level of difficulty is relatively low in comparison to the level of assistance they provide. Significant correlations were found between the difficulties experienced and the burden scale. There is a need for occupational therapists to address the specific daily tasks and the concerns experienced by caregivers and to provide them with adequate support to improve the quality of care for people with dementia.
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Affiliation(s)
- Carmen Amato
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Gemma Burridge
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - David Basic
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Danielle Huynh
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Emma Gibbons
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
| | | | - Karen P Y Liu
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
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22
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Ng KP, Chiew HJ, Hameed S, Ting SKS, Ng A, Soo SA, Wong BYX, Lim L, Yong ACW, Mok VCT, Rosa‐Neto P, Dominguez J, Kim S, Hsiung GYR, Ikeda M, Miller BL, Gauthier S, Kandiah N. Frontotemporal dementia and COVID-19: Hypothesis generation and roadmap for future research. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 6:e12085. [PMID: 33490361 PMCID: PMC7810128 DOI: 10.1002/trc2.12085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic has caused tremendous suffering for patients with dementia and their caregivers. We conducted a survey to study the impact of the pandemic on patients with mild frontotemporal dementia (FTD). Our preliminary findings demonstrate that patients with FTD have significant worsening in behavior and social cognition, as well as suffer greater negative consequences from disruption to health-care services compared to patients with AD. The reduced ability to cope with sudden changes to social environments places patients with FTD at increased vulnerability to COVID-19 infection as well as to poorer clinical and social outcomes. Caregivers of FTD patients also demonstrate high burden during crisis situations. A proportion of patients with FTD benefitted from use of web-based interactive platforms. In this article, we outline the priority areas for research as well as a roadmap for future collaborative research to ensure greatest benefit for patients with FTD and their caregivers.
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Affiliation(s)
- Kok Pin Ng
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Hui Jin Chiew
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Shahul Hameed
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Simon Kang Seng Ting
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Adeline Ng
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - See Ann Soo
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | | | - Levinia Lim
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Alisa C. W. Yong
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Vincent C. T. Mok
- Gerald Choa Neuroscience CentreLui Che Woo Institute of Innovative MedicineDepartment of Medicine and TherapeuticsPrince of Wales HospitalFaculty of MedicineThe Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina
| | - Pedro Rosa‐Neto
- Translational Neuroimaging LaboratoryMcGill University Research Centre for Studies in AgingAlzheimer’s Disease Research UnitDouglas Research InstituteLe Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest‐de‐l'Île‐de‐MontréalDepartment of Neurology and Neurosurgery, Psychiatry and Pharmacology and TherapeuticsMcGill UniversityMontrealCanada
| | | | - SangYun Kim
- Department of NeurologySeoul National University College of Medicine and Clinical Neuroscience Center of Seoul National University Bundang HospitalSeongnam‐siKorea
| | - G. Y. Robin Hsiung
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manabu Ikeda
- Department of PsychiatryGraduate School of Medicine, Osaka UniversityOsakaJapan
| | - Bruce L. Miller
- Memory and Aging CenterDepartment of NeurologyUniversity of CaliforniaSan FranciscoSan FranciscoCaliforniaUSA
| | - Serge Gauthier
- Translational Neuroimaging LaboratoryMcGill University Research Centre for Studies in AgingAlzheimer’s Disease Research UnitDouglas Research InstituteLe Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest‐de‐l'Île‐de‐MontréalDepartment of Neurology and Neurosurgery, Psychiatry and Pharmacology and TherapeuticsMcGill UniversityMontrealCanada
| | - Nagaendran Kandiah
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
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23
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Shu J, Qiang Q, Yan Y, Wen Y, Ren Y, Wei W, Zhang L. Distinct Patterns of Brain Atrophy associated with Mild Behavioral Impairment in Cognitively Normal Elderly Adults. Int J Med Sci 2021; 18:2950-2956. [PMID: 34220322 PMCID: PMC8241773 DOI: 10.7150/ijms.60810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/30/2021] [Indexed: 01/25/2023] Open
Abstract
A cross-sectional study was conducted to evaluate patterns of gray matter changes in cognitively normal elderly adults with mild behavioral impairment (MBI). Sixteen MBI patients and 18 healthy controls were selected. All the participants underwent a neuropsychological assessment battery, including the Mini-mental State Examination (MMSE), Geriatric Depression Scale (GDS), Self-rating Anxiety Scale (SAS), and Chinese version of the mild behavioral impairment-checklist scale (MBI-C), and magnetic resonance imaging (MRI) scans. Imaging data was analyzed based on voxel-based morphometry (VBM). There was no significant difference in age, gender, MMSE score, total intracranial volume, white matter hyperdensity, gray matter volume, white matter volume between the two groups (p > 0.05). MBI group had shorter education years and higher MBI-C score, GDS and SAS scores than the normal control group (p < 0.05). For neuroimaging analysis, compared to the normal control group, the MBI group showed decreased volume in the left brainstem, right temporal transverse gyrus, left superior temporal gyrus, left inferior temporal gyrus, left middle temporal gyrus, right occipital pole, right thalamus, left precentral gyrus and left middle frontal gyrus(uncorrected p < 0.001). The grey matter regions correlated with the MBI-C score included the left postcentral gyrus, right exterior cerebellum, and left superior frontal gyrus. This suggests a link between MBI and decreased grey matter volume in cognitively normal elderly adults. Atrophy in the left frontal cortex and right thalamus in MBI patients is in line with frontal-subcortical circuit deficits, which have been linked to neuropsychiatric symptoms (NPS) in dementia. These initial results imply that MBI might be an early harbinger for subsequent cognitive decline and dementia.
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Affiliation(s)
- Jun Shu
- Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China
| | - Qiang Qiang
- Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China
| | - Yuning Yan
- Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China
| | - Yang Wen
- Department of Neurology, The Third People's Hospital of Chengdu, China
| | - Yiqing Ren
- Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China
| | - Li Zhang
- Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China
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24
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Vu LH, Markides KS, Downer B. Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older. Gerontol Geriatr Med 2021; 7:23337214211002724. [PMID: 33796630 PMCID: PMC7983470 DOI: 10.1177/23337214211002724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from Wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.
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Affiliation(s)
- Lan H. Vu
- University of Texas Medical Branch, Galveston, USA
| | | | - Brian Downer
- University of Texas Medical Branch, Galveston, USA
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25
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Frontotemporal Dementia Knowledge Scale: Development and Preliminary Psychometric Properties. Alzheimer Dis Assoc Disord 2020; 34:59-65. [PMID: 31460870 DOI: 10.1097/wad.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Frontotemporal dementia (FTD) accounts for ∼10% of dementia cases and is the most common cause of early-onset dementia. However, no well-validated instrument currently exists to measure knowledge about FTD. In this study, we used systematic scale development procedures to create a scale to measure knowledge of FTD based on a contemporary understanding of the disease. METHODS Standard scale development methods were used to create items and evaluate their psychometric properties. A total of 72 health care professionals and 102 caregivers of people with FTD responded to items measuring FTD knowledge, general dementia knowledge, crystallized intelligence, experience with FTD, and demographic information. RESULTS The Frontotemporal Dementia Knowledge Scale (FTDKS) contains 18 items that cover key, basic knowledge about FTD in the domains of risk factors, symptoms, course, caregiving, and treatment. The scale uses a 4-point True/False format with a Don't Know option and takes ∼5 minutes to complete. In the current sample the FTDKS had good psychometric properties in terms of reliability and validity. IMPLICATIONS The FTDKS can be used with health care professionals and caregivers of people with FTD to assess their knowledge about the disease. The scale may be useful to evaluate knowledge in clinical care and educational program contexts.
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26
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Regier NG, Hodgson NA, Gitlin LN. Neuropsychiatric symptom profiles of community-dwelling persons living with dementia: Factor structures revisited. Int J Geriatr Psychiatry 2020; 35:1009-1020. [PMID: 32363605 PMCID: PMC8942615 DOI: 10.1002/gps.5323] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/18/2020] [Accepted: 04/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Most persons living with dementia (PLWD) will develop neuropsychiatric symptoms (NPS) at some point. NPS are often clustered into subsyndromes with other related symptoms, but the evidence supporting commonly used clusters is insufficient. We reexamine behavioral clusters in community-dwelling PLWD and identify associated risk factors and potential contributors. METHODS This study used baseline data from a longitudinal behavioral intervention study of 250 community-dwelling older adults with dementia and their caregivers. Using exploratory factor analysis (principal component analysis [PCA]), the factor structure of NPS frequency scores of the Neuropsychiatric Inventory (NPI-C) was evaluated. Multiple linear regressions assessed the association of the derived behavioral clusters with caregiver burden, caregiver depression, and quality of life of the PLWD. RESULTS PCA yielded eight behavioral clusters (factors): 1 = Aggression/Rejection of Care, 2 = Apathy/Withdrawal, 3 = Restlessness/Agitation, 4 = Anxiety, 5 = Impulsivity/Disinhibition, 6 = Psychosis, 7 = Circadian Disturbance, and 8 = Depression. In multiple linear regressions, caregiver burden was significantly influenced by the anxiety cluster, caregiver depression was significantly influenced by the apathy/withdrawal cluster, and quality of life of the PLWD was significantly associated with the anxiety and circadian disturbance clusters. CONCLUSIONS Our eight derived behavioral clusters suggest that commonly accepted clusters of NPS may not reflect the clinical reality for community-dwelling PLWD. Behavioral clusters appear to differentially impact and put caregivers and PLWD at risk such that personalized intervention strategies are warranted. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Natalie G. Regier
- Johns Hopkins University School of Nursing, Baltimore, MD,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD
| | - Nancy A. Hodgson
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Laura N. Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD,Drexel College of Nursing and Health Professions, Philadelphia, PA
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27
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Ilik F, Büyükgöl H, Kayhan F, Ertem DH, Ekiz T. Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers' Depression on Caregiver Burden. J Geriatr Psychiatry Neurol 2020; 33:243-249. [PMID: 31526077 DOI: 10.1177/0891988719874123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers' depression, on the caregiver burden. METHOD One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI). RESULTS Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD (P = .009, χ2 = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs (P = .000, χ2 = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores (P < .05). CONCLUSIONS The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.
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Affiliation(s)
- Faik Ilik
- Department of Neurology, KTO University Medical Faculty affiliated Konya Medicana Hospital, Konya, Turkey
| | - Hüseyin Büyükgöl
- Department of Neurology, KTO University Medical Faculty affiliated Konya Medicana Hospital, Konya, Turkey
| | - Fatih Kayhan
- Department of Psychiatry, Private Institution, Konya, Turkey
| | - Devrimsel Harika Ertem
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Timur Ekiz
- İstanbul Gedik University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, İstanbul, Turkey
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28
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Ramaboa KKKM, Fredericks I. Muslims' Affective and Cognitive Attitudes towards Formal Dementia Care in South Africa: Do They Vary according to Family Structure and the Experience of Familial Caregiving? Dement Geriatr Cogn Disord 2020; 48:261-270. [PMID: 32069454 DOI: 10.1159/000505833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The feelings and beliefs of some social groups sharing the same values about formal care institutions impacts their likelihood of using such services. Socialisation theory posits that there should not be any difference in attitudes towards formal care in the Muslim community, as they are influenced by the principles of Confucianism. However, demographic, epistemological, and socio-economic trends, as well as globalisation, may be impacting the efficacy of caring for people with dementia (PWD) at home. OBJECTIVE This study examines the affective and cognitive attitudes of South African Muslims towards formal care, and whether they vary according to family structure and experience with informal dementia care. METHODS We conducted a survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa. The topics addressed included the demographics of the respondents, whether they had experience with informal dementia care, the structure of their family, and affective and cognitive attitudinal variables. RESULTS 422 responses were analysed, with the results demonstrating negative attitudes across family structures and experience with informal dementia care. This indicates that the changes brought about by economic development and globalisation are not impacting the social influence of the Islam religion towards caregiving. CONCLUSION With up to 90% of PWD moving into formal care before they die in some countries, governments and other service providers of formal care need to provide culturally congruent care. There is also a need to build relationships with minority social groups that are not cared for by geriatric service organisations (governmental and non-governmental) in order to break down the negative attitudes that families have about formal care, and provide the families caring for PWD at home with coping strategies and support programmes to enhance the caregiving experience.
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Affiliation(s)
| | - Iman Fredericks
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
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29
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Ramaboa KKKM, Fredericks I. Demographic Characteristics Associated with the Likelihood to Use Paid Home Care for People with Dementia among South African Muslims. Dement Geriatr Cogn Disord 2020; 48:337-348. [PMID: 32241008 DOI: 10.1159/000506511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In societies where the value of filial piety is observed, a preference for caregiving to take place at home exists. In fact, institutional and paid home care for people with dementia (PWD) are still taboo in some Muslim societies. However, economic development and globalisation have resulted in intergenerational separation, thus impacting the ability by young adults to provide care for the elderly at home. OBJECTIVE We establish the demographic characteristics most likely to be associated with the use of paid home care - age, gender, education level, marital status, family structure, experience with dementia care in the family, and number of dependents - for PWD among South African Muslims. METHODS A survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa was conducted. Multiple logistic regression was used to test the effects of the demographic variables on the type of care choice arrangement (family as primary caregiver vs. paid home caregiving). RESULTS 422 responses were analysed, 28% of which indicated the respondents' desire to use paid home caregivers. The multiple logistic regression results indicate that South African Muslim families are more likely to use paid home care if they are older (that is, over 40 years; OR = 1.972, 95% CI: 1.445-2.695), are female (OR = 1.637, 95% CI: 1.089-2.457), and have high levels of education (OR = 1.828, 95% CI: 1.070-3.125). CONCLUSION Home-based care is touted as the next dementia care model. Given that intergenerational mobility is likely to increase as future generations continue to participate more in the labour market, minority groups with a disposition to the same familial social values will require appropriate support in order to cope with the demands of caring for PWD. Suitable interventions for Muslim families who are not open to using external assistance, as well as those who are, need to be administered to enable the caregiver and care recipient to thrive at home.
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Affiliation(s)
| | - Iman Fredericks
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
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30
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Brites R, Brandão T, Moniz Pereira F, Hipólito J, Nunes O. Effects of supporting patients with dementia: A study with dyads. Perspect Psychiatr Care 2020; 56:614-620. [PMID: 31970779 DOI: 10.1111/ppc.12476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to examine the factors associated with the development of higher burden in informal caregivers of patients with dementia, using dyadic data. DESIGN AND METHODS Seventy-two dyads of patients with dementia and their informal caregivers were assessed, the former in terms of behavioral-psychological symptoms and autonomy, the latter in terms of burden and individual needs. FINDINGS Caregivers at risk for developing higher burden are those who are female, whose care recipient present psychiatric symptoms and lower autonomy, and those who recognize the need for more information/support. PRACTICE IMPLICATIONS Interventions should offer caregivers the tools to provide care, maintaining their psychological well-being. Interventions should target not only common aspects of caregiver burden but also the specificities of caring for a person with dementia.
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Affiliation(s)
- Rute Brites
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - Tânia Brandão
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal.,Centro de Psicologia, Universidade do Porto, Porto, Portugal
| | - Francisco Moniz Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Departamento de Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - João Hipólito
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - Odete Nunes
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
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31
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Shdo SM, Ranasinghe KG, Sturm VE, Possin KL, Bettcher BM, Stephens ML, Foley JM, You SCC, Rosen HJ, Miller BL, Kramer JH, Rankin KP. Depressive Symptom Profiles Predict Specific Neurodegenerative Disease Syndromes in Early Stages. Front Neurol 2020; 11:446. [PMID: 32547476 PMCID: PMC7273507 DOI: 10.3389/fneur.2020.00446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 04/27/2020] [Indexed: 12/05/2022] Open
Abstract
Background: During early stages, patients with neurodegenerative diseases (NDG) often present with depressive symptoms. However, because depression is a heterogeneous disorder, more precise delineation of the specific depressive symptom profiles that arise early in distinct NDG syndromes is necessary to enhance patient diagnosis and care. Methods and Findings: Five-hundred and sixty four participants self-reported their depressive symptoms using the Geriatric Depression Scale (GDS), including 111 healthy older control subjects (NC) and 453 patients diagnosed with one of six NDGs who were at the mild stage of disease (CDR® Dementia Staging Instrument ≤ 1) [186 Alzheimer's disease (AD), 76 behavioral variant frontotemporal dementia (bvFTD), 52 semantic variant primary progressive aphasia (svPPA), 46 non-fluent variant PPA (nfvPPA), 49 progressive supranuclear palsy syndrome (PSPS), 44 corticobasal syndrome (CBS)]. The GDS was divided into subscales based on a previously published factor analysis, representing five symptoms (dysphoria, hopelessness, withdrawal, worry, and cognitive concerns). Mixed models were created to examine differences in depression subscale by group, and logistic regression analyses were performed to determine if patterns of depressive symptoms could predict a patient's NDG syndrome. PSPS patients presented with a hopeless, dysphoric, and withdrawn pattern, while patients with CBS presented with a similar but less severe pattern. Worry was a key symptom in the profile of patients with svPPA, while ADs only had abnormally elevated cognitive concerns. Depressive profile accurately predicted NDG diagnosis at a rate of between 70 and 84% accuracy. Conclusions: These results suggest that attention to specific depressive symptom profile can improve diagnostic sensitivity and can be used to provide more individualized patient care.
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Affiliation(s)
- Suzanne M. Shdo
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Kamalini G. Ranasinghe
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Virginia E. Sturm
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine L. Possin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Brianne M. Bettcher
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of Colorado School of Medicine, Denver, CO, United States
| | - Melanie L. Stephens
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica M. Foley
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Shou-Chin Christine You
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Howard J. Rosen
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L. Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Joel H. Kramer
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P. Rankin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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Vismara M, Cirnigliaro G, Piccoli E, Giorgetti F, Molteni L, Cremaschi L, Fumagalli GG, D'addario C, Dell'Osso B. Crossing Borders Between Frontotemporal Dementia and Psychiatric Disorders: An Updated Overview. J Alzheimers Dis 2020; 75:661-673. [PMID: 32310172 DOI: 10.3233/jad-191333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Frontotemporal dementia (FTD) includes a group of neurocognitive syndromes, clinically characterized by altered behaviors, impairment of language proficiency, and altered executive functioning. FTD is one of the most frequently observed forms of dementia in the elderly population and the most common in presenile age. As for other subtypes of dementia, FTD incidence is constantly on the rise due to the steadily increasing age of the population, and its recognition is now becoming a determinant for clinicians. FTD and psychiatric disorders can overlap in terms of clinical presentations by sharing a common genetic predisposition and neuropathological mechanism in some cases. Nonetheless, this association is often unclear and underestimated. Since its first reports, research into FTD has constantly grown, with the identification of recent findings related to its neuropathology, genetic, clinical, and therapeutic issues. Literature is thriving on this topic, with numerous research articles published in recent years. In the present review, we aimed to provide an updated description of the clinical manifestations that link and potentially confound the diagnosis of FTD and psychiatric disorders in order to improve their differential diagnosis and early detection. In particular, we systematically reviewed the literature, considering articles specifically focused on the behavioral variant FTD, published after 2015 on the PubMed database.
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Affiliation(s)
- Matteo Vismara
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Eleonora Piccoli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Federica Giorgetti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Laura Molteni
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Laura Cremaschi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | | | - Claudio D'addario
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.,"Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
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Abstract
The theory of "disinhibition" has been very influential in psychiatry and neurology for over a century. Disinhibition has been used to explain clinical findings in many neurological and psychiatric disorders including dementia, traumatic brain injury, attention deficit hyperactive disorder, substance abuse, impulsivity in personality disorders, and neurodevelopmental disorders. In addition, disinhibition has been used as a unifying theory to link clinical observations with cognitive findings, and even cellular findings. This review discusses the origins and history of the theory of disinhibition and its strengths and weaknesses in four domains: face validity, consistency with other brain mechanisms, consistency with evolutionary mechanisms, and empiric support. I assert that the vagueness of the theory, inconsistency with other brain mechanisms, and lack of empiric support limit the usefulness of this theory. Alternative approaches, based on findings in other motor, language, and cognitive functions, are discussed.
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Affiliation(s)
- Edward D Huey
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York
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Abstract
REASONS FOR THE STUDY The Neuropsychiatric Inventory (NPI) has been used for studies of neuropsychiatric symptoms in neurodegenerative disorders for the past 25 years. This article reviews the history of the development and application of the NPI. MAIN FINDINGS The NPI consists of 10 (or 12) items that are assayed with questions, subquestions, and ratings of frequency and severity. The NPI has been shown to be valid and reliable. The NPI has been translated into approximately 40 languages; it has 4 of versions designed for different clinical applications. The NPI studies show contrasting profiles of behavioral symptoms in different neurologic disorders. The NPI has been used in approximately 350 clinical trials. In economic studies, the NPI captures the cost of behavioral symptoms in dementias. PRINCIPLE CONCLUSIONS The NPI is a useful instrument for capturing behavioral changes in Alzheimer disease and other neurodegenerative disorders.
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Affiliation(s)
- Jeffrey Cummings
- Department of Brain Health, School of integrated Health Sciences, UNLV, Las Vegas, NV, USA,Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
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Kawano Y, Terada S, Takenoshita S, Hayashi S, Oshima Y, Miki T, Yokota O, Yamada N. Patient affect and caregiver burden in dementia. Psychogeriatrics 2020; 20:189-195. [PMID: 31698515 DOI: 10.1111/psyg.12487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/05/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous studies focusing on the burden of caregivers of dementia patients have been published. However, there have been few studies focusing on positive affect as an important factor affecting the caregiver burden, and only a few studies comparing the caregiver burden between different dementia diseases have been reported. METHODS Three hundred and thirty-seven consecutive caregivers of people with dementia participated in this study. The caregiver burden was evaluated by the short version of the Japanese version of the Zarit Burden Interview. RESULTS Positive affect scores had a significant relationship with the scores of the short version of the Zarit Burden Interview. Caregivers for patients with dementia with Lewy bodies or frontotemporal dementia suffered from a greater burden than those for patients with Alzheimer's disease dementia. CONCLUSIONS The caregiver burden differed between people caring for patients with different dementia diseases. Positive affect of dementia patients has a significant relationship with caregiver burden, independently from neuropsychiatric symptoms of patients.
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Affiliation(s)
- Yoshiko Kawano
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Shintaro Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Satoshi Hayashi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Yoshitaka Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Tomoko Miki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
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Bramboeck V, Moeller K, Marksteiner J, Kaufmann L. Loneliness and Burden Perceived by Family Caregivers of Patients With Alzheimer Disease. Am J Alzheimers Dis Other Demen 2020; 35:1533317520917788. [PMID: 32281389 PMCID: PMC10624003 DOI: 10.1177/1533317520917788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present study aimed at investigating loneliness and burden experienced by family members caring for relatives diagnosed with Alzheimer disease. METHODS Participants were 40 caregivers of inpatients with Alzheimer disease. Correlation and multiple regression analyses were conducted to investigate whether caregivers' loneliness (uni- and multidimensional) and burden are associated with and predicted by (1) specific caregiver characteristics and/or (2) patients' dementia severity and neuropsychiatric symptoms. RESULTS Loneliness was significantly correlated with caregivers' sex, age, and living circumstances, while burden was significantly correlated with caregivers' education solely. Regression analyses revealed that caregivers' sex and living circumstances contributed significantly to variance explanation of loneliness (but not burden), while the additional consideration of patient variables did not improve model fit. CONCLUSIONS Loneliness reported by caregivers of relatives diagnosed with dementia is significantly modulated by caregiver (but not patient) characteristics. Notably, both uni- and multidimensional loneliness scales seem to be sensitive diagnostic tools.
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Affiliation(s)
- Verena Bramboeck
- Department of Psychiatry and Psychotherapy A, General Hospital Hall, Hall in Tirol, Austria
| | - Korbinian Moeller
- Leibniz-Institut für Wissensmedien, University of Tuebingen, Germany
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital Hall, Hall in Tirol, Austria
| | - Liane Kaufmann
- Department of Psychiatry and Psychotherapy A, General Hospital Hall, Hall in Tirol, Austria
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Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1326-1334. [PMID: 30198597 DOI: 10.1002/gps.4965] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. METHODS We searched PubMed and Google Scholar for potential eligible articles. RESULTS Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. CONCLUSION Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.,Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
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Balzotti A, Filograsso M, Altamura C, Fairfield B, Bellomo A, Daddato F, Vacca RA, Altamura M. Comparison of the efficacy of gesture-verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia. Int J Geriatr Psychiatry 2019; 34:1308-1315. [PMID: 30136743 PMCID: PMC6766963 DOI: 10.1002/gps.4961] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of neuropsychiatric symptoms (NPS) diminishes the quality of life and increases the care burden in patients with dementia. Despite the clinical importance of dementia-associated NPS, no protocols for treating NPS are already well established. Attention has turned to the effectiveness of nonpharmacological treatments for NPS since their potential safe alternative to pharmacotherapy. OBJECTIVE This study is aimed to compare the effects in older individuals with dementia living in a residential care, of two intervention programs, the gesture-verbal treatment (GVT), a treatment implemented by us on a previous method for word retrieval in individuals with aphasia, and the better-known doll therapy (DT). The GVT would act on both receptive and expressive language skills, the DT on attachment and emotional connections. METHODS We evaluated NPS by the neuropsychiatric inventory in a total of 30 patients divided into 3 groups, the GVT, the DT, and control groups, using a pre-post design. The treatment groups completed 12-week nonpharmacological interventions in addition to standard rehabilitative therapies, while the control group participated only in standard rehabilitative therapies. RESULTS The DT group showed significant improvements in agitation, irritability, apathy, depression, and delusions relative to controls. The GVT group showed significant improvements in apathy and depression with respect to controls. The DT intervention ameliorated symptoms of agitation compared to the GVT intervention whereas the GVT intervention improved apathy compared to the DT intervention. CONCLUSION Improved understanding of the potential therapeutic benefits of different treatments for neuropsychiatric symptoms is crucial for establishing nonpharmacological interventions in dementia.
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Affiliation(s)
- Angela Balzotti
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Marianna Filograsso
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Claudia Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Beth Fairfield
- Department of Psychological, Health and Territorial SciencesUniversity of ChietiChietiItaly
- Center of Excellence on Aging and Translational Medicine (CeSI‐MeT)University of ChietiChietiItaly
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Fabio Daddato
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Rosa Anna Vacca
- Institute of Biomembranes Bioenergetics and Molecular Biotechnologies, Italian National Research Council (CNR)BariItaly
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
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Chan EY, Phang KN, Glass GF, Lim WS. Crossing, Trudging and Settling: A phenomenological inquiry into lived experience of Asian family caregivers of older persons with dementia. Geriatr Nurs 2019; 40:502-509. [PMID: 30979516 DOI: 10.1016/j.gerinurse.2019.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
Abstract
Throughout Asian societies, family members often adopt the role of caregiving for older persons, providing essential care for loved ones with dementia. To date, there has been limited insight into the lived experience and meaning ascribed to the journey of these caregivers. This descriptive phenomenological study aims to explore the lived experience of Asian family caregivers of persons with dementia. Semi-structured face-to-face interviews were conducted with 16 family members caring for aged persons with dementia. Interviews were audio-recorded and data analysed using Colaizzi's technique. Analysis revealed the essential structure of a caregiver's journey with three major transitions, namely: (1) Crossing the threshold from ordinary world into caregiving world, (2) Trudging on the road of trials and obstacles, and (3) Settling into a new normalcy. Understanding the lived experience of Asian caregivers can help clinicians in targeting relevant support and information, and prepare new caregivers for the demands of their role.
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Affiliation(s)
- Ee-Yuee Chan
- Nursing Service, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore; Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore, Singapore.
| | - Koh Ni Phang
- Nursing Service, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore
| | | | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric and Active Aging, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kim K, Lee J. Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis. J Korean Acad Nurs 2019; 49:225-240. [DOI: 10.4040/jkan.2019.49.3.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/22/2019] [Accepted: 04/02/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Kyungsoo Kim
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Jia Lee
- College of Nursing Science, Kyung Hee University, Seoul, Korea
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Gossink F, Pijnenburg Y, Scheltens P, Pera A, Kleverwal R, Korten N, Stek M, Dröes RM, Dols A. An intervention programme for caregivers of dementia patients with frontal behavioural changes: an explorative study with controlled effect on sense of competence. Psychogeriatrics 2018; 18:451-459. [PMID: 30066463 DOI: 10.1111/psyg.12351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 04/23/2018] [Accepted: 06/28/2018] [Indexed: 11/27/2022]
Abstract
AIM Caregivers of dementia patients experience high levels of burden; this is especially true of caregivers of dementia patients with behavioural problems. As intervention studies for these caregivers are still lacking, we conducted an explorative pilot study into the efficacy of a support programme. METHODS Participants were caregivers of dementia patients affected by apathy, disinhibition, and/or stereotypical behaviour. All patients had a Frontal Behavioural Inventory score of 11 or higher. Caregivers were randomized to the intervention group or control group (both n = 15). The intervention was a 6-month programme that consisted of psychoeducation, social support, and behavioural cognitive therapy. Quantitative and qualitative data were collected at baseline and after the intervention. RESULTS An increased sense of competence was found in the intervention group. Burden, perceived stress, and depressive symptoms decreased, although the difference between the intervention and control groups was not significant. CONCLUSIONS Caregivers' sense of competence improved as a result of the support programme, and caregivers revealed its comprehensive supportive effects. Further research into the efficacy of the programme on a larger scale is recommended.
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Affiliation(s)
- Flora Gossink
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande Pijnenburg
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Aafke Pera
- Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rikie Kleverwal
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole Korten
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre & Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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Smaling HJA, Joling KJ, van de Ven PM, Bosmans JE, Simard J, Volicer L, Achterberg WP, Francke AL, van der Steen JT. Effects of the Namaste Care Family programme on quality of life of nursing home residents with advanced dementia and on family caregiving experiences: study protocol of a cluster-randomised controlled trial. BMJ Open 2018; 8:e025411. [PMID: 30327407 PMCID: PMC6196971 DOI: 10.1136/bmjopen-2018-025411] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Quality of life of people with advanced dementia living in nursing homes is often suboptimal. Family caregivers can feel frustrated with limited contact with their relatives, which results in visits that are perceived as stressful and not very meaningful. Few psychosocial interventions are specifically developed for people with advanced dementia, and actively involve family caregivers or volunteers. Also, interventions usually stop when it becomes difficult for people to participate. The Namaste Care Family programme aims to increase the quality of life of people with advanced dementia, and improve family caregiving experiences through connecting to people and making them comfortable. METHODS AND ANALYSIS Our study will evaluate the effects of the Namaste Care Family programme on quality of life of people with advanced dementia living in nursing homes and family caregiving experiences using a cluster-randomised controlled trial. Longitudinal analyses will be performed taking into account clustering at the nursing home level. Both a cost-effectiveness and a cost-utility analysis from a societal perspective will be performed. We will modify the Namaste Care Family programme to increase family and volunteer involvement in ongoing and end-of-life care. Data collection involves assessments by family caregivers, nursing staff and elderly care physicians using questionnaires, and observations by the researchers at baseline and multiple times over 12 months. The last questionnaire will be sent up to month 24 after the death of the person with dementia. During semistructured interviews, the feasibility, accessibility and sustainability of the Namaste Care Family programme will be assessed. ETHICS AND DISSEMINATION The study protocol is approved by the Medical Ethics Review Committee of the VU University Medical Center in Amsterdam (protocol no. 2016.399) and registered with the Nederlands Trial Register (NTR5692). The findings will be disseminated via publications in peer-reviewed journals, conference presentations and presentations for healthcare professionals where appropriate. TRIAL REGISTRATION NUMBER NTR5692.
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Affiliation(s)
- Hanneke J A Smaling
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn J Joling
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Joyce Simard
- School of Nursing and Midwifery, College of Health and Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Land O'Lakes, Florida, USA
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Caregiver burden, sleep quality, depression, and anxiety in dementia caregivers: a comparison of frontotemporal lobar degeneration, dementia with Lewy bodies, and Alzheimer's disease. Int Psychogeriatr 2018; 30:1131-1138. [PMID: 29223171 DOI: 10.1017/s1041610217002630] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
UNLABELLED ABSTRACTBackground:Very few recent studies are available that compare caregiver burden, sleep quality, and stress in caregivers of different types of dementia. We aimed to investigate caregiver burden, sleep quality, and stress in caregivers of patients with frontotemporal lobar degeneration and dementia with Lewy bodies, as compared with caregivers of patients with Alzheimer's disease. METHODS This study was carried out from March 2011 to January 2014. In total, 492 dyads of patient and caregiver (frontotemporal lobar degeneration, n = 131; dementia with Lewy bodies, n = 36; Alzheimer's disease, n = 325) participated in this study. We compared patients with respect to the Neuropsychiatric Inventory and caregivers with respect to the Zarit Caregiver Burden Interview, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Generalized Anxiety Disorder scale. RESULTS Frontotemporal lobar degeneration and dementia with Lewy bodies patients presented significantly more neuropsychiatric symptoms compared to Alzheimer's disease patients. Caregivers of frontotemporal lobar degeneration and dementia with Lewy bodies patients experienced significantly more burden compared to Alzheimer's disease caregivers. Furthermore, among caregivers of both frontotemporal lobar degeneration and dementia with Lewy bodies patients burden was predicted by the neuropsychiatric symptoms, PHQ-9 scores, and GAD-7 scores. CONCLUSIONS The frequency and severity of behavioral disturbances in patient and caregiver stress accounted for the increased caregiver burden, which suggests that frontotemporal lobar degeneration and dementia with Lewy bodies caregivers should receive more support than is currently available.
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Zhong X, Shi H, Hou L, Chen B, Peng Q, Chen X, Wu Z, Wang Y, Mai N, Huang X, Ning Y. Neuropsychiatric Features of Neurosyphilis: Frequency, Relationship with the Severity of Cognitive Impairment and Comparison with Alzheimer Disease. Dement Geriatr Cogn Disord 2018; 43:308-319. [PMID: 28538242 DOI: 10.1159/000476060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The pattern of neuropsychiatric features of patients with neurosyphilis and the impact of the severity of cognitive impairment on neuropsychiatric syndromes are unknown. OBJECTIVE We aim to assess the neuropsychiatric features of patients with neurosyphilis, and compare the impact of the severity of cognitive impairment on the neuropsychiatric syndromes between neurosyphilis and Alzheimer disease (AD). METHODS Neuropsychiatric symptoms and the degree of cognitive impairment were assessed in a case-control study of 91 neurosyphilis, 162 AD, 157 mild cognitive impairment, and 139 normal controls by the Neuropsychiatric Inventory (NPI) scale and Clinical Dementia Rating scale, respectively. Factor analysis was performed on the 12 NPI items. RESULTS Factor analysis showed that patients with neurosyphilis showed more severe neuropsychiatric syndromes at the dementia stage than those neurosyphilis patients at the mild cognitive impairment stage, while neuropsychiatric manifestations were equally common among the different stages of dementia (all p < 0.05). Frontal lobe syndrome was more severe in patients with neurosyphilis than in patients with AD from the early mild cognitive impairment stage to the moderate dementia stage (all p < 0.01). CONCLUSIONS Patients with neurosyphilis show different patterns of neuropsychiatric syndromes at the mild cognitive impairment and dementia stages, and differ from patients with AD.
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Affiliation(s)
- Xiaomei Zhong
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Hallikainen I, Koivisto AM, Välimäki T. The influence of the individual neuropsychiatric symptoms of people with Alzheimer disease on family caregiver distress-A longitudinal ALSOVA study. Int J Geriatr Psychiatry 2018; 33:1207-1212. [PMID: 29851148 DOI: 10.1002/gps.4911] [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: 11/22/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Family caregivers (FCs) face a variety of demands while caring for persons with Alzheimer disease (AD). Longitudinal studies identifying the specific AD-related neuropsychiatric symptoms (NPS) that contribute to FC distress are rare. We analyzed which NPS in association with care recipient and caregiver demographic factors are associated with FC psychological distress over a 36-month follow-up period. DESIGN This is a longitudinal study with annual follow-up. Participants were people with AD (n = 226) and their FCs (n = 226). MEASUREMENTS The Neuropsychiatric Inventory was used to assess NPS, and The General Health Questionnaire was used as a measure of caregiver distress. The effect of NPS on FC psychological distress over time was analyzed using a linear-mixed effect model. RESULTS Delusions (P = .003), agitation (P < .001), and sleep disturbance (P = .005) are associated with FC psychological distress. One of four people with AD developed delusions and agitation during the early stages of the disease. Sleep disturbances increased over the follow-up time. A marital relationship was associated with FC distress, while some prevalent symptoms, such as depression, did not affect distress. CONCLUSIONS Delusions, agitation, and sleep disturbances may cause distress to the FCs of persons with AD, especially if they live together. Clinicians should meet with FCs regularly and recognize those FCs at risk for a decline in psychosocial health.
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Affiliation(s)
- Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- NeuroCentre, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Zhang M, Chang YP, Liu YJ, Gao L, Porock D. Burden and Strain among Familial Caregivers of Patients with Dementia in China. Issues Ment Health Nurs 2018; 39:427-432. [PMID: 29775139 DOI: 10.1080/01612840.2017.1418034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Alzheimer's disease is one of a variety of progressive and ultimately fatal neurodegenerative diseases that are characterized by a number of nervous and mental symptoms and behavior disorders. These problems are likely to cause burden and strain on caregivers. In this study, we demonstrated the level and relationship of burden and strain among caregivers of dementia patients in China. METHODS A total of 212 caregivers of family members with dementia responded to the survey. A 22-item of the Zarit Burden Interview and a 13-item Caregiver Strain Index (CSI) were used. RESULTS The results showed that women comprised 88.2% of caregivers, and 58.5% of caregivers reported a level of medium burden. Over one-half of the caregivers reported a level of high strain, with the low income group being more likely to have high levels of burden and strain. CONCLUSION Chinese familial caregivers of patients with dementia experience a moderate level of burden and a high level of strain. The main strain factors that affected the burden were changes in personal plans, time demands, and emotional adjustment.
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Affiliation(s)
- Min Zhang
- a Beihua University , School of Nursing , Jilin, Jilin , China
| | - Yu-Ping Chang
- b University at Buffalo , The State University of New York, School of Nursing , Buffalo , New York , USA
| | - Yu Jin Liu
- c Northeast Normal University , Nursing Department, College of Humanities , Changchun , Jilin , China
| | - Ling Gao
- a Beihua University , School of Nursing , Jilin, Jilin , China
| | - Davina Porock
- d City University of New York City , Lehman College , New York , New York , USA
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Ransmayr G, Hermann P, Sallinger K, Benke T, Seiler S, Dal-Bianco P, Marksteiner J, Defrancesco M, Sanin G, Struhal W, Guger M, Vosko M, Hagenauer K, Lehner R, Futschik A, Schmidt R. Caregiving and Caregiver Burden in Dementia Home Care: Results from the Prospective Dementia Registry (PRODEM) of the Austrian Alzheimer Society. J Alzheimers Dis 2018; 63:103-114. [DOI: 10.3233/jad-170657] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Philipp Hermann
- Department of Applied Statistics, Johannes Kepler University Linz, Austria
| | | | - Thomas Benke
- Department of Neurology, Medical University Innsbruck, Austria
| | - Stephan Seiler
- Department of Neurology, Section of Neurogeriatrics, Medical University Graz, Austria
| | | | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall, Austria
| | - Michaela Defrancesco
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Austria
| | - Günter Sanin
- Department of Neurology, Medical University Innsbruck, Austria
| | - Walter Struhal
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Milan Vosko
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Karin Hagenauer
- Department for Clinical and Health Psychology, Med Campus III, Kepler University Hospital, Linz, Austria
| | - Riccarda Lehner
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Andreas Futschik
- Department of Applied Statistics, Johannes Kepler University Linz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Section of Neurogeriatrics, Medical University Graz, Austria
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Koyama A, Hashimoto M, Fukuhara R, Ichimi N, Takasaki A, Matsushita M, Ishikawa T, Tanaka H, Miyagawa Y, Ikeda M. Caregiver Burden in Semantic Dementia with Right- and Left-Sided Predominant Cerebral Atrophy and in Behavioral-Variant Frontotemporal Dementia. Dement Geriatr Cogn Dis Extra 2018; 8:128-137. [PMID: 29706989 PMCID: PMC5921212 DOI: 10.1159/000487851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 02/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Caregiver burden is a serious concern for family caregivers of dementia patients, but its nature is unclear in patients with semantic dementia (SD). This study aimed to clarify caregiver burden for right- (R > L) and left-sided (L > R) predominant SD versus behavioral-variant frontotemporal dementia (bvFTD) patients. Methods Using the Japanese version of the Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory, we examined caregiver burden and behavioral and psychological symptoms of dementia (BPSD) in 43 first-visit outpatient/family caregiver dyads (bvFTD, 20 dyads; SD [L > R], 13 dyads; SD [R > L], 10 dyads). Results We found a significant difference in ZBI score between the 3 diagnostic groups. Post hoc tests revealed a significantly higher ZBI score in the bvFTD than in the SD (L > R) group. The ZBI scores in the SD (L > R) and SD (R > L) groups were not significantly different, although the effect size was large. Caregiver burden was significantly correlated with BPSD scores in all groups and was correlated with activities of daily living and instrumental activities of daily living decline in the bvFTD and SD (R > L) groups. Conclusion Caregiver burden was highest in the bvFTD group, comparatively high in the SD (R > L) group, and lowest in the SD (L > R) group. Adequate support and intervention for caregivers should be tailored to differences in caregiver burden between these patient groups.
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Affiliation(s)
- Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoko Ichimi
- Department of Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Akihiro Takasaki
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masateru Matsushita
- Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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Yassuda MS, Lima da Silva TB, O'Connor CM, Mekala S, Alladi S, Bahia VS, Amaral-Carvalho V, Guimaraes HC, Caramelli P, Balthazar MLF, Damasceno B, Brucki SMD, Nitrini R, Hodges JR, Piguet O, Mioshi E. Apathy and functional disability in behavioral variant frontotemporal dementia. Neurol Clin Pract 2018; 8:120-128. [PMID: 29708208 DOI: 10.1212/cpj.0000000000000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
Background Behavioral variant frontotemporal dementia (bvFTD) has profound consequences on patients and their families. In this multicenter study, we investigated the contribution of cognitive and neuropsychiatric factors to everyday function at different levels of overall functional impairment. Methods In a retrospective cross-sectional study, 109 patients with bvFTD from 4 specialist frontotemporal dementia centers (Australia, England, India, and Brazil) were included. The measures administered evaluated everyday function (Disability Assessment for Dementia [DAD]), dementia staging (Clinical Dementia Rating [CDR]), general cognition (Addenbrooke's Cognitive Examination-revised [ACE-R]), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). Patients were then subdivided according to functional impairment on the DAD into mild, moderate, severe, and very severe subgroups. Three separate multiple linear regression analyses were run, where (1) total DAD, (2) basic activities of daily living (BADL), and (3) instrumental activities of daily living (IADL) scores were dependent variables; ACE-R total score and selected NPI domains (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) were used as independent variables. Age, sex, education, and country of origin were controlled for in the analyses. Results Cognitive deficits were similar across the mild, moderate, and severe subgroups but significantly worse in the very severe subgroup. NPI domain scores (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) did not differ across the DAD subgroups. In the multiple regression analyses, a model including ACE-R and NPI apathy explained 32.5% of the variance for total DAD scores. For IADL, 35.6% of the variance was explained by the ACE-R only. No model emerged for BADL scores. Conclusions Cognitive deficits and apathy are key contributors to functional disability in bvFTD but factors underlying impairment in BADLs remain unclear. Treatments targeting reduction of disability need to address apathy and cognitive impairment to ensure greater efficacy, especially in regards to IADLs.
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Affiliation(s)
- Mônica S Yassuda
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Thais B Lima da Silva
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Claire M O'Connor
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Shailaja Mekala
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Suvarna Alladi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Valeria S Bahia
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Viviane Amaral-Carvalho
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Henrique C Guimaraes
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Paulo Caramelli
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Marcio L F Balthazar
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Benito Damasceno
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Sonia M D Brucki
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Ricardo Nitrini
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - John R Hodges
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Olivier Piguet
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
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Zhu Q, Lin M, Bi S, Ni Z, Zhao J, Chen B, Fan G, Shang X. Impaired Frontolimbic Connectivity and Depressive Symptoms in Patients with Alzheimer's Disease. Dement Geriatr Cogn Disord 2018; 41:281-91. [PMID: 27331920 DOI: 10.1159/000447056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Depressive symptoms are commonly observed in Alzheimer's disease (AD). The underlying mechanisms of depressive symptoms in AD remain unclear; frontolimbic circuitry dysfunction may play a role. We aimed to investigate the microstructural integrity of frontolimbic connectivity of specific fiber tracts in AD patients with and without depressive symptoms using diffusion tensor imaging (DTI). METHODS Eleven AD patients with depressive symptoms (dep-AD), 18 AD patients without depressive symptoms (nondep-AD), and 18 normal control (NC) subjects were included. The cingulum bundle (CB), uncinate fasciculus (UF), and fornix, mainly frontolimbic connectivity, were measured by DTI tractography and the metrics of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity (RD) were calculated. RESULTS Compared with NC subjects, both dep-AD and nondep-AD patients showed significant differences for all indices in the fornix and significantly decreased FA and increased MD and RD in the bilateral CB and UF. When compared to nondep-AD patients, dep-AD patients showed significantly increased MD and RD in the bilateral CB and right UF. CONCLUSION Depressive symptoms in AD patients may be involved in greater microstructural abnormalities of frontolimbic connectivity and myelin injury in the bilateral CB and right UF might contribute to the pathophysiology of depressive symptoms in AD.
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Affiliation(s)
- Qingyong Zhu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
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