The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia

Are behavioral and psychological symptoms of dementia related to sensory processing?

Problems with sensory processing may have an impact on the behavioral and psychological symptoms that can be seen in Alzheimer's patients. Examining the relationship between the two factors may provide a new perspective for the management of behavioral and psychological symptoms of dementia. Mid-stage Alzheimer's patients completed the Neuropsychiatric Inventory and Adolescent/Adult Sensory Profile. The relationship between behavioral and psychological symptoms of dementia and sensory processing was investigated. Sixty individuals with a mean age of 75.35 (7.86) years and diagnosed with Alzheimer's Dementia 6.6 (2.92) years ago participated in the study. Individuals with severe behavioral and psychological symptoms had higher scores than individuals with moderate behavioral and psychological symptoms in low registration and sensory sensitivity quadrants . A relationship was found between sensory processing and behavioral and psychological symptoms of dementia in mid-stage Alzheimer's patients. This study highlighted the sensory processing differences in patients with Alzheimer's dementia. In future studies, interventions for sensory processing skills may play a role in improving the quality of life of individuals by contributing to the management of behavioral and psychological symptoms of dementia.

DEprescribing and Care to reduce Antipsychotics in DEmentia (DECADE)-A Hybrid Effectiveness-Implementation Pilot Study

OBJECTIVES

The aim of DEprescribing and Care to reduce Antipsychotics in Dementia (DECADE) was to evaluate a multifaceted intervention to reduce antipsychotic use among nursing home residents with dementia without medication shifts (increase in the use of other psychotropic medications) or worsening Behavioral and Psychological Symptoms of Dementia (BPSD).

METHODS

From June 2022 to January 2024, a type 2 hybrid effectiveness-implementation pilot study was conducted across six Danish nursing homes. The intervention included education for general practitioners and healthcare professionals, medication reviews, and individualized care plans for 40 residents with dementia using antipsychotic medications. The data collection focused on implementation, antipsychotic use, psychotropic medication use, and BPSD. Implementation was assessed through fidelity analysis and surveys assessing providers' perceptions of the models' acceptability, appropriateness, feasibility, and healthcare providers' self-reported knowledge and competence. Changes in antipsychotic use, medication shifts, and BPSD scores measured effectiveness.

RESULTS

Fidelity was generally high, but participation in education was low. About half of the respondents considered the model appropriate and feasible. The intervention led to a significant reduction in antipsychotic use among the 40 included residents, with a decrease of 97.6 mg in olanzapine equivalents corresponding to a daily mean use of 5.9 mg olanzapine equivalents at baseline to a daily mean use of 4.8 mg, at study end (averaged reduction of 1.1 mg/day). In total, 36% of the residents achieved ≥50% reductions, and without an increase in the use of other psychotropic drugs or worsening of BPSD.

CONCLUSIONS

DECADE reduced antipsychotic use without worsening BPSD, highlighting its potential for broader applications. Multidisciplinary collaboration and ongoing education regarding antipsychotic use in dementia care are essential.

Depressive Symptoms Correlate With Tau Accumulation Rates in Amyloid Positive Adults

OBJECTIVE

Depression in Alzheimer's disease (AD) is linked to faster cognitive decline and increased tau pathology. This study examines the relationship between depressive symptoms and tau accumulation rates in older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database.

METHODS

Three-hundred and three ADNI participants with normal cognition, mild cognitive impairment, or dementia underwent serial [18F]-flortaucipir tau positron-emission tomography (PET) between 2015 and 2022. We assessed whether the Geriatric Depression Scale (GDS) score between baseline and final PET scans correlated with rates of tau accumulation in a temporal lobe meta-region of interest.

RESULTS

GDS score was positively correlated with annualized tau accumulation rates in models adjusted for baseline tau burden, amyloid status on PET, and APOE genotype. This correlation was observed in amyloid-positive, but not amyloid-negative, participants.

CONCLUSION

Depressive symptoms in amyloid-positive adults correlate with accelerated tau accumulation, suggesting that depression may have particular relevance as an indicator of AD pathology progression, and represents a target for future research into modifiable risk factors in AD.

Brain network connectivity underlying neuropsychiatric symptoms in prodromal Lewy body dementia

Neuropsychiatric symptoms (NPS) are prevalent, emerge early, and are associated with poorer outcomes in Lewy body dementia (LBD). Research suggests NPS may reflect LBD-related dysfunction in distributed neuronal networks. This study investigated NPS neural correlates in prodromal LBD using resting-state functional MRI. Fifty-seven participants were included with mild cognitive impairment (MCI) with Lewy bodies (MCI-LB, n = 28) or Parkinson's disease (PD-MCI, n = 29). Functional MRI assessed connectivity within five resting-state networks: primary visual, dorsal attention, salience, limbic, and default mode networks. NPS were measured using the Neuropsychiatric Inventory. Principal component analyses identified three neuropsychiatric factors: affective disorder (apathy, depression), psychosis (delusions, hallucinations) and anxiety. Seed-to-voxel connectivity maps were analysed to determine associations between NPS and network connectivity. In PD-MCI, affective symptoms and anxiety were associated with greater connectivity between limbic orbitofrontal cortex and default mode areas, including medial prefrontal cortex, subgenual cingulate and precuneus, and weaker connectivity between limbic orbitofrontal cortex and the brainstem and between the salience network and medial prefrontal cortex (all pFWE<0.001). Psychosis severity in PD-MCI correlated with connectivity across multiple networks (all pFWE<0.001). In MCI-LB, no significant correlations were found between NPS severity and network connectivity. However, participants with anxiety demonstrated a trend towards greater connectivity within medial prefrontal areas than those without (pFWE=0.046). Altered connectivity within and between networks associated with mood disorders may explain affective and anxiety symptoms in PD-MCI. Neural correlates of NPS in MCI-LB, however, remain unclear, highlighting the need for research in larger, more diverse LBD populations to identify symptomatic treatment targets.

Factors associated with length of stay in patients from residential aged care facilities admitted for behavioural and psychological symptoms of dementia

OBJECTIVE

To determine factors affecting the length of stay (LOS) in patients from residential aged care facilities (RACFs) admitted for behavioural and psychological symptoms of dementia (BPSD).

METHODS

Medical records for RACF patients admitted to Flinders Medical Centre between January and December 2018 were reviewed. For patients admitted with BPSD, demographics, clinical characteristics, admission characteristics and outcomes were extracted. Key outcomes were LOS and admission to a subacute unit (psychogeriatric or geriatric) for ongoing care. Factors influencing LOS and subacute admission were explored.

RESULTS

The average LOS was 21.7 days and median LOS 10.5 days. Younger age, prior Dementia Behaviour Management Advisory Service review, psychogeriatrician assessment, inpatient treatment order and increased number of Code Blacks (hospital code for violent behaviour) were associated with a longer LOS and subacute admission. Being women and being bed-bound were associated with shorter admission and direct discharge. Opioid use was associated with shorter admission. Use of benzodiazepine and higher dose, higher antipsychotic dose, use of antidepressant or mood stabilisers were associated with subacute admission. The presence of reversible causes was associated with direct discharge.

CONCLUSIONS

Certain clinical characteristics may be associated with LOS in patients with BPSD from RACFs. This information may help in the development of strategies to prevent acute presentation to hospital, minimise LOS and create pathways for improved management.

Association of Visual Impairment With Neuropsychiatric Symptoms of Dementia

BACKGROUND

Visual impairment is a risk factor for cognitive impairment and hallucinations in older adults, but associations with other neuropsychiatric symptoms (NPS) of dementia have not been examined.

METHODS

We analyzed cross-sectional data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of the US population aged 70+ years. Vision was measured by self-report and using a near card. Dementia was ascertained through cognitive testing with expert consensus, and NPS were screened using the Neuropsychiatric Inventory. We used logistic regression to measure the association between visual impairment and prevalent NPS adjusting for sociodemographic factors and comorbidities. Analyses incorporated sample weights to account for the complex survey design of ADAMS.

RESULTS

Of 624 participants with dementia, 332 (53%) had self-reported visual impairment and 193 (31%) had best-corrected acuity of 20/40 or worse. In unadjusted models, self-reported visual impairment was significantly associated with hallucinations (OR 2.88; 95% CI 1.12-7.44), depression (OR 2.79; 95% CI 1.7-4.57), and agitation (OR 1.61; 95% CI 1.05-2.48). Reduced visual acuity was associated with hallucinations (OR 10.13; 95% CI 2.93-34.98), psychosis (OR 6.69, 95% CI 2.53-17.7), and mania (OR 5.92, 95% CI 1.77-19.82). However, these associations did not remain significant after covariate adjustment.

CONCLUSIONS

Visual impairment was associated with hallucinations, depression, agitation, psychosis, and mania in patients with dementia, but at least some of this relationship is explained by age, comorbidities, and other factors.

Alternative Diagnoses in the Work Up of Down Syndrome Regression Disorder

PURPOSE

Down Syndrome Regression Disorder (DSRD) is a diagnosis of exclusion. Psychiatric and neuroimmunologic etiologies have been proposed although the exact etiology remains unknown. This study sought to review non-DSRD diagnoses at a large quaternary medical center specializing in the diagnosis of DSRD and compare clinical characteristics between those diagnosed with DSRD and those with non-DSRD diagnoses.

METHODS

The authors performed a single-center retrospective, chart-based, review of referrals for developmental regression in individuals with Down syndrome.

RESULTS

Two hundred and sixty-six individuals were evaluated for DSRD and of these, 54 (20%) ultimately had alternative diagnoses. Individuals with DSRD were more likely to have shorter nadir to clinical symptoms (p = 0.01, 95% CI: 0.36-0.47) and have preceding triggers (p < 0.001, 95% CI: 1.13-1.43) compared to those with alternative diagnoses. Individuals with non-DSRD diagnoses were more likely to be born premature (p = 0.01, 95% CI: 0.51-0.87) and have a history of epilepsy (p = 0.01, 95% CI: 0.23-0.77) but were also less likely to have a history of cytokine abnormalities on bloodwork (p < 0.001, 95% CI: 1.19-1.43) and have catatonia (p < 0.001, 95% CI: 1.54-2.17). The majority of alternative diagnoses (41/54, 76%) were autism spectrum disorder. In these cases, symptoms were more likely to be longstanding (symptoms > 12 months) and earlier onset (median 8 years, IQR: 6-11). Other diagnoses included epilepsy (5/54, 9%), Celiac disease (5/54, 9%), cerebrovascular disease (3/54, 6%).

CONCLUSIONS

This study identifies that 20% of individuals referred with concerns for DSRD have alternative diagnoses. The majority of these diagnoses were autism, but rare treatable conditions were also identified, highlighting the importance of a thorough neurodiagnostic assessment.

Affective experiences and implicit representation of affect valence in young, middle-aged and older adults: Evidence based on ecological momentary assessment and implicit association test

The current study examined adult age differences in emotional well-being and emotion-regulation motivation in the Indian context using the ecological momentary assessment (EMA) (experience sampling), self-reported preferences for affect-valence and the Implicit Association Test (IAT, to measure implicit mental representations of affect valence) across three age groups. Findings reveal an overall preference for positive affect, feeling of pleasantness in daily life and a greater prevalence for pro-hedonic than contra-hedonic motivation. Middle-aged and older adults reported greater experience of positive than negative affect, (t[87] = 4.77, p = .013) and (t[87] = 13.93, p < .001, respectively) compared to younger adults, which may be attributed to changes in the motivation for emotionally meaningful goals, consistent with the socioemotional selectivity theory. The IAT showed a greater distinctiveness between positive and negative affect valence among older adults than middle-aged and young adults (greater D1 scores among older adults than younger (2.35) and middle-aged adults (2.15) (t[27] = -2.56, p = .007) and (t[27] = -2.93, p = .002), respectively), which may be modulated by cognitive control and motivation for emotion regulation. Additionally, very few instances of mixed affect (feeling sad to be happy or enjoying being sad) and contra-hedonic motivation (in comparison to what has been observed so far in western cohorts) were reported across the three age groups in this study (age × motivation × valence, F[2, 87] = 1.77. p = .17). We observed reductions in heterogeneity and a greater discriminability with respect to positive versus negative affective experiences and in the preferences for affect valence across age groups (results based on principal component analysis). Thus, affective experiences were found to be more strongly defined by positive affect among middle-aged and older adults. This shift in emotional goals towards positive affect among middle-aged and older adults is associated with distinctive mental representations of affect valence.

The Impact of Caregiving on Informal Caregivers of People with Dementia: Family Functioning, Burden, and Burnout

Caregiving is a complex occupation, with a significant impact for informal caregivers (IC). Stress-process models propose a framework that considers that this impact depends on primary and secondary stressors, but also on the IC situation appraisal. This work aimed to verify: whether being, or not, an IC of an individual with dementia influenced the relationship between family functioning and burnout; the association between neuropsychiatric symptoms of the individual with dementia and IC burnout and whether the IC burden and perceived family functioning had a mediating role in such relationship. This cross-sectional study investigated differences in family functioning and its association with burnout between IC and non-IC. For IC specifically, the study examined a mediation model to explore the possibility of neuropsychiatric symptoms indirectly affecting IC burnout through the impact on family functioning and burden. Measures included the Copenhagen Burnout Inventory, the McMaster Family Assessment Device, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Results showed an association between poorer family function and high burnout, specifically in IC. They also showed that burden mediated the relationship between neuropsychiatric symptoms and burnout. The findings offer a significant contribution to the growing knowledge about the relationship between stressors associated with informal caregiving in dementia context, such as neuropsychiatric symptoms and its outcomes, like burnout.

Empirical Classification of Neuropsychiatric Symptoms and Association of Classes With Diagnostic Progression and Cognitive Decline in Mild Cognitive Impairment and Alzheimer's Disease Populations

BACKGROUND

The current study aimed to identify classes of cognitively impaired older individuals based on their neuropsychiatric symptoms (NPSs) and to investigate the contribution of NPS class to cognitive decline and Alzheimer's disease (AD) risk in mild cognitive impairment (MCI).

METHODS

Our study included 1472 participants (age range 55-91 years) from the ADNI (Alzheimer's Disease Neuroimaging Initiative) who were diagnosed with MCI or mild AD and completed the Neuropsychiatric Inventory at their baseline visit. We used latent class analysis to categorize groups by NPS patterns. Linear mixed models of repeated measures were used to compare changes in cognitive performance across 5 years as a function of NPS class. Subsequently, Cox proportional hazards models were used in individuals with MCI to assess whether the rate of conversion to AD differed across the NPS groups.

RESULTS

We identified 3 latent classes of NPSs: no NPS (n = 799, 51.7%), apathy/affective NPS (n = 572, 39.8%), and complex NPS (n = 108, 8.5%). In longitudinal analyses, we observed interactions between class and time, indicating accelerated cognitive decline in memory and executive function in the apathy/affective class. In MCI, hazard ratios for conversion to AD were 1.39 (95% CI, 1.10-1.76) for the apathy/affective class and 2.03 (95% CI, 1.33-3.10) for the complex class compared with the no NPS group after adjusting for age, sex, education, global cognition, and APOE ε4 positivity.

CONCLUSIONS

Among cognitively impaired older adults, empirically derived clusters of NPS profiles were associated with cognitive decline and risk of conversion from MCI to AD. Such NPS classes may reflect specific neurobiological mechanisms within or related to AD-related neurodegeneration. Further studies with biological markers are needed to clarify these neurobiological mechanisms.

Assessment of the validity of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem): a cross-sectional survey study

OBJECTIVES

The aim of the present study was to examine the reliability and validity (structural and convergent) of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem).

DESIGN

Cross-sectional survey study.

SETTING

Online survey in Germany.

PARTICIPANTS

The ResQ-Care-Dem was completed by 243 informal caregivers of people with dementia (Mage=59.7 years, SD=10.9, 84.8% female).

METHODS

The ResQ-Care-Dem consists of four scales: two resilience scales (psychological aspects and social aspects of resilience) and two burden scales (interpersonal burden and general burden). The reliability of the two resilience and two burden scales was assessed using Cronbach's alpha as a measure of internal consistency. Structural validity was examined using a principal axis factor analysis. Convergent validity was assessed by Pearson's correlations with the Zarit Burden Interview (ZBI-7), the Caregiver Self-Efficacy Scale (CES-8) and the Gain in Alzheimer Care Instrument (GAIN).

RESULTS

The ResQ-Care-Dem scales' internal consistencies ranged between 0.65 and 0.81. The factorial structure could partly be confirmed, with the items of the four scales primarily loading on four factors. The burden scales demonstrated high and positive correlations with the score for caregiver burden (ZBI-7, r=0.51 - 0.55) and small to high, negative correlations with the scores for caregiver self-efficacy (CES-8, r=-0.52 -0.56) and gains from caregiving (GAIN, r=-0.21 -0.22), supporting construct validity of the scales. The resilience scales showed small to high positive correlations with the scores for caregiver self-efficacy (CES-8, r=0.50 - 0.57) and gains from caregiving (GAIN, r=0.27 - 0.50), as well as moderate negative correlations with the caregiver burden score (ZBI-7, r=-0.45 -0.50), providing evidence for the scales' construct validity.

CONCLUSIONS

The reliability and structural validity of the ResQ-Care-Dem were partially confirmed. Evidence supporting its convergent validity suggests that the questionnaire has potential as a tool for assessing caregiver burden and resilience factors among informal caregivers of people with dementia. While these findings indicate potential practical applicability, future studies should investigate its performance in real-world settings and assess changes over time (eg, responsiveness) in longitudinal studies.

Prevalence of low scores in the Uniform Data Set version 3.0: Comparison of older adults with and without a self-reported history of traumatic brain injury

OBJECTIVE

To assess for differences in low score frequency on cognitive testing amongst older adults with and without a self-reported history of traumatic brain injury (TBI) in the National Alzheimer's Coordinating Center (NACC) dataset.

METHOD

The sample included adults aged 65 or older who completed the Uniform Data Set 3.0 neuropsychological test battery (N = 7,363) and was divided by individuals with and without a history of TBI, as well as cognitive status as measured by the CDR. We compared TBI- and TBI + groups by the prevalence of low scores obtained across testing. Three scores falling at or below the 2nd percentile or four scores at or below the 5th percentile were criteria for an atypical number of low scores. Nonparametric tests assessed associations among low score prevalence and demographics, symptoms of depression, and TBI history.

RESULTS

Among cognitively normal participants (CDR = 0), older age, male sex and greater levels of depression were associated with low score frequency; among participants with mild cognitive impairment (CDR = 0.5-1), greater levels of depression, shorter duration of time since most recent TBI, and no prior history of TBI were associated with low score frequency.

CONCLUSIONS

Participants with and without a history of TBI largely produced low scores on cognitive testing at similar frequencies. Cognitive status, sex, education, depression, and TBI recency showed variable associations with the number of low scores within subsamples. Future research that includes more comprehensive TBI history is indicated to characterize factors that may modify the association between low scores and TBI history.

Korean medicine registry for cognitive disorder: A protocol for prospective observational multi-center study

OBJECTIVE

Despite the rapid increase in dementia and cognitive impairment incidence in Korea, research on integrative treatment for cognitive impairment using Korean medicine (KM) is still in its infancy. Thus, prospective studies with systematic data collection are required. This study aims to systematically collect and explore data from patients with dementia and mild cognitive impairment (MCI) who visit KM institutions. The data collected will include the participants' baseline characteristics, cognitive impairment severity, KM diagnosis and treatment status, as well as the factors influencing their choice of integrative medical treatment.

MATERIALS AND METHODS

This registry study will be conducted from the time of registration in 2024 until December 31, 2029, at Wonkwang University Korean Medicine Hospital, Wonkwang University Jangheung Integrated Medical Hospital, and Daejeon Korean Medicine Hospital of Daejeon University. Approximately 300 participants will be enrolled and visit the hospital annually for data collection. The collected data will include sociodemographic characteristics, laboratory tests, medical device inspections, long-term care information, and various questionnaires related to dementia and cognitive impairment. No predefined interventions or restrictions on treatment will be imposed. Standard and KM treatments for cognitive impairment, including combination therapies, are permitted. As a registry study, the purpose is to investigate the participants' characteristics as outlined in the study objectives, including severity, KM diagnosis and interventions, and clinical outcomes. This epidemiological study is designed to include additional statistical analyses in response to research questions that emerge over time.

DISCUSSION

This study represents a pioneering effort in the KM field establishing the first registry of its kind focusing on dementia and MCI. This study aims to identify the characteristics of patients with dementia and MCI who visit KM institutions, explore the factors influencing KM treatment, and observe clinical outcomes according to KM pattern identification, providing evidence based on real-world data.

Paraneoplastic LGI1 Encephalitis Associated with Lung Adenocarcinoma: A Case Report

Limbic encephalitis (LE) associated with anti-LGI1 antibodies is an autoimmune disorder characterized by memory decline, behavioral changes, and temporal lobe epilepsy. Faciobrachial dystonic seizures (FBDS) are a hallmark symptom, often preceding cognitive and psychiatric issues. This report presents an 80-year-old male with LGI1 encephalitis, initially manifesting as FBDS. A lung adenocarcinoma was diagnosed two months after the onset of neurological symptoms. Clinical and paraclinical data, including MRI and [18]FDG PET imaging, are described. The patient responded to immunotherapy, including steroids and plasma exchange, along with tumor resection. Following treatment, neurological symptoms resolved, except for mild anxiety and apathy. Further research is needed to determine whether LGI1 encephalitis may occasionally have a paraneoplastic origin, potentially influencing screening and management strategies.

Association Between Angiotensin-Converting Enzyme (ACE) Gene Insertion/Deletion (I/D) Polymorphism Genotypes With Brain Volume and Hypertension in Alzheimer's Disease-A Retrospective Study

This study investigates the role of the ACE I/D polymorphism in Alzheimer's disease (AD) patients, particularly in relation to hypertension and its influence on brain volume. Seventy-seven AD patients, diagnosed based on Aging and Alzheimer's Association criteria, were enrolled from the Kaohsiung Municipal Ta-Tung Hospital Dementia Cohort. ACE I/D genotypes were identified through polymerase chain reaction, and various factors such as age, sex, education, brain volume, and neuropsychological test scores were analyzed. The results indicated that ACE genotypes, presence of apolipoprotein epsilon 4 (APOEε4), and brain volume did not significantly differ between patients with and without hypertension. While age and sex were associated with gray matter volume, cerebrospinal fluid volume correlated with age, sex, and hypertension. Total cranial volume was linked to sex, and the cerebrospinal fluid-to-total intracranial volume ratio was influenced by sex and education. Overall, ACE I/D genotypes and APOEε4 did not have a significant impact on brain volume in AD patients, regardless of hypertension status. Instead, brain atrophy was associated with sex, age, education, and hypertension. These findings suggest that although ACE may not significantly influence brain volume in AD patients, further large-scale studies are needed to clarify its role in AD pathogenesis.

Non-pharmacological interventions to reduce neuropsychiatric symptoms in hospitalised patients for behavioural crises with cognitive impairment: A systematic review

Non-pharmacological interventions are pivotal to reducing neuropsychiatric symptoms (NPS) in patients with cognitive impairment. This systematic review assessed the effectiveness of non-pharmacological interventions applicable by nursing staff to reduce NPS in older patients with cognitive impairment hospitalised for behavioural crises. Six databases were searched for randomised or non-randomised controlled trials. Two authors screened full-texts and assessed the quality of the studies using the Modified Downs and Black Checklist. Results were presented narratively using the PRISMA guideline. Only five studies could be included, all were conducted in geriatric psychiatry. Three studies showed significant effects on NPS. They tested physical exercise, behavioural activation for meaningful activity and listening to individualised music and were of good, moderate and low quality, respectively. The best evidence was found for physical exercise. Due to the small number of studies with heterogeneous quality, the results must be interpreted with caution, limiting the scope of conclusions. While more research is needed, we recommend that non-pharmacological interventions in clinical practice be adjusted to patient characteristics, contextual factors and existing care practices.

A Descriptive Statistical Analysis of Neuropsychiatric Symptom Pair Prevalence

Neuropsychiatric symptoms (NPS) are very common and associated with high levels of distress, both in dementia patients and their caregivers. Especially at more advanced dementia disease stages, NPS rarely occur in isolation and the presence of two or more NPS may affect disease severity as well as the response to therapy. There is limited quantitative information on prevalence of specific symptom combinations in the general population, as well as in the populations recruited for symptom-specific investigations. We performed cross-sectional analyses of data from two longitudinal studies (Aging, Demographics, and Memory Study (ADAMS) and the National Alzheimer's Coordinating Center data (NACC)). In both studies and all Mini Mental State Examination (MMSE) strata, we observed every possible pair combination, from commonly recognized and discussed associations (e.g., hallucinations and delusions) to what might be seen as rather counter-intuitive patterns (e.g., apathy and agitation). In conclusion, prevalence of symptom pairs cannot be readily predicted based on prevalence of individual symptoms. Further, the presence of cognitive deficit and degree of cognitive impairment is associated with increased prevalence of all symptoms and symptom pairs, albeit to different degrees. The present study illustrates that, while there is the possibility of any combination of neuropsychiatric symptoms presenting during the course of dementia, their co-occurrence cannot be readily predicted based on the prevalence of individual symptoms. Thus, our study results serve as a source of reference information to inform the design and recruitment strategies for future clinical studies and epidemiological research on neuropsychiatric symptoms in people with dementia.

Validating the Chinese version of the Apathy Motivation Index and network analysis of apathy subtypes in a healthy Chinese sample

Apathy is a neuropsychiatric syndrome associated with various negative outcomes in patients with motivational disorders, commonly examined in multiple dimensions including cognitive, behavioral, and emotional domains. While there are some tools to measure apathy in China, there is a lack of appropriate instruments specifically designed to assess social motivation for a more comprehensive definition of apathy. Moreover, there is limited research on the complex interrelations among the intrinsic domains of apathy. Therefore, we developed the Chinese version of the Apathy Motivation Index (AMI) and assessed its reliability and validity in a sample of 758 participants. Network analysis was employed to explore the relationships among different domains of apathy. The Chinese version of the AMI classifies apathy into three domains, namely, behavioral activation, social motivation, and emotional sensitivity, which is consistent with the original scale; it also has good reliability and validity, making it suitable for measuring apathy and motivation in both healthy and patient populations. Additionally, network analysis revealed that apathy within the behavioral activation domain critically contributes to the overall measurement of apathy, while the social motivation dimension may serve as a bridge connecting other dimensions. Our study offers a reliable instrument to investigate apathy in Chinese-speaking individuals and could provide new insights for a better understanding of apathy in neuropsychiatric disorders.

Genetic variability in ADAM17/TACE is associated with sporadic Alzheimer's disease risk, neuropsychiatric symptoms and cognitive performance on the Rey Auditory Verbal Learning and Clock Drawing Tests

Recent studies have highlighted the significant role of ADAM17/TACE (encoded by ADAM17/TACE) in the pathogenesis of Alzheimer's disease (AD). Yet, the relationship between ADAM17/TACE gene polymorphisms and AD was less studied. This study aims to analyse the relationship of ADAM17/TACE gene polymorphism with the risk, age of onset, neuropsychiatric manifestations, cognitive impairment, and medial temporal lobe atrophy in sporadic AD (sAD). This case-control association study was conducted in an Italian cohort consisting of 297 sAD patients and 316 controls. Seven tag-SNPs were selected and genotyped. Linear and logistic regression analyses were used to assess the association between parameters of interest and the genetic variability of ADAM17/TACE. After Bonferroni correction, our findings underscore the complexity of genetic influences of ADAM17/TACE on sAD, particularly the roles of rs12692385 in modulating sAD risk and the performance on the Rey Auditory Verbal Learning Test - delayed recall. In addition, rs13008101 significantly affected the performance on the Clock Drawing Test. Moreover, rs10179642 and rs35280016 were associated with a higher frequency and severity of hallucinations and agitation/aggression, respectively. These results contribute to a deeper understanding of the genetic underpinnings of sAD and may be useful for examining the risk of developing sAD, assessing cognitive deficits, neuropsychiatric symptoms, and informing new therapeutic strategies and future research targeting ADAM17/TACE.

Internal consistency, construct validity, and responsiveness of the MRC Prion Disease Rating Scale

BACKGROUND

The Medical Research Council-Prion Disease Rating Scale (MRC-PDRS) is a 20-point clinician-reported outcome scale to assess disease progression in patients with prion disease, an invariably fatal neurodegenerative disease caused by misfolded prion protein. This study aims to evaluate the measurement properties and interpretability of the MRC-PDRS to support the measure's use for effective disease management and research evaluating effectiveness of treatment options for prion diseases.

METHODOLOGY

Utilizing patient data from the Telemedicine Assessment Program for CJD (TAPCJD), statistical assessment was conducted of internal consistency, construct validity (including convergent, divergent validity, and known-groups discriminant validity), responsiveness, and interpretation guidelines using distribution-based approaches to estimate thresholds indicating minimal important change (MIC) in MRC-PDRS scores. Criterion measures used for evaluating construct validity and responsiveness included the Telephone Interview for Cognitive Status (TICS) and Neuropsychiatric Inventory-Questionnaire (NPI-Q).

RESULTS/CONCLUSIONS

These findings provide strong preliminary evidence that the MRC-PDRS is reliable, valid, and responsive as a tool for measuring disease progression in patients with prion disease, with preliminary MIC estimates ranging from 1 to 3 points. This supports the use of MRC-PDRS in evaluating potential treatment benefits of prion disease clinical trials, and potentially in clinical practice settings.

The use and effect of virtual reality as a non-pharmacological intervention for behavioural and psychological symptoms of dementia: a systematic review and meta-analysis

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSD) are complex neuropsychiatric symptoms that contribute to caregiver strain, increased rates of institutionalisation and reduced quality of life. Virtual reality (VR) has gained interest as a non-pharmacological approach to potentially reduce BPSD severity.

OBJECTIVE

This review sought to synthesise evidence on the effectiveness of VR in reducing BPSD severity, while exploring its acceptability, safety, and optimal dosage in dementia care.

METHODS

MEDLINE, EMBASE, CINAHL and SCOPUS were searched for randomised and quasi-experimental trials assessing VR's effect on BPSD. JBI critical appraisal checklists were used to assess methodological quality. Findings were presented narratively, with meta-analysis performed on a subset of BPSD symptoms where data were available.

RESULTS

Of the ten included studies, four found no significant change in overall BPSD. Mixed findings were observed for individual BPSD symptoms. Meta-analysis showed a significant reduction in depressive symptoms (mean diff -0.38, P= .026) and no reduction in agitation (mean diff 1.87, P = .2). Two studies reported reduced aggression and mixed findings were found for anxiety. Reduced apathy was observed in one study following each VR session and during the session in another. VR was generally well-accepted with few side effects reported.

CONCLUSION

VR appears to be an acceptable non-pharmacological intervention for BPSD reduction. However, the limited available studies, methodological variations and quality issues suggest the need for future larger-scale research to confirm its efficacy and effectiveness.

The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment

INTRODUCTION

The aim of this study is to retrospectively evaluate the relationship between dementia stage, cognitive and behavioral scales, and functional status in patients with cognitive impairment.

METHODS

The medical records of patients over 50 years of age, who were followed up for cognitive impairment at the neurology outpatient clinic were retrospectively scanned between January 1990 and November 2022. The Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS) and Functional Assessment Staging Test (FAST), The Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscore (ADAS-Cog) were recorded. The neuropsychiatric symptoms were evaluated by the Neuropsychiatric Inventory (NPI) and The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Patients' Instrumental Assessment of Daily Living (IADL) scores were recorded to assess functional capacity.

RESULTS

This study analyzed 871 patients with cognitive impairment, 69.8% of whom were having functional impairment. Alzheimer's disease was the most common type of dementia (64.6%), with memory problems as the key symptom (65.6%). Neuropsychiatric symptoms such as hallucinations, delusion, and eating disturbances were significantly associated with disability (p < 0.001), while depression and anxiety were not. CDR scale was the strongest predictor of disability (OR: 4.9, AUC = 0.740), outperforming other dementia staging scales. Cognitive and behavioral scales like MMSE and NPI showed stronger correlations with functional impairment than with the dementia staging scales (-0.132 < rs < 0.472, p < 0.001 and -0.284 < rs < -0.357, p < 0.001, respectively).

CONCLUSION

Our study demonstrated that both cognitive status and behavioral symptoms are critical in determining the level of functional impairment in cognitive impairments, but their contributions differ in magnitude and focus. As well as cognitive decline, neuropsychiatric symptoms may also need targeted management to reduce their impact on functionality. We need a practical tool that can be used in all stages of dementia, that does not overlook the impact of neuropsychological symptoms, and that can assess ADL according to the needs of patients and carers.

Melatonin for Huntington's Disease (HD) gene carriers with HD-related sleep disturbance - A pilot study

BACKGROUND

Sleep disorders are common in people with Huntington's Disease (HD). Possible causes include disruptions to the body's internal clock and changes in melatonin levels. Although melatonin is known to treat sleep disruptions related to circadian rhythm disorders, its effects on HD patients have not been thoroughly explored.

OBJECTIVE

to assess the effectiveness of melatonin in improving the sleep quality of individuals with HD.

METHODS

double-blind, randomized, placebo-controlled, crossover trial with individuals with HD experiencing sleep disturbances, defined as Pittsburgh Sleep Quality Index (PSQI) > 5. Participants received 4-week treatments with 5 mg immediate-release melatonin/placebo, separated by a one-week wash-out (NCT04421339). Clinical assessments were conducted at baseline, week 5 (crossover visit), and week 9 (final visit) and included the PSQI, HD Sleep Questionnaire (HD-SQ), Epworth Sleepiness Scale (ESS), Montreal Cognitive Assessment (MoCA), Neuro-QoL™ v2.0 Cognitive Function, Neuropsychiatric Inventory Questionnaire (NPI-Q), Hospital Anxiety and Depression Scale (HADS), Unified Huntington Disease Rating Scale (UHDRS), and Clinical Global Impression (CGI).

RESULTS

Fifteen patients (46.53 ± 13.92 years old, seven females) completed the study procedures. We found no significant differences between melatonin and placebo treatments in the primary outcome (PSQI), other sleep measures (ESS and HD-SQ), neuropsychiatric symptoms (NPI-Q, HADS, Neuro-QoL, MoCA), and motor/functional measures.

CONCLUSIONS

We found that melatonin did not significantly differ from placebo in improving sleep quality in individuals with HD. Given the conflicting findings from previous research, it may be beneficial to explore alternative dosages of melatonin, increase the sample size, and consider different stages of HD in future studies.

Domestic violence in Lewy body dementia: A national study

A descriptive study using a transversal national online survey to evaluate the prevalence and characteristics of behavioral and psychological symptoms (BPSD) of dementia with Lewy bodies (DLB), and specifically, the perpetration of violent acts against primary caregivers. 196 responses, obtained in one month, were analyzed. Delirium, hallucinations, anxiety, and apathy were the most frequently reported BPSD symptoms (over 80% of responders). Primary caregivers expressed the highest degree of distress from agitation and aggressive behavior. Moreover, 45.9% of primary caregivers reported being the target of violent behaviors from DLB patients. No statistical association was found between the presence of BPSD and violent acts.

Mixed methods feasibility study of Music Attuned Technology Care via eHealth (MATCH) for people with complex behavioral and psychological symptoms of dementia within an acute psychogeriatric ward

INTRODUCTION

Music-based strategies can reduce distress, agitation, and promote wellbeing in people with dementia. Research in specialized dementia care units is limited.

METHODS

Mixed-methods pre-post study evaluated the feasibility and preliminary effects of Music Attuned Technology Care via eHealth (MATCH) in a dementia-specialized inpatient ward. Staff completed MATCH training and administered MATCH strategies over 8 weeks with enrolled patients.

RESULTS

Twenty-four staff and 14 patients were recruited. Severity of dementia symptoms, measured by the Neuropsychiatric Inventory Questionnaire, was reduced (median change: -3.0, 95% CI: -9.5, 0.5), especially agitation (median change -3.0, 95% confidence interval -5.5, -0.5). Staff reported high acceptability of MATCH (median score: 13 [interquartile range: 12-14]) and implementing strategies enhanced person-centered care. Patients' positive responses to music motivated increased use. No changes in staff knowledge or patient depression were found.

DISCUSSION

MATCH was acceptable to staff and showed potential to reduce agitation symptoms and medication use, warranting further trials to determine effectiveness.

CLINICAL TRIAL REGISTRATION

The clinical trial is registered with the Australia New Zealand Clinical Trials Registry (ACTRN12623001134617).

HIGHLIGHTS

MATCH decreased the severity of dementia symptoms, measured by the NPI-Q. Staff reported high acceptability of MATCH. Personalized music enhanced person-centered care. Patients' positive responses to music motivated increased use. No changes in staff knowledge or patient depression were found.

Clinical Evolution of Neuropsychiatric Symptoms in Alzheimer's Disease and Dementia With Lewy Bodies in a Post-Mortem Cohort

BACKGROUND

Almost all patients with neurodegenerative dementias experience neuropsychiatric symptoms (NPS) but the timing and clinical course is highly variable.

METHODS

In a prospective cohort study in Western Norway, patients with a new diagnosis of mild dementia were assessed annually in the Neuropsychiatric Inventory (NPI) for up to 9 years until death. Patients with post-mortem neuropathological diagnoses of Alzheimer's disease (pAD) (n = 37), Lewy body disease (pLBD) (n = 14) or meeting criteria for both AD and LBD (mixed AD+LBD) (n = 11) were included in this study. Neuropathological assessment was performed according to standardised protocols and blind to clinical information. In mixed effects logistic regression, longitudinal change in NPS was explored across neuropathological diagnoses and substrates. Additionally, the odds of NPS early and late in disease was evaluated in logistic regression.

RESULTS

Early onset hallucinations were significantly more common in pLBD than pAD (OR 0.069 [95% CI 0.012-0.397], p = 0.003) or mixed AD+LBD (OR 0.09 [95% CI 0.010-0.771], p = 0.028) and there was a greater increase in the odds of hallucinations over time in pAD and AD+LBD than pLBD such that there was was no difference in the prevalence of late-onset hallucinations between pLBD, pAD or AD+LBD. Hallucinations early in disease were associated with higher LBD α-synuclein stages and neocortical LBD, in addition and sparser amyloid distribution. Higher density of amyloid plaques, tau tangles, cerebrovascular disease and increasing additional co-pathologies were associated with increasing odds of hallucinations over time.

CONCLUSIONS

LBD, without significant comorbid AD pathology, is associated with hallucinations early in the course of disease while multiple other pathologies may be implicated in aetiology of late-onset hallucinations. Hallucinations increase in AD+LBD as disease progresses, a trajectory more closely aligned with AD than LBD.

Influence of WWOX/MAF genes on cognitive performance in patients with Parkinson's disease

BACKGROUND

Beyond its hallmark motor symptoms, Parkinson's disease (PD) encompasses a range of non-motor disturbances, particularly cognitive impairment, which significantly affects patients' quality of life. Cognitive impairment is a shared manifest in both PD and Alzheimer's disease (AD), two prevalent neurodegenerative disorders. Existing literature has identified the WWOX/MAF genes as potential risk factors for AD, but their role in cognitive functions among PD remains unclear.

OBJECTIVES

This study examines the influence of AD-associated risk genes, specifically WWOX/MAF, on cognitive function in PD, aiming to bridge the neuropathological gap between AD and PD.

PARTICIPANTS

A total of 402 participants were included in this study, comprising 150 individuals with PD and 252 healthy controls (HC).

MEASUREMENTS

Participants underwent comprehensive neuropsychological assessment and genotyping. A moderation regression model was employed to assess the impact of WWOX/MAF single nucleotide polymorphisms on cognitive function and the potential modulatory effect of PD.

RESULTS

The WWOX gene was found to influence verbal fluency performance across the entire cohort. Additionally, PD significantly moderated the effect of genetic variants on attention (p = 0.000040), non-verbal memory (p = 0.000007), and visuospatial function (p = 0.000303), suggesting a distinct impact within this group. Further analysis indicated that cognitive status moderated the effect of genetic variants on verbal memory across the entire cohort (p < 0.001). Among individuals with PD, genetic variants also influenced verbal fluency (p = 0.000113) and verbal memory (p = 0.000440 and p = 0.000032).

CONCLUSIONS

These findings underscore the critical role of WWOX/MAF genes in cognitive impairments associated with PD, enhancing our understanding of their connection to AD and providing deeper insights into neurodegenerative disease progression.

Cognitive benefits of hearing intervention vary by risk of cognitive decline: A secondary analysis of the ACHIEVE trial

INTRODUCTION

Results from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial suggest hearing intervention may not reduce 3-year cognitive decline in all older adults with hearing loss but may be beneficial in certain groups. This secondary analysis investigated if participants with multiple risk factors for cognitive decline received greater benefits.

METHODS

We used a sample of dementia-free participants (N = 2692) from the Atherosclerosis Risk in Communities (ARIC) cohort to develop a predictive model for cognitive decline. The model was applied to baseline measures of ACHIEVE participants (N = 977) to estimate predicted risk. We tested an interaction between predicted risk and randomization to hearing intervention or health education control.

RESULTS

Among ACHIEVE participants in the top quartile of predicted risk, 3-year cognitive decline in the hearing intervention was 61.6% (95% confidence interval [CI]: 33.7%-94.1%) slower than the control.

DISCUSSION

The effect of hearing intervention on reducing 3-year cognitive decline was greatest among individuals with multiple baseline risk factors associated with faster cognitive decline.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03243422 HIGHLIGHTS: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial tested the effect of hearing intervention on cognitive decline. Participants were recruited from the Atherosclerosis Risk in Communities (ARIC) cohort or de novo from the local community. A 48% reduction in cognitive decline was observed in ARIC cohort participants. In this secondary analysis, there was an interaction between hearing intervention and predicted risk of cognitive decline. Among participants in the top quartile of predicted risk of cognitive decline, hearing intervention slowed cognitive decline by 62%.

The Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS): A 10-year report

INTRODUCTION

Virtually all adults with Down syndrome (DS) will accumulate the neuropathologies associated with Alzheimer's disease (AD) by age 40, with the majority having a clinical dementia diagnosis by their middle 50s.

METHODS

This paper complements a 2020 publication describing the Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS) methodology by highlighting protocol changes since initial funding in 2015. It describes available clinical, neuropsychological, neuroimaging, and biofluid data and bio-specimen repository. Ten years of accomplishments are summarized.

RESULTS

Over 500 adults with DS and 59 sibling controls have been enrolled since 2015 with nearly 800 follow-up visits. More than 900 magnetic resonance imaging (MRI), 800 amyloid positron emission tomography (PET), and 600 tau PET scans have been conducted; multiple omics data have been generated using over 1100 blood and 100 cerebrospinal fluid (CSF) samples.

DISCUSSION

ABC-DS is the largest U.S.-based, multi-site (including the United Kingdom and Puerto Rico), longitudinal biomarker initiative to target adults with DS at risk for AD.

HIGHLIGHTS

The Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS) is entering its 10th year. Over 500 adults with Down syndrome (DS) and 59 sibling controls have been enrolled. More than 900 magnetic resonance imaging (MRI), 800 amyloid positron emission tomography (PET), and 600 tau PET scans have been conducted. Multiple omics data have been generated using over 1100 blood and 100 cerebrospinal fluid (CSF) samples. It is positioned to continue to make substantial contributions to the DS field.

Validity and Sensitivity to Change of a Self-Report Quality of Life Measure in Patients With Korsakoff's Syndrome

BACKGROUND

Assessing (self-reported) quality of life (QoL) in patients with Korsakoff's syndrome (KS) is important to gain insight into these patients' well-being and to optimize their care in long-term care facilities. In this study, we describe the development of the QUALIKO-Self Report (QUALIKO-SR), an instrument for objectifying self-reported QoL in patients with KS. Next, we compared the QUALIKO-SR scores with the scores on the QUALIKO-Proxy Version (QUALIKO-PV) and examined changes in QoL over time. Finally, we assessed the convergent validity and investigated whether QUALIKO-SR scores were related to the severity of the cognitive impairments.

METHODS

The study took place in specialized long-term care facilities providing care for patients with KS. 116 patients with alcoholic KS participated in this study. The QUALIKO-SR was developed and validated against the QUALIKO-PV, the Manchester Short Assessment of Quality of Life (MANSA-16), and the Montreal Cognitive Assessment 8.1 (MoCA).

RESULTS

Significant differences were found between self- and proxy reported QoL on the subscales Negative Affect, Social Isolation, and Feeling at Home. No significant differences were found on the other subscales. QUALIKO-SR scores did not significantly vary over time. However, caregivers reported significant improvements in Care Relationships, Autonomy, Restless Tense Behavior, Social Isolation, and Feeling at Home over time. A significant, positive association was found between the QUALIKO-SR and the MANSA-16. No significant correlations were found between the QUALIKO-SR and the MoCA.

CONCLUSIONS

This study describes the development and validation of a self-report instrument for objectifying QoL in patients with KS living in 24-h care facilities, the QUALIKO-SR. Measuring QoL in patients with severe cognitive impairments, such as patients with KS, is complex and we advise to include both self-report and proxy-report measures in future studies as well as in clinical practice. The availability of the QUALIKO-SR and QUALIKO-PV encourages researchers and clinicians to do so in patients with KS.

Clinical and Imaging Features of Sporadic and Genetic Frontotemporal Lobar Degeneration TDP-43 A and B

OBJECTIVE

Certain frontotemporal lobar degeneration subtypes, including TDP-A and B, can either occur sporadically or in association with specific genetic mutations. It is uncertain whether syndromic or imaging features previously associated with these patient groups are subtype or genotype specific. Our study sought to discern the similarities and differences between sporadic and genetic TDP-A and TDP-B.

METHODS

We generated individual atrophy maps and extracted mean atrophy scores for regions of interest-frontotemporal, occipitoparietal, thalamus, and cerebellum-in 54 patients with FTLD-TDP types A or B. We calculated asymmetry as the absolute difference in atrophy between right and left frontotemporal regions, and dorsality as the difference in atrophy between dorsal and ventral frontotemporal regions. We used ANCOVAs adjusted for disease severity to compare atrophy extent or imbalance, neuropsychological tests, and behavioral measures.

RESULTS

For some regions, volumetric differences were found either between TDP subtypes (e.g., worse occipitoparietal and cerebellum atrophy in TDP-A than B), or within subtypes depending on genetic status (e.g., worse thalamic and occipitoparietal atrophy in C9orf72-associated TDP-B than sporadic TDP-B). While progranulin mutation-associated TDP-A and sporadic TDP-A cases can be strongly asymmetric, TDP-A and TDP-B associated with C9orf72 tended to be symmetric. TDP-A was more dorsal in atrophy than TDP-B, regardless of genetic status.

INTERPRETATION

While some neuroimaging features are FTLD-TDP subtype-specific and do not significantly differ based on genotype, other features differ between sporadic and genetic forms within the same subtype and could decrease accuracy of classification algorithms that group genetic and sporadic cases.

Caregiver burden in mild cognitive impairment due to Alzheimer's disease-a longitudinal study

BACKGROUND

Caregivers of people with mild forms of cognitive decline, namely mild cognitive impairment (MCI), are subjected to caregiver burden. In recent years, a major breakthrough was the possibility of diagnosing Alzheimer's disease (AD) reliably in patients that present with MCI, as required for the use of the recently approved anti-amyloid therapies. We aimed to examine the caregiver burden in caregivers of patients with MCI due to AD, describe how caregiver burden evolves with time, and determine caregiver baseline factors that might predict the progression of burden.

METHODS

Twenty-five dyads of community-dwelling patients and caregivers were consecutively recruited from a memory outpatient clinic, after receiving the diagnosis of MCI due to AD. Caregiver burden was measured with the Zarit Burden Inventory (ZBI), life satisfaction with Satisfaction With Life Scale, depressive symptoms with the Centre for Epidemiological Studies-Depression Scale (CES-D), anxiety symptoms with the State Anxiety Subscale of the State-Trait Anxiety Inventory (STAI) and patient neuropsychiatric symptoms with the Neuropsychiatric Inventory (NPI).

RESULTS

At baseline, the mean ZBI score was 24.5 ± 15.2 and correlated positively with caregiver CES-D and STAI scores and with patient neuropsychiatric symptoms (NPI-frequency × severity) and distress felt by the caregiver (NPI-distress). At follow-up (17.7 ± 9.4 months) the mean ZBI score increased to 31.4 ± 16.3 (P < 0.001); however, no baseline caregiver or patient characteristics were identified associated with the evolution of caregiver burden.

CONCLUSIONS

Caregivers of patients who received a diagnosis of MCI due to AD report substantial burden, that increased with time. Future studies should investigate caregiver characteristics that may predict burden progression and help delineate strategies to minimise it.

A Comparative Study of Anticipatory Grief in Caregivers of Patients With Alzheimer's Disease and Hematological Malignancy

BACKGROUND

Anticipatory grief (AG) is a common experience that affects caregivers of patients with chronic illnesses, particularly Alzheimer's disease. Cognitive disorders leading to social death produce a greater impact on the relationship, and thus on AG, than physical disorders.

OBJECTIVE

The purpose of this study is to examine the prevalence and severity of AG in caregivers of patients with major neurocognitive disorder due to Alzheimer's disease (MNCD-AD) compared to hematological malignancies and to identify the characteristics associated with AG.

METHODS

A total of 132 dyads (patients and their caregivers) completed measures of AG, caregiver burden, anxiety, and depressive symptoms, as well as mental status.

RESULTS

The point prevalence of significant AG was similar in the MNCD-AD (57.6%) and hematological malignancy (51.5%) groups. There was no statistically significant difference between the groups in terms of the severity of AG (48.77 ± 17.98 vs 44.18 ± 15.57, respectively). However, the personal sacrifice burden was significantly higher in the MNCD-AD group (P = 0.043). The severity of AG of caregivers is correlated with caregiver burden (r = 0.735), cognitive decline (r = 0.575), and neuropsychiatric symptoms (R = 0.627) of the MNCD-AD patient.

CONCLUSIONS

The results of the study highlighted that the disease type can influence the AG of caregivers in a qualitative rather than a quantitative manner. Future studies are recommended to consider effects of psychological or interpersonal factors on AG. In addition, psychiatric comorbidities among family caregivers of MNCD-AD patients should be examined.

Mapping of validated apathy scales onto the apathy diagnostic criteria for neurocognitive disorders

BACKGROUND

Diagnostic criteria for apathy in neurocognitive disorders (DCA-NCD) have recently been updated.

OBJECTIVES

We investigated whether validated scales measuring apathy severity capture the three dimensions of the DCA-NCD (diminished initiative, diminished interest, diminished emotional expression).

MEASUREMENTS

Degree of mapping ("not at all", "weakly", or "strongly") between items on two commonly used apathy scales, the Neuropsychiatric Inventory-Clinician (NPI-C) apathy and Apathy Evaluation Scale (AES), with the DCA-NCD overall and its 3 dimensions was evaluated by survey.

DESIGN

Survey participants, either experts (n = 12, DCA-NCD authors) or scientific community members (n = 19), rated mapping for each item and mean scores were calculated. Interrater reliability between expert and scientific community members was assessed using Cohen's kappa.

RESULTS

According to experts, 9 of 11 (81.8%) NPI-C apathy items and 6 of 18 (33.3%) AES items mapped strongly onto the DCA-NCD overall. For the scientific community group, 10 of 11 (90.9%) NPI-C apathy items and 7 of 18 (38.8%) AES items mapped strongly onto the DCA-NCD overall. The overall mean mapping scores were higher for the NPI-C apathy compared to the AES for both expert (t (11) = 3.13, p = .01) and scientific community (t (17) = 3.77, p = .002) groups. There was moderate agreement between the two groups on overall mapping for the NPI-C apathy (kappa= 0.74 (0.57, 1.00)) and AES (kappa= 0.63 (0.35, 1.00)).

CONCLUSIONS

More NPI-C apathy than AES items mapped strongly and uniquely onto the DCA-NCD and its dimensions. The NPI-C apathy may better capture the DCA-NCD and its dimensions compared with the AES.

Exploring emotion recognition in patients with mild cognitive impairment and Alzheimer's dementia undergoing a rehabilitation program emotion recognition in patients with dementia

AIM

This study aimed to explore differences in the emotions of patients with mild cognitive impairment (MCI) and Alzheimer's dementia (AD) in group rehabilitation using facial analysis.

METHOD

We conducted rehabilitation consisting of aerobic exercise, cognitive training, dual tasks (a combination of exercise and cognitive training), and creative activities in a group format with patients with MCI and dementia. The faces of the 30 patients (MCI: n=14; mild/moderate AD: n=16) who participated were filmed from the front with a small camera during the four tasks. Then, we used the Kokoro Sensor (CAC Corporation, Japan), a device which estimates emotion scores (anger, contempt, disgust, fear, joy, sadness, surprise) based on different parts of the face using artificial intelligence, to calculate emotion scores for each activity, and compared them between the MCI and AD groups.

RESULTS

Emotion scores for fear and surprise were significantly higher for the AD group than for the MCI group during dual tasks (p=0.016), while emotion scores for joy were significantly higher for the MCI group than for the AD group during creative activities (p=0.012).

CONCLUSION

Creative activities and dual tasks, which require simultaneous physical activity and cognitive thinking, were difficult for patients with AD. On the other hand, tasks which used a range of cognitive functions, such as creative activities, evoked joy in patients with MCI. It may be beneficial to provide tasks and support to patients with respect to their unique emotions based on these results.

Comparing two caregiver-delivered music listening interventions for community-dwelling people with dementia: A randomised controlled crossover pilot trial

Objectives: To facilitate access to music-based interventions (MBIs) for people with dementia in the community, it is necessary to develop MBIs that can be used by people with dementia and their informal caregivers at home. In this pilot trial, we aimed to establish whether using slow and fast music of positive valence in a caregiver-delivered MBI results in differential effects. Methods: 17 person-with-dementia-and-caregiver dyads were randomised. Dyads underwent 6-week periods of two music listening interventions, 'MBI A' (consisting of fast, positively valenced music) and 'MBI B' (slow, positively valenced music). The order of these was crossed-over. Half of the dyads also completed a control intervention (6-week care-as-usual). People with dementia listened on tablets or CDs provided. Quantitative assessments included person with dementia outcomes (cognition, well-being, quality of life) and caregiver-reported outcomes (behavioural and psychiatric symptom severity and related distress). Dyads' descriptions of experiences were also recorded. Results: MBI A was associated with superior delayed recall compared to MBI B (MBI A- B: 1.04 [95% CI: 0.16, 1.92], p = .028, Hedge's gav = 0.70). Dyads' descriptions highlight 'in-the-moment' effects of the MBIs. Positive effects of MBI A included heightened mood and movement (e.g. clapping), MBI B was associated with relaxation. Conclusions: The positive effect of MBI A on delayed recall performance suggests that fast, positively valenced music may be explored further to support cognition in people with dementia. Dyads' reports underline the value of music listening to the momentary well-being of people with dementia.

Clinical and brain volumetric correlates of decreased DTI-ALPS, suggestive of local glymphatic dysfunction, in iRBD

Glymphatic alterations may underlie neurodegeneration in alpha-synucleinopathies. Reduced Diffusion-Tensor Imaging ALong the Perivascular Space (DTI-ALPS), a proxy of perivascular glymphatic activity, has been scarcely studied in isolated REM sleep behaviour disorder (iRBD), a prodromal synucleinopathy stage. Furthermore, its associations with clinical symptoms and brain structural abnormalities remain unexplored. We assessed the DTI-ALPS in sixty-two patients with iRBD and twenty-three healthy controls (HC), exploring its associations with clinical symptoms, cortical thickness and brain volumetric data. iRBD patients exhibited a lower DTI-ALPS and poorer odor identification, semantic fluency and processing speed relative to HC. The DTI-ALPS positively correlated with cognitive performance, olfactory function and amygdalar, hippocampal, brainstem and diencephalic volumes, and negatively with age in iRBD. Perivascular glymphatic activity is compromised in iRBD and is associated with brain atrophy and clinical risk factors of progression to alpha-synucleinopathies, supporting the potential of the DTI-ALPS index as an early imaging neurodegeneration marker.

Impact of obesity on neuropsychiatric symptoms in Alzheimer's disease: Insights from the ADNI cohort

BackgroundObesity is a major global health issue linked to increased risks of dementia, including Alzheimer's disease (AD). While the association between obesity and neuropsychiatric symptoms (NPS) in AD remains underexplored, identifying these links could aid in weight management in AD patients.ObjectiveThis study investigates the relationship between body mass index (BMI) and NPS in AD dementia patients, focusing on the potential mediating role of systemic inflammation.MethodsWe employed Generalized Additive Models (GAMs) to explore the relationship between BMI and NPS, as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q). Participants were classified into ideal, overweight, and obese groups based on WHO criteria. Longitudinal analyses assessed the trajectory of NPI-Q scores in different groups over a one-year follow-up.ResultsBMI significantly affects NPI-Q total scores and specific symptoms, including delusions, hallucinations, agitation/aggression, elation/euphoria, disinhibition, irritability/lability, aberrant motor behavior, nighttime disturbances, and appetite/eating disturbances. Obese patients exhibited higher NPI-Q total scores and greater severity in symptoms such as hallucinations, agitation/aggression, elation/euphoria, apathy/indifference, disinhibition, aberrant motor behavior, and nighttime disturbances. Additionally, CRP and complement C3 were identified as mediators in the relationship between obesity and NPS, highlighting the role of systemic inflammation.ConclusionsThis study demonstrates that obesity is associated with a heightened burden of NPS in AD dementia patients. The identification of CRP and complement C3 as mediators suggests inflammation plays a crucial role in the association between obesity and NPS. These findings underscore the importance of addressing obesity and its inflammatory consequences in managing NPS among this vulnerable population.

The Impact of Behavioral and Psychological Symptoms on Financial Decision-Making Capacity in Mild to Moderate Dementia

OBJECTIVES

The study aims to assess the impact of behavioral and psychological symptoms on financial decision-making in individuals with mild to moderate dementia.

METHODS

A cross-sectional quantitative study assessed cognitive status, behavioral and psychological symptoms as well as financial capacities. A multiple regression hierarchical model determined the relative contributions of demographic, cognitive, and behavioral and psychological symptoms to financial capacity.

RESULTS

A total of 87 participants, with a median age of 84 years, were included in the study. Nearly all participants (94.5%) exhibited one or more behavioral and psychological symptoms. Greater dementia severity, increased behavioral and psychological symptoms, and lower educational levels were associated with poorer financial capacity.

CONCLUSIONS

This study underlines the impact of behavioral and psychological symptoms on financial decision-making in individuals with mild to moderate dementia, even when accounting education and dementia severity. Further research is necessary to elucidate the connection between these symptoms and financial capacity.

CLINICAL IMPLICATIONS

The critical need for early diagnosis of dementia and its associated behavioral and psychological symptoms is highlighted. Additionally, implementing timely behavioral and psychological management strategies and encouraging patients to engage in lifetime intellectual enrichment may be helpful for preserving financial capacity and promoting independence in individuals with dementia.

Association between comorbidity indices and nursing home admission in patients with Alzheimer's disease: a longitudinal observational study using the MEMORA cohort

BACKGROUND

Alzheimer's disease (AD) is among the leading cause of nursing home admission (NHA). Identifying potentially modifiable factors associated with the risk of NHA is crucial to reduce this risk in individuals with AD.

OBJECTIVE

We aimed to assess the relationship between comorbidity burden, as measured by the Charlson comorbidity index, the multimorbidity-weighted index and the health related quality of life comorbidity index, and NHA in patients with AD.

METHODS

We conducted an observational longitudinal study including patients from the MEMORA real-life cohort. Patients had to be aged 60 years or older, with a diagnosis of AD. The association between comorbidity indices and occurrence of NHA was assessed using Cox proportional-hazards models and competing-risks regressions considering mortality as a competing event. All analyses were adjusted for age, sex, educational level, stage of AD and the presence of neuropsychiatric symptoms.

RESULTS

Overall, 488 AD patients were included (68.2% with dementia). There were 125 (26%) NHA that occurred during the follow-up, with a median time of 25 months until NHA. Higher level of comorbidity burden as measured by the three comorbidity indices was associated with higher risk of NHA compared to lower level of comorbidity burden. Similar findings were found after considering mortality as a competing event, with a HR of 2.41(95%CI:1.36-4.28, p = 0.003) for MWI, an HR of 1.96(95%CI:1.22-3.17, p = 0.006), and an HR of 1.68(95%CI:1.04-2.71, p = 0.034).

CONCLUSION

The implementation of appropriate interventions that aim to improve the management of the comorbidity burden could help to reduce the risk of NHA in individuals with AD.

Conversion to Mild Cognitive Impairment and Alzheimer's Disease Dementia Related to Apathy, APOE Genotype and Antidepressant Use

ObjectiveApathy and APOE ε4 genotype are risk factors for developing Alzheimer's disease dementia (ADD). Antidepressant use is known to induce apathy. This study aimed to examine associations between APOE ε4, apathy, and antidepressant use with progression from cognitively normal (CN) to mild cognitive impairments (MCI), and MCI to ADD.MethodsParticipants aged 55-90 were recruited from the Alzheimer's Disease Neuroimaging Initiative. Participants were CN or had MCI at baseline and had completed at least 3 consecutive study visits. The NPI and NPI-Q apathy subscales were used to index the presence of apathy. Antidepressants used by participants included SSRIs, SNRIs, and AYTADs. Cox proportional hazards analyses examined the combined effects of apathy, APOE ε4 genotype, and antidepressant use on conversion from CN to MCI and from MCI to ADD.ResultsApathy and APOE ε4 were associated with increased risk of conversion along the CN-MCI-ADD continuum. Antidepressant use was associated with progression from MCI to ADD, and progression from CN to MCI in non-apathetic APOE ε4 carriers.ConclusionOur findings support apathy and APOE ε4 as robust predictors of conversion to MCI and ADD, and demonstrate novel associations between antidepressant use and conversion. Future research should explore whether antidepressant use in MCI and ADD causes apathetic symptoms or serves to index apathy/depression severity.

Caregiver Assessment of Socioemotional Functioning in People Living With Neurodegenerative Disease (Part 2): Concurrent Validity and Test-Retest Reliability of a New Measure

BACKGROUND AND OBJECTIVES

Care recipients with neurodegenerative disease can have socioemotional impairments that are challenging for their caregivers. We examine the concurrent and incremental validity of a novel informant-rated measure of care recipient functioning, the Caregiver Assessment of Socioemotional Functioning (CASEF), by examining links with clinician-rated behavioral problems, neuropsychiatric symptoms, and disease severity, as well as caregivers' reported burden and relationship quality. We also examine test-retest reliability of the CASEF.

RESEARCH DESIGN AND METHODS

Informal caregivers (N = 177) of individuals with neurodegenerative disease reported on their care recipients' socioemotional functioning and completed structured interviews with clinicians to assess care recipients' disease severity and neuropsychiatric symptoms. Care recipients' behavioral symptoms were evaluated with clinician rating scales. Another sample of caregivers (N = 61) repeated the CASEF 4-6 months following an initial administration.

RESULTS

CASEF subscales evidenced concurrent validity with other measures of care recipients' socioemotional functioning, disease severity, neuropsychiatric symptoms, and behavioral symptoms. CASEF subscales also evidenced incremental validity by accounting for significant additional variance in caregiver burden and relationship quality after accounting for care recipients' neuropsychiatric and behavioral symptoms. Finally, CASEF subscales demonstrated adequate to excellent test-retest reliability.

DISCUSSION AND IMPLICATIONS

Findings highlight the validity and reliability of the CASEF. Coupled with findings from Part 1 of this series (which established CASEF's construct validity), these findings support using the CASEF in clinical and research settings to assess changes in care recipient socioemotional functioning over time and to examine links between care recipient socioemotional changes and caregiver burden, health, and well-being.

Caregiver Assessment of Socioemotional Functioning in People Living With Neurodegenerative Disease (Part 1): Construct Validity of a New Measure

BACKGROUND AND OBJECTIVES

Neurodegenerative diseases cause socioemotional changes that are commonly measured using laboratory-based assessments. However, these assessments can be labor-, cost-, and time-intensive. We aim to establish the psychometric properties of a novel informant-rated measure, the Caregiver Assessment of Socioemotional Functioning (CASEF).

RESEARCH DESIGN AND METHODS

Using 3 independent samples including 366 informal caregivers and their 366 care recipients with a variety of neurodegenerative diseases and 240 neurotypical individuals, we conducted exploratory and confirmatory factor analyses to establish the structural validity of the CASEF. Additionally, to establish convergent validity, we compared caregiver reports of socioemotional functioning to care recipients' objective performance on a variety of laboratory measures of socioemotional functioning.

RESULTS

The CASEF captured multiple aspects of care recipients' socioemotional functioning, including the ability to (a) generate negative emotional responses (negative emotional reactivity), (b) generate positive emotional responses (positive emotional reactivity), (c) recognize others' emotions (emotion recognition), and (d) control emotional responses (emotion regulation). Each factor was associated with a corresponding laboratory-based measure, except for emotion regulation, which instead corresponded to a clinician-rated measure of care recipient disinhibition.

DISCUSSION AND IMPLICATIONS

Findings suggest the CASEF is a psychometrically sound informant-report measure of socioemotional functioning in people living with neurodegenerative diseases and may be a valuable tool for identifying specific socioemotional impairments in the context of neurodegenerative disease.

Effects of 52 weeks of precuneus rTMS in Alzheimer's disease patients: a randomized trial

BACKGROUND

Personalized repetitive transcranial magnetic stimulation (rTMS) of the precuneus (PC) is emerging as a new non-invasive therapeutic approach in treating Alzheimer's disease (AD). Here we sought to investigate the effects of 52 weeks of rTMS applied over the PC on cognitive functions in patients with mild-to-moderate dementia due to AD.

METHODS

Forty-eight patients with mild-to-moderate dementia due to AD were enrolled for the study. Of those 31 patients were extended to 52 weeks after being included in a 24-week trial (NCT03778151) with the same experimental design. The trial included a 52-week treatment with a 2-week intensive course where rTMS (or sham) was applied over the PC daily (5 times per week, Monday to Friday), followed by a 50-week maintenance phase in which the same stimulation was applied once weekly. Personalization of rTMS treatment was established using neuronavigated TMS in combination with electroencephalography (TMS-EEG). The primary outcome measure was change from baseline to week 52 of the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB). Secondary outcomes included score changes in the Alzheimer's Disease Assessment Scale- Cognitive Subscale (ADAS-Cog)11, Mini Mental State Examination (MMSE), Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL) and Neuropsychiatric Inventory (NPI). Changes in cortical activity and connectivity were monitored by TMS-EEG.

RESULTS

Among 48 patients randomized (mean age 72.8 years; 56% women), 32 (68%) completed the study. Repetitive TMS of the PC (PC-rTMS) had a significant effect on the primary outcome measure. The estimated mean change in CDR-SB after 52 week was 1.36 for PC-rTMS (95% confidence interval (CI) [0.68, 2.04]) and 2.45 for sham-rTMS group (95%CI [1.85, 3.05]). There were also significant effects for the secondary outcomes ADAS-Cog11, ADCS-ADL and NPI scores. Stronger DMN connectivity at baseline was associated with favorable response to rTMS treatment.

CONCLUSIONS

Fifty-two weeks of PC-rTMS may slow down the impairment of cognitive functions, activities of daily living and behavioral disturbances in patients with mild-to-moderate AD. Further multicenter studies are needed to confirm the clinical potential of DMN personalized rTMS.

TRIAL REGISTRATION

The study was registered on the clinicaltrial.gov website on 07-07-2022 (NCT05454540).

The Excess Direct Social Costs of Dementia-Related Neuropsychiatric Symptoms: A Regionwide Cohort Study Beyond Silos

OBJECTIVES

To estimate the excess formal social costs or direct non-healthcare costs of dementia-related neuropsychiatric symptoms (NPS).

METHODS

The presence of dementia, NPS, antipsychotic and antidepressant use, somatic and psychiatric comorbidities, and formal social benefits were studied in a regionwide cohort of all 60-year-old and older individuals. A random forest-based algorithm identified NPS, and 2-part regression models and entropy balance were used.

RESULTS

Of the 215 859 individuals, 7553 (3.50%) had dementia, 74 845 (34.7%) had some NPS, and 20 787 (9.63%) received long-term care benefits. Notably, nearly two-thirds (63.9%) of people with dementia received benefits. The probability of having social costs varied markedly with age (odds ratio [OR] 12.28 [10.17-14.82] for >90-year-olds category), and the presence of dementia (OR 7.36 [6.13-8.84]) or NPS (OR 3.23 [2.69-3.88]). NPS (relative change [RC] 1.39 [1.31-1.49]) and dementia (RC 1.32 [1.24-1.41]) were associated with higher average benefit costs. Low socioeconomic status was significantly associated with both a higher probability of receiving benefits (OR 1.52 [1.38-1.68]) and higher costs of their provision (RC 1.18 [1.15-1.21]).

CONCLUSIONS

The burden of caring for NPS is greater than that indicated by the literature as these symptoms multiply the social costs of dementia by more than 3, owing to the greater use of residential care and formal coverage reaching more patients than that indicated by the literature. The greater presence of dementia and NPS in the population of lower socioeconomic status indicates an inequality in health attenuated by greater use of social benefits.

Altered Intra- and Inter-Network Resting-State Functional Connectivity is Associated with Neuropsychological Functioning and Clinical Symptoms in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder

BACKGROUND

Isolated rapid-eye movement (REM) sleep behavior disorder (iRBD) is characterized by abnormal behaviors in REM sleep and is considered as a prodromal symptom of alpha-synucleinopathies. Resting-state functional magnetic resonance imaging (rsfMRI) studies have unveiled altered functional connectivity (rsFC) in patients with iRBD. However, the associations between intra- and inter-network rsFC with clinical symptoms and neuropsychological functioning in iRBD remain unclear.

OBJECTIVE

To characterize intra- and inter-network rsFC in iRBD patients using a data-driven approach and to assess its associations with clinical features and cognitive functioning.

METHODS

Forty-two patients with iRBD and 45 healthy controls (HC) underwent rsfMRI and comprehensive neuropsychological testing. Resting-state networks were characterized using independent component analyses. Group differences in intra- and inter-network rsFC and their associations with clinical and neuropsychological data were studied. A threshold of corrected P < 0.05 was used in all the analyses.

RESULTS

iRBD patients displayed lower intra-network rsFC within basal ganglia, visual, sensorimotor, and cerebellar networks, relative to HC. Mean rsFC strength within the basal ganglia network positively correlated with processing speed and negatively with the non-motor symptoms in iRBD patients. Reduced inter-network rsFC between sensorimotor and visual medial networks was observed in iRBD patients, which was associated with global cognitive status.

CONCLUSIONS

iRBD is characterized by both reductions in intra-network rsFC in cortical and subcortical networks and inter-network dysconnectivity between sensorimotor and visual networks. Abnormalities in intra- and inter-network rsFC are associated with cognitive performance and non-motor symptoms, suggesting the utility of both rsFC measures as imaging markers in prodromal alpha-synucleinopathies. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

A Cross Sectional and Longitudinal Assessment of Neuropsychiatric Symptoms and Brain Functional Connectivity in Patients With Mild Cognitive Impairment, Cerebrovascular Disease and Parkinson Disease

INTRODUCTION

Mild Behavioral Impairment (MBI) is characterized by later-life emergent and persistent neuropsychiatric symptoms (NPS) in older adults without dementia, serving as a potential precursor to various forms of dementia. This study explores the association between NPS and functional connectivity (FC) of the default mode network (DMN), executive control network (ECN), and salience network (SN) across three cohorts: mild cognitive impairment due to AD (MCI), cerebrovascular disease (CVD), and Parkinson's disease (PD). Additionally, the effect of CNS medication on NPS-FC associations was explored.

METHODS

Participants were recruited from the Ontario Neurodegenerative Disease Research Initiative (ONDRI). NPS were evaluated using the Neuropsychiatric Inventory Questionnaire (NPI-Q). We used dual regression to generate subject-specific whole-brain FC maps of the DMN, ECN, and SN. Using permutation testing we examined the association between NPS scores and FC maps at baseline (n = 349) and over a 2-year period (n = 225), controlling for age, sex, and years of education. A post-hoc linear model was used to assess the effect of CNS medication on each significant NPI-FC association within each group.

RESULTS

In the MCI group (n = 73), baseline disturbed nighttime behavior was positively correlated with functional connectivity (FC) between the anterior sensorimotor network. Longitudinally (n = 46), appetite changes were positively associated with FC between the anterior SN and fusiform gyrus. Disinhibition and apathy correlated with FC between the posterior SN and DMN. In the CVD group (n = 144), baseline anxiety was negatively associated with FC within the DMN and between the right ECN and DMN in the left hippocampus. Longitudinally (n = 99), agitation/aggression changes were negatively associated with FC between the right ECN and left anterior cerebellum. Irritability, the most common symptom in both MCI and CVD, did not have identifiable neural correlates, possibly due to its complexity or analysis limitations. In the PD group (n = 132), baseline disturbed nighttime behavior was positively associated with FC between the right ECN and DMN in the precuneus and left ECN and fusiform gyrus. Longitudinally (n = 80), changes in nighttime behavior correlated with FC between the left ECN and DMN in the precuneus. CNS medications had no effect on NPI-FC associations in the MCI group. In the CVD group, the absence of CNS medications was linked to decreased right ECN FC. In the PD group, Parkinson's medications changed the direction of the NPI night-time score-FC correlation at both baseline and the 2-year assessment, with higher scores associated with reduced left ECN FC in medicated individuals.

CONCLUSIONS

In conclusion, our study highlights the critical role of the DMN, ECN, and SN in processing neuropsychiatric symptoms (NPS) across MCI, CVD, and PD populations. We found significant associations between NPS and functional connectivity (FC) within and between these networks. MCI and PD showed positive associations with FC, particularly for disturbed nighttime behavior, while CVD exhibited negative associations, notably with anxiety and agitation. Although irritability was common in both MCI and CVD groups, its neural correlates remain unclear, emphasizing the need for further investigation. These findings support existing literature and pave the way for targeted therapeutic approaches, such as brain stimulation, to alleviate NPS. Additionally, the complex role of CNS medications in modulating NPS and FC warrants further investigation.

Allogeneic mesenchymal stem cell therapy with laromestrocel in mild Alzheimer's disease: a randomized controlled phase 2a trial

Alzheimer's disease (AD) is characterized by progressive cognitive decline, severe brain atrophy and neuroinflammation. We conducted a randomized, double-blind, placebo-controlled, parallel-group phase 2a clinical trial that tested the safety and efficacy of laromestrocel, a bone-marrow-derived, allogeneic mesenchymal stem-cell therapy, in slowing AD clinical progression, atrophy and neuroinflammation. Participants across ten centers in the United States were randomly assigned 1:1:1:1 to four infusion groups: group 1 (placebo; four monthly infusions, n = 12); group 2 (25 million cells, one infusion followed by three monthly infusions of placebo, n = 13); group 3 (25 million cells; four monthly doses, n = 13); and group 4 (100 million cells; four monthly doses, n = 11). The study met its primary end point of safety; the rate of treatment-emergent serious adverse events within 4 weeks of any infusion was similar in all four groups: group 1, 0% (95% CI 0-26.5%); group 2, 7.7% (95% CI 0.2-36%); group 3, 7.7% (95% CI 0.2-36%) and group 4, 9.1% (95% CI 0.2-41.3%). Additionally, there were no reported infusion-related reactions, hypersensitivities or amyloid-related imaging abnormalities. Laromestrocel improved clinical assessments at 39 weeks compared to placebo, as measured by a composite AD score (secondary end point was met: group 2 versus placebo change: 0.38; 95% CI -0.06-0.82), Montreal cognitive assessment and the Alzheimer's Disease Cooperative Study Activities of Daily Living. At 39 weeks, Laromestrocel slowed the decline of whole brain volume compared to placebo (n = 10) by 48.4% for all treatment groups combined (groups 2-4: P = 0.005; n = 32) and left hippocampal volume by 61.9% (groups 2-4, P = 0.021; n = 32), and reduced neuroinflammation as measured by diffusion tensor imaging. The change in bilateral hippocampal atrophy correlated with the change in mini-mental state exam scores (R = 0.41, P = 0.0075) in all study patients (N = 42). Collectively these results support safety of single and multiple doses of laromestrocel treatment for mild AD and provide indications of efficacy in combating decline of brain volume and potentially cognitive function. Larger-scale clinical trials of laromestrocel in AD are warranted. ClinicalTrials.gov registration: NCT05233774 .

Impact of APOE and MAPT genetic profile on the cognitive functions among Amyotrophic Lateral Sclerosis Tunisian patients

Amyotrophic Lateral Sclerosis(ALS) has traditionally been managed as a neuromuscular disorder. However, recent evidence suggests involvement of non-motor domains. This study aims to evaluate the impact of APOE and MAPT genotypes on the cognitive features of ALS. We included confirmed ALS cases from the Neurology department at Razi University Hospital, Tunisia. APOE and MAPT screening were conducted with Sanger sequencing validation, and preliminary screening for four main ALS genes was performed. Clinical phenotypes and genotypes were analyzed using appropriate tests, with healthy controls (HC) representing the Tunisian population. Two-hundred-seventy ALS patients were included, stratified as 213 spinal cases,49 with bulbar onset and 8 patients with generalized form with 140 HC. Regarding APOE, we reported high frequency of ALS cases carrier of APOE-ε4 isoform compared to controls(p < 0.0001).We found a significant association between APOE-ɛ4 and ALS onset site (p = 0.05,r = 0.33),with higher frequencies in bulbar onset patients. Cognitive signs were more frequent in ɛ4 carriers (r = 0.43,p < 0.01),and a significant link was observed between dysexecutive functions and the APOE risk allele (p = 0.0495).Concerning the MAPT haplotypes, we reported high frequency of ALS cases carrier of MAPT H1-haplotype HC (94.45% and 72.14% respectively, p < 0.001).Among ALS cases,MAPT-H1 showed a stronger positive correlation with the presence of oculomotor signs(p = 0.05,r = 0.28).As well as significant positive association between cognitive impairments(p = 0.039,r = 0.59). Our findings emphasize the correlation between APOE and MAPT genotypes and the cognitive features in our ALS patients. We also observed other interesting, though weak, significant correlations (with coefficients not exceeding 0.20),which require further validation in a larger cohort to confirm our results.

Fractional amplitude of low-frequency fluctuations in right dorsal cingulum bundle associated with depression symptoms in AD patients: effects of donepezil intervention

OBJECTIVES

Our aim was to investigate the mechanisms of spontaneous brain activity of white matter functional signals in Alzheimer's disease (AD) patients after donepezil intervention.

METHODS

We used resting-state functional magnetic resonance imaging and the fractional amplitude of low-frequency fluctuations (fALFF) approach to investigate changes in spontaneous brain activity of white matter functional signals in AD patients before and after donepezil intervention. A total of 32 subjects participated in the study, including 16 healthy subjects (HCs) and 16 AD patients. The 16 AD patients underwent brain imaging and neuropsychological assessment before and after donepezil. ANOVA and post hoc t-test analysis were used to compare the differences in fALFF between the three groups. Pearson correlations were used to investigate the relationships between abnormal fALFF values and clinical variables in AD patients before and after intervention (P < 0.05).

RESULTS

Compared to HCs, AD patients before donepezil intervention had an abnormal fALFF in superior longitudinal fasciculus 2; AD patients after donepezil intervention had an abnormal fALFF in right superior longitudinal fasciculus 1,2 and right dorsal cingulum, Compared with baseline, AD patients after donepezil intervention had an abnormal fALFF in the right dorsal cingulum. Compared with the baseline, AD patients after donepezil intervention had significantly decreased depression scores (P < 0.0003).

CONCLUSIONS

Our study showed that spontaneous activity of functional signalling in the cholinergic pathway was altered in AD patients after donepezil intervention and that this change was associated with depressive symptoms in AD patients.