1
|
Tang WK, Hui E, Leung TWH. Behavioral disinhibition in stroke. Front Neurol 2024; 15:1345756. [PMID: 38500811 PMCID: PMC10944941 DOI: 10.3389/fneur.2024.1345756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Background Post-stroke behavioral disinhibition (PSBD) is common in stroke survivors and often presents as impulsive, tactless or vulgar behavior. However, it often remains undiagnosed and thus untreated, even though it can lead to a longer length of stay in a rehabilitation facility. The proposed study will aim to evaluate the clinical, neuropsychological and magnetic resonance imaging (MRI) correlates of PSBD in a cohort of stroke survivors and describe its 12-month course. Methods This prospective cohort study will recruit 237 patients and will be conducted at the Neurology Unit of the Prince of Wales Hospital. The project duration will be 24 months. The patients will be examined by multiple MRI methods, including diffusion-weighted imaging, within 1 week after stroke onset. The patients and their caregivers will receive a detailed assessment at a research clinic at 3, 9 and 15 months after stroke onset (T1, T2 and T3, respectively). The disinhibition subscale of the Frontal Systems Behavior Scale (FrSBe) will be completed by each subject and caregiver, and scores ≥65 will be considered to indicate PSBD.A stepwise logistic regression will be performed to assess the importance of lesions in the regions of interest (ROIs), together with other significant variables identified in the univariate analyses. For patients with PSBD at T1, the FrSBe disinhibition scores will be compared between the groups of patients with and without ROI infarcts, using covariance analysis. The demographic, clinical and MRI variables of remitters and non-remitters will be examined again at T2 and T3 by logistic regression. Discussion This project will be the first MRI study on PSBD in stroke survivors. The results will shed light on the associations of lesions in the orbitofrontal cortex, anterior temporal lobe and subcortical brain structures with the risk of PSBD. The obtained data will advance our understanding of the pathogenesis and clinical course of PSBD in stroke, as well as other neurological conditions. The findings are thus likely to be applicable to the large population of patients with neurological disorders at risk of PSBD and are expected to stimulate further research in this field.
Collapse
Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Edward Hui
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Thomas Wai Hong Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Nuebling GS, Butzhammer E, Lorenzl S. Assisted Suicide in Parkinsonian Disorders. Front Neurol 2021; 12:656599. [PMID: 33790854 PMCID: PMC8005587 DOI: 10.3389/fneur.2021.656599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Due to the high prevalence of suicidal ideation in Parkinson's Disease (PD) and exploratory data indicating a similar prevalence in atypical Parkinsonian disorders (APD), we sought to determine the frequency of assisted suicide (AS) as well as factors driving these decisions in PD and APD. Methods: Retrospective chart analysis (2006-2012) at a Swiss Right-to-Die organization. Patients with PD and APD who completed AS were analyzed concerning disease state, symptom burden, medication, and social factors. Results: We identified 72 patients (PD = 34, PSP = 17, MSA = 17, CBS = 4; 7.2% of all AS cases), originating mainly from Germany (41.7%), Great Britain (29.2%), and the US (8.3%). Predominant symptoms at the time of application were immobility (PD/APD: 91%/97%), helplessness (63%/70%), pain (69%/19%), dysarthria (25%/32%), and dysphagia (19%/59%). APD patients generally showed a higher symptom burden and a higher frequency of diagnosed depression (8.8%/28.9%). While most patients with diagnosed depression received antidepressants (80%), other symptoms such as pain (59%) were treated less consistently. Of note, time from diagnosis to application differed greatly between PD (8.5 ± 6.8 years) and APD (1.5 ± 1.3 years, p < 0.0001). Conclusions: In our analysis, Parkinsonian disorders appeared to be overrepresented as a cause of AS considering the prevalence of these diseases. The observation that assisted suicide is sought early after initial diagnosis in APD implies the need for early comprehensive psychological support of these patients and their relatives.
Collapse
Affiliation(s)
- Georg S Nuebling
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany.,Department for Palliative Medicine, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Elisabeth Butzhammer
- Department for Palliative Medicine, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Lorenzl
- Department for Palliative Medicine, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany.,Professorship for Palliative Care, Institute of Nursing Science and -Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| |
Collapse
|
3
|
Suicidal and death ideation in patients with progressive supranuclear palsy and corticobasal syndrome. J Affect Disord 2020; 276:1061-1068. [PMID: 32768878 DOI: 10.1016/j.jad.2020.07.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/17/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A large proportion of patients with atypical parkinsonian syndromes suffer from depression, an antecedent of suicide. This study aimed to explore the prevalence and clinical correlates of suicidal and death ideation (SDI) in patients with Progressive Supranuclear Palsy (PSP) and Corticobasal Syndrome (CBS), as well as compare the differences with patients with Parkinson's disease (PD). METHODS This was a case-control, cross-sectional study. SDI was diagnosed based on the assessment of the Hamilton Depression Rating Scale (HRDS). The prevalence of SDI among patients with PD, PSP, and CBS (n = 3400, 268, and 65 respectively) were compared before and after propensity score matching (PSM). A forward binary logistic regression model was used to explore the associated factors of SDI. RESULTS None of the patients reported suicide attempts. The prevalence of SDI in patients with PSP and CBS were 27.2% and 29.2%, respectively, which was significantly higher than that in patients with PD before and after PSM (P < 0.05). The prevalence of SDI was not significantly different among patients with PSP with different subtypes (Richardson syndrome, Parkinsonism, and other), both before and after PSM (P > 0.05). Multivariate analysis indicated that higher gait and midline score and depression were independently associated with an increased risk of SDI in patients with PSP (P < 0.05), while higher non-motor symptoms score and depression were independently associated with the occurrence of SDI in patients with CBS (P < 0.05). CONCLUSIONS Our study highlights the importance of screening SDI in patients with PSP and CBS.
Collapse
|
4
|
Shdo SM, Ranasinghe KG, Sturm VE, Possin KL, Bettcher BM, Stephens ML, Foley JM, You SCC, Rosen HJ, Miller BL, Kramer JH, Rankin KP. Depressive Symptom Profiles Predict Specific Neurodegenerative Disease Syndromes in Early Stages. Front Neurol 2020; 11:446. [PMID: 32547476 PMCID: PMC7273507 DOI: 10.3389/fneur.2020.00446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 04/27/2020] [Indexed: 12/05/2022] Open
Abstract
Background: During early stages, patients with neurodegenerative diseases (NDG) often present with depressive symptoms. However, because depression is a heterogeneous disorder, more precise delineation of the specific depressive symptom profiles that arise early in distinct NDG syndromes is necessary to enhance patient diagnosis and care. Methods and Findings: Five-hundred and sixty four participants self-reported their depressive symptoms using the Geriatric Depression Scale (GDS), including 111 healthy older control subjects (NC) and 453 patients diagnosed with one of six NDGs who were at the mild stage of disease (CDR® Dementia Staging Instrument ≤ 1) [186 Alzheimer's disease (AD), 76 behavioral variant frontotemporal dementia (bvFTD), 52 semantic variant primary progressive aphasia (svPPA), 46 non-fluent variant PPA (nfvPPA), 49 progressive supranuclear palsy syndrome (PSPS), 44 corticobasal syndrome (CBS)]. The GDS was divided into subscales based on a previously published factor analysis, representing five symptoms (dysphoria, hopelessness, withdrawal, worry, and cognitive concerns). Mixed models were created to examine differences in depression subscale by group, and logistic regression analyses were performed to determine if patterns of depressive symptoms could predict a patient's NDG syndrome. PSPS patients presented with a hopeless, dysphoric, and withdrawn pattern, while patients with CBS presented with a similar but less severe pattern. Worry was a key symptom in the profile of patients with svPPA, while ADs only had abnormally elevated cognitive concerns. Depressive profile accurately predicted NDG diagnosis at a rate of between 70 and 84% accuracy. Conclusions: These results suggest that attention to specific depressive symptom profile can improve diagnostic sensitivity and can be used to provide more individualized patient care.
Collapse
Affiliation(s)
- Suzanne M. Shdo
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Kamalini G. Ranasinghe
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Virginia E. Sturm
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine L. Possin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Brianne M. Bettcher
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of Colorado School of Medicine, Denver, CO, United States
| | - Melanie L. Stephens
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica M. Foley
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Shou-Chin Christine You
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Howard J. Rosen
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L. Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Joel H. Kramer
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P. Rankin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
5
|
Fabbrini G, Fabbrini A, Suppa A. Progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration. ACTA ACUST UNITED AC 2019; 165:155-177. [DOI: 10.1016/b978-0-444-64012-3.00009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
6
|
Hartzell JW, Geary R, Gyure K, Chivukula VR, Haut MW. Completed suicide in an autopsy-confirmed case of early onset Alzheimer's disease. Neurodegener Dis Manag 2018; 8:81-88. [PMID: 29319406 PMCID: PMC6367712 DOI: 10.2217/nmt-2017-0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a case of a 57-year-old male with clinically diagnosed and autopsy-confirmed early onset Alzheimer's disease who completed suicide by gunshot wound to the chest. This case has several unique aspects that have not been discussed in previous case reports of completed suicide in Alzheimer's disease. In particular, our patient's death was highly planned with successful compensation for his cognitive deficits. After all firearms had been removed from the home as a safety precaution, he obtained a new weapon, hid it and left himself cues to find and use it. The case is discussed in the context of literature differentiating the neural circuitry propagating impulsive versus planned suicidal acts.
Collapse
Affiliation(s)
- Jennifer Wiener Hartzell
- Department of Supportive Oncology, Levine Cancer Institute, Carolinas HealthCare System, NC 28202, USA.,Department of Neuropsychology & Psychology, Carolinas Rehabilitation, Carolinas HealthCare System, NC 28203, USA
| | - Richard Geary
- Department of Psychiatry, Overlake Medical Center, WA 98004, USA
| | - Kymberly Gyure
- Department of Pathology, West Virginia University School of Medicine, WV 26506, USA.,Department of Neurology, West Virginia University School of Medicine, WV 26506, USA.,Department of Neurosurgery, West Virginia University School of Medicine, WV 26506, USA
| | - Venkata Ravi Chivukula
- Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, WV 26505, USA
| | - Marc W Haut
- Department of Neurology, West Virginia University School of Medicine, WV 26506, USA.,Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, WV 26505, USA.,Department of Radiology, West Virginia University School of Medicine, WV 26506, USA
| |
Collapse
|
7
|
Belvisi D, Berardelli I, Suppa A, Fabbrini A, Pasquini M, Pompili M, Fabbrini G. Neuropsychiatric disturbances in atypical parkinsonian disorders. Neuropsychiatr Dis Treat 2018; 14:2643-2656. [PMID: 30349262 PMCID: PMC6186304 DOI: 10.2147/ndt.s178263] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) are the most common atypical parkinsonisms. These disorders are characterized by varying combinations of autonomic, cerebellar and pyramidal system, and cognitive dysfunctions. In this paper, we reviewed the evidence available on the presence and type of neuropsychiatric disturbances in MSA, PSP, and CBD. A MedLine, Excerpta Medica, PsycLit, PsycInfo, and Index Medicus search was performed to identify all articles published on this topic between 1965 and 2018. Neuropsychiatric disturbances including depression, anxiety, agitation, and behavioral abnormalities have been frequently described in these disorders, with depression as the most frequent disturbance. MSA patients show a higher frequency of depressive disorders when compared to healthy controls. An increased frequency of anxiety disorders has also been reported in some patients, and no studies have investigated apathy. PSP patients may have depression, apathy, disinhibition, and to a lesser extent, anxiety and agitation. In CBD, neuropsychiatric disorders are similar to those present in PSP. Hallucinations and delusions are rarely reported in these disorders. Neuropsychiatric symptoms in MSA, PSP, and CBD do not appear to be related to the severity of motor dysfunction and are one of the main factors that determine a low quality of life. The results suggest that neuropsychiatric disturbances should always be assessed in patients with atypical parkinsonisms.
Collapse
Affiliation(s)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Suppa
- IRCCS Neuromed, Pozzilli, Italy, .,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, Italy, .,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| |
Collapse
|