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Fan W, Ma S, Wang Z, Han Y, Liu X, Gu R, Cai Q. Correlation between white matter hyperintensity and delusional symptoms in Alzheimer's disease. BMC Psychiatry 2023; 23:914. [PMID: 38057778 PMCID: PMC10698988 DOI: 10.1186/s12888-023-05420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Patients with Alzheimer's disease (AD) often exhibit neuropsychiatric symptoms (NPS), particularly delusions. Previous studies have shown an association between white matter hyperintensities (WMH) and specific NPS. This study aims to explore the relationship between WMH volume and delusions in AD patients by comparing the WMH volumes of delusional and non-delusional subgroups. METHODS 80 AD patients were divided into a delusion group (n = 36) and a non-delusion group (n = 44) based on the Neuropsychiatric Inventory (NPI). The brain cortical volume and WMH volume were quantitatively calculated for all 80 patients, including total WMH volume, periventricular WMH (PVWMH) volume, deep WMH volume, as well as bilateral frontal lobe, temporal lobe, parietal lobe, and occipital lobe WMH volumes. Firstly, we compared the differences in WMH volumes between the delusion group and non-delusion group. Then, within the delusion group, we further categorized patients based on severity scores of their delusional symptoms into mild (1 point), moderate (2 points), or severe groups (3 points). We compared the WMH volumes among these three groups to investigate the role of WMH volume in delusional symptoms. RESULTS There was a significant difference in left occipital lobe WMH volume between the delusion group and non-delusion group(P < 0.05). Within the delusion group itself, there were significant differences in overall WMH volume as well as PVWMH volume among patients with mild or severe levels of delusions(P < 0.05). CONCLUSION Left occipital lobe WMH volume may be associated with the occurrence of delusional AD patients, and the total volume of whole-brain WMH and PVWMH volume may affect the degree of severity of delusional symptoms.
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Affiliation(s)
- Wei Fan
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Shaolun Ma
- University of Electronic Science and Technology of China, Chengdu, China
| | - Ziqi Wang
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Yuanyuan Han
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xiaowei Liu
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Rui Gu
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Qingyan Cai
- University of Electronic Science and Technology of China, Chengdu, China.
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Accelerated atrophy in dopaminergic targets and medial temporo-parietal regions precedes the onset of delusions in patients with Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci 2023; 273:229-241. [PMID: 35554669 PMCID: PMC9958148 DOI: 10.1007/s00406-022-01417-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/11/2022] [Indexed: 12/21/2022]
Abstract
People with Alzheimer's disease (AD) and delusions have worse quality of life and prognosis. However, early markers of delusions have not been identified yet. The present study investigated whether there are any detectable differences in grey matter (GM) volume and cognitive changes in the year before symptom onset between patients with AD who did and did not develop delusions. Two matched samples of AD patients, 63 who did (PT-D) and 63 who did not develop delusions (PT-ND) over 1 year, were identified from the Alzheimer's Disease Neuroimaging Initiative database. The Neuropsychiatric Inventory (NPI) was used to assess the presence of delusions. Sixty-three additional matched healthy controls (HC) were selected. Repeated-measures ANCOVA models were used to investigate group-by-time effects on the volume of selected GM regions of interest and on cognitive performance. No neurocognitive differences were observed between patient groups prior to symptom onset. Greater episodic memory decline and GM loss in bilateral caudate nuclei, medio-temporal and midline cingulo-parietal regions were found in the PT-D compared with the PT-ND group. A pattern of faster GM loss in brain areas typically affected by AD and in cortical and subcortical targets of dopaminergic pathways, paralleled by worsening of episodic memory and behavioural symptoms, may explain the emergence of delusions in patients with AD.
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3
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Prevalence of multidimensional frailty and pre-frailty in older people in different settings: A systematic review and meta-analysis. Ageing Res Rev 2021; 72:101498. [PMID: 34700009 DOI: 10.1016/j.arr.2021.101498] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
Frailty is a common condition in older people. The epidemiological data available, however, are mainly based on the physical frailty phenotype. An extensive literature has suggested that frailty should be identified using a multidimensional approach. Based on these recommendations, we estimated the prevalence of frailty and pre-frailty in the older population, using the multidimensional prognostic index (MPI), a common tool for defining multidimensional frailty. We searched several databases until 10th May 2021 for studies reporting the prevalence of frailty according to MPI values. MPI was categorized, where possible, in < 0.33 (robustness), 0.33-0.66 (pre-frailty) and > 0.66 (frailty) or using a RECursive Partition and AMalgamation approach. A meta-analysis of the prevalence, with the correspondent 95% confidence intervals (CIs) of pre-frailty and frailty was performed stratified by setting (population-based, ambulatory, nursing home, and hospital). Among 177 papers initially screened, we included 57 studies for a total of 56,407 older people. The mean age was 78.6 years, with a slight prevalence of women (58%). The overall prevalence of multidimensional frailty (MPI-3) was 26.8% (95%CI: 22.1-31.5), being higher in nursing home setting (51.5%) and lower in population-based studies (13.3%). The prevalence of pre-frailty (MPI-2) was 36.4% (95%CI: 33.1-39.7), being higher in hospital setting (39.3%) and lower in nursing home (20%). In conclusion, frailty and pre-frailty, according to a multidimensional definition, are common in older people affecting, respectively, one person over four and one over three. Our work further strengths the importance of screening frailty in older people using a multidimensional approach.
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Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:175-196. [PMID: 34389117 DOI: 10.1016/b978-0-12-822290-4.00015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.
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Urso D, Gnoni V, Filardi M, Logroscino G. Delusion and Delirium in Neurodegenerative Disorders: An Overlooked Relationship? Front Psychiatry 2021; 12:808724. [PMID: 35115974 PMCID: PMC8804700 DOI: 10.3389/fpsyt.2021.808724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/24/2021] [Indexed: 12/04/2022] Open
Abstract
Delusions are part of the neuropsychiatric symptoms that patients suffering from neurodegenerative conditions frequently develop at some point of the disease course and are associated with an increased risk of cognitive and functional decline. Delirium is a syndrome characterized by acute onset of deficits in attention, awareness, and cognition that fluctuate in severity over a short time period. Delusions and delirium are frequently observed in the context of neurodegeneration, and their presence can easily mislead clinicians toward a misdiagnosis of psychiatric disorder further delaying the proper treatment. Risk factors for developing delusion and delirium in neurodegenerative conditions have been investigated separately while the possible interplay between these two conditions has not been explored so far. With this study, we aim to achieve a more comprehensive picture of the relationship between delusions and delirium in neurodegeneration by analyzing prevalence and subtypes of delusions in different neurodegenerative disorders; providing an overview of clinical tools to assess delusions in neurodegenerative patients and how delusions are covered by delirium assessment tools and discussing the possible common pathophysiology mechanisms between delusion and delirium in neurodegenerative patients. A more extensive characterization of the relationship between delusions and delirium may help to understand whether delusions may constitute a risk factor for delirium and may ameliorate the management of both conditions in patients with neurodegenerative disorders.
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Affiliation(s)
- Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Valentina Gnoni
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Filardi
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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6
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Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing Res Rev 2020; 60:101047. [PMID: 32171786 PMCID: PMC7461697 DOI: 10.1016/j.arr.2020.101047] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
Abstract
Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI "plasticity" provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults.
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Affiliation(s)
- Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy; Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Maggi
- National Research Council (CNR), Aging Section, Padova, Italy
| | | | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy
| | - Luigi Ferrucci
- National Institute on Aging, NIH, Baltimore, MD, United States
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7
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Kaur P, Tan WS, Gunapal PPG, Ding YY, Ong R, Wu HY, Hum A. Deaths in dementia: a scoping review of prognostic variables. BMJ Support Palliat Care 2020; 11:242-252. [PMID: 32561548 DOI: 10.1136/bmjspcare-2020-002217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify the types of factors included in research examining mortality in patients with dementia, and to stratify the identified factors by care settings. DESIGN We systematically searched PubMed, Embase, PsycINFO and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, and identified grey literature from the Networked Digital Library of Theses and Dissertations, Open Grey and Grey Literature Report. Two authors independently screened for eligibility of studies. Independent reviewers extracted relevant study information. We conducted a narrative synthesis of the data. RESULTS We identified 8254 articles, of which 94 met the inclusion criteria. More than half (n=53) were published between 2009 and 2018 with half from Europe. Studies were conducted across hospices/nursing homes (n=25), hospital (n=23), outpatient clinics (n=21), mixed settings (n=15) and in the community (n=10). Nearly 60% adopted a prospective cohort study design with 87% performing multivariable analysis. Overall, 239 variables were identified and classified into six themes-individual factors, health status, functional ability, cognition and mental health, treatments and health system factors. Although a general set of factors were common across all studies, when stratified by care settings, variations were seen in the specific variables included. CONCLUSION Identifying prognostic variables relevant to the dementia population in each setting is key to facilitate appropriate care plans and to ensure timely access to palliative care options. Future research should also focus on ensuring the replicability of prognostic models and to generate a better understanding of the direct and interacting influence of the identified factors on mortality.
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Affiliation(s)
- Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore
| | | | - Yew Yoong Ding
- Geriatric Education and Research Institute, Singapore.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Reuben Ong
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Huei Yaw Wu
- Palliative Care Centre for Excellence in Research and Education, Singapore.,Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
| | - Allyn Hum
- Palliative Care Centre for Excellence in Research and Education, Singapore .,Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
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8
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Jorge C, Cetó M, Arias A, Blasco E, Gil MP, López R, Dakterzada F, Purroy F, Piñol-Ripoll G. Level of understanding of Alzheimer disease among caregivers and the general population. NEUROLOGÍA (ENGLISH EDITION) 2020; 36:426-432. [PMID: 34238525 DOI: 10.1016/j.nrleng.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Understanding of Alzheimer disease (AD) is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of AD among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale (ADKS). PATIENTS AND METHODS We assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. ADKS scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving. RESULTS A total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall ADKS score (19.1 vs 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse ADKS scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers' knowledge of AD symptoms (P = .00) and diagnosis (P = .05). CONCLUSION Assessing the degree of understanding of AD is essential to the development of health education strategies both in the general population and among caregivers.
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Affiliation(s)
- C Jorge
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - M Cetó
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - A Arias
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - E Blasco
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - M P Gil
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - R López
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - F Dakterzada
- Department of Experimental Medicine, Clinical Neuroscience Research, IRBLleida, Lleida, Spain
| | - F Purroy
- Servicio Neurología, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Arnau Vilanova Lleida, Lleida, Spain
| | - G Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain.
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9
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Gottesman RT, Stern Y. Behavioral and Psychiatric Symptoms of Dementia and Rate of Decline in Alzheimer's Disease. Front Pharmacol 2019; 10:1062. [PMID: 31616296 PMCID: PMC6768941 DOI: 10.3389/fphar.2019.01062] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
Alzheimer’s disease causes both cognitive and non-cognitive symptoms. There is increasing evidence that the presentation and course of Alzheimer’s disease is highly heterogenous. This heterogeneity presents challenges to patients, their families, and clinicians due to the difficulty in prognosticating future symptoms and functional impairment. Behavioral and psychiatric symptoms are emerging as a significant contributor to this clinical heterogeneity. These symptoms have been linked to multiple areas of neurodegeneration, which may suggest that they are representative of network-wide dysfunction in the brain. However, current diagnostic criteria for Alzheimer’s disease focus exclusively on the cognitive aspects of disease. Behavioral and psychiatric symptoms have been found in multiple studies to be related to disease severity and to contribute to disease progression over time. A better understanding of how behavioral and psychiatric symptoms relate to cognitive aspects of Alzheimer’s disease would help to refine the models of disease and hopefully lead to improved ability to develop therapeutic options for this devastating disease.
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Affiliation(s)
- Reena T Gottesman
- Division of Aging and Dementia, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Yaakov Stern
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University Medical Center, New York, NY, United States
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10
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Lai L, Lee PE, Chan P, Fok MC, Hsiung GYR, Sepehry AA. Prevalence of delusions in drug-naïve Alzheimer disease patients: A meta-analysis. Int J Geriatr Psychiatry 2019; 34:1287-1293. [PMID: 29023987 DOI: 10.1002/gps.4812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are common at all stages of Alzheimer disease (AD). Delusions in AD are associated with negative clinical consequences and may signal rapid disease progression. Hence, we sought to determine the prevalence of delusions in drug-naïve (no cholinesterase inhibitor or neuroleptic medications) AD patients. METHODS In this meta-analysis, a search of the EMBASE, MEDLINE, and PsycINFO databases was performed. We selected studies reporting delusion prevalence measured by the Neuropsychiatric Inventory (NPI) in drug-naïve AD patients. An aggregate delusion event rate with 95% confidence interval (CI) was calculated. The I2 statistic was used to assess the magnitude of between-study heterogeneity. Single variable meta-regressions allowed examination of the effect of moderating factors and heterogeneity. Quantitative measures were used to appraise for publication bias. RESULTS We identified 6 studies with 591 participants allowing calculation of the aggregate delusional prevalence rate. Irrespective of dementia severity, the aggregate event rate for delusions was 29.1% (95% CI: 20-41%; I2 = 84.59). No publication bias was observed. CONCLUSION This meta-analysis calculates a 29.1% prevalence rate of delusions in AD patients. There is a trend towards increasing delusion prevalence in concordance with increasing severity of dementia. Given delusions are associated with poorer outcomes, the obtained prevalence should motivate clinicians to screen carefully for delusions. Current literature limitations warrant future studies, with sub-analyses on dementia severity, and other neurobiological factors known to influence the presence of delusions.
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Affiliation(s)
- Leo Lai
- University of British Columbia, Department of Medicine, Division of Geriatric Medicine, Vancouver, Canada
| | - Philip E Lee
- University of British Columbia, Department of Medicine, Division of Geriatric Medicine, Vancouver, Canada
| | - Peter Chan
- University of British Columbia, Department of Psychiatry, Division of Geriatric Psychiatry, Vancouver, Canada
| | - Mark C Fok
- University of British Columbia, Department of Medicine, Division of Geriatric Medicine, Vancouver, Canada
| | - Ging-Yuek R Hsiung
- University of British Columbia, Department of Medicine, Division of Neurology, Vancouver, Canada
| | - Amir A Sepehry
- University of British Columbia, Department of Medicine, Division of Neurology, Vancouver, Canada
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Agitation in patients with dementia: a systematic review of epidemiology and association with severity and course. Int Psychogeriatr 2019; 31:1305-1318. [PMID: 30855002 DOI: 10.1017/s1041610218001898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES More than 90% of individuals with Alzheimer's disease (AD) experience behavioral and neuropsychiatric symptoms (NPS), such as agitation. However, little is known regarding the specific burden of agitation for Alzheimer's patients. DESIGN A global systematic literature review was conducted in MEDLINE and Embase for studies of clinical, humanistic, and economic burden of agitation in AD/dementia published from 2006-2016. References of identified papers and related literature reviews were examined. Studies meeting predetermined inclusion criteria for burden of agitation/NPS were summarized. RESULTS Eighty papers met the inclusion criteria for burden of agitation in dementia. Wide ranges of agitation prevalence were reported, but few papers provided information on incidence. The association of agitation with AD severity was presented in multiple studies; a few suggested positive association of agitation with mortality. CONCLUSIONS High prevalence of agitation is consistent with earlier reports, but several gaps in understanding of agitation in AD need further exploration.
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12
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D'Onofrio G, Panza F, Sancarlo D, Addante F, Solfrizzi V, Cantarini C, Mangiacotti A, Lauriola M, Cascavilla L, Paris F, Lozupone M, Daniele A, Greco A, Seripa D. Executive Dysfunction Detected with the Frontal Assessment Battery in Alzheimer's Disease Versus Vascular Dementia. J Alzheimers Dis 2019; 62:699-711. [PMID: 29480171 DOI: 10.3233/jad-170365] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect.
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Affiliation(s)
- Grazia D'Onofrio
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Daniele Sancarlo
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Filomena Addante
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Chiara Cantarini
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Mangiacotti
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Michele Lauriola
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Leandro Cascavilla
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesco Paris
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
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D’Onofrio G, Panza F, Sancarlo D, Lauriola M, Dagostino MP, Paroni G, Lozupone M, Mangiacotti A, Bisceglia P, Gravina C, Urbano M, Addante F, Paris F, Cascavilla L, Greco A, Seripa D. Hydroxytryptamine transporter gene-linked polymorphic region (5HTTLPR) is associated with delusions in Alzheimer's disease. Transl Neurodegener 2019; 8:4. [PMID: 30733861 PMCID: PMC6357440 DOI: 10.1186/s40035-019-0144-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Serotoninergic pathways underlying delusion symptoms in Alzheimer's disease (AD) have not been fully clarified. 5-Hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR) is a variable number tandem repeats in the promoter region of serotonin transporter encoding-gene affecting transcription. METHODS We investigated the association of 5-HTTLPR with delusions in a total of 257 consecutive patients clinically diagnosed as AD according to the National Institute on Aging-Alzheimer's Association criteria. All participants underwent a comprehensive evaluation with a standardized comprehensive geriatric assessment and Neuropsychiatric Inventory. RESULTS Delusion symptoms were observed in 171 patients (66.54%). In respect to AD patients without delusions, AD patients with delusions showed a low prevalence of S-plus carriers (5-HTTLPR-L/S + 5-HTTLPR-S/S genotypes) [p < 0.001; odds ratio (OR) = 0.240, 95% confidence interval (CI) = 0.121-0.471]. Logistic regression analysis adjusted for the apolipoprotein E polymorphism showed that in AD patients with delusions the presence of an 5-HTTLPR-S allele may reduce disease duration (p = 0.005; OR = 0.680, 95% CI = 0.522-0.886) and increase aberrant motor activity (p = 0.013; OR = 2.257, 95% CI = 1.195-4.260). The present findings suggested that 5-HTTLPR might be associated with delusions in AD. S-plus carriers might be associated with protective effect against delusions in AD. CONCLUSIONS More studies on wider samples of high selected demented patients are needed to confirm our results. However, the present findings suggested that a genetic factor related to serotonin metabolism might exert a protective role on the clinical expression of neuropsychiatric clusters in AD with important implications regarding mechanisms underlying delusions and their possible treatment across the AD and dementia spectrum.
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Affiliation(s)
- Grazia D’Onofrio
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Francesco Panza
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
| | - Daniele Sancarlo
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Michele Lauriola
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Mariangela P. Dagostino
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Giulia Paroni
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Mangiacotti
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Paola Bisceglia
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Carolina Gravina
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Maria Urbano
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Filomena Addante
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Francesco Paris
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Leandro Cascavilla
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Antonio Greco
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
| | - Davide Seripa
- Fondazione Casa Sollievo della Sofferenza, Department of Medical Sciences, Geriatrics Unit, San Giovanni Rotondo (FG) Foggia, Italy
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Rothenberg KG, Rajaram R. Advances in Management of Psychosis in Neurodegenerative Diseases. Curr Treat Options Neurol 2019; 21:3. [PMID: 30673880 DOI: 10.1007/s11940-019-0545-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF THE REVIEW Psychosis is broadly defined as a disengagement from reality. It describes syndromes that impair both thought content and thought process. Psychosis negatively impacts an individual's quality of life, in addition to the families caring for them. Psychosis with different types of hallucinations and delusions occurs in the context of delirium. Neuropsychiatric symptoms (NPS) are almost universal in the course of common neurodegenerative disorders (NDD) like Alzheimer's disease (AD) or Parkinson's disease (PD). In this paper, the authors took an effort to characterize AD and PD psychosis with a special focus on the most diagnostically reliable features. Effectiveness and limitations of pharmacological interventions are discussed. RECENT FINDINGS Consensus diagnostic criteria have evolved for psychosis secondary to AD as well as psychosis in PD. Psychotropic medications can be effective in the treatment of NPS in NDD; however, clinicians must be mindful of the side effects. There is a consensus on benefit of initiating any acetylcholinesterase inhibitor (ACHI: donepezil, rivastigmine, and galantamine) as a first line of treatment for psychosis in AD, as it may reduce and/or avoid the need for the use antipsychotics. Pimavanserin, a selective-serotonin inverse agonist that preferentially targets 5-HT2A receptors, while avoiding activity at dopamine and other receptors commonly targeted by antipsychotics had recently been approved by FDA to treat hallucinations and delusions in PD. Quetiapine is widely prescribed for the treatment of psychosis in different NDD, but the data remains equivocal. Psychosis with different types of hallucinations and delusions may occur in the context of delirium and is almost universal as a neuropsychiatric symptom in the course of PD and AD. Currently, pimavanserin remains the only pharmacologic agent approved for treatment of psychosis in PD. In cases of other NPS in other than Parkinson's diseases, atypical antipsychotics are commonly used off-label. More research is greatly needed to advance this field and address NPS especially psychosis in geriatric population.
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Affiliation(s)
- Kasia Gustaw Rothenberg
- Cleveland Clinic Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Ryan Rajaram
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
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Jaïdi Y, Guilloteau A, Nonnonhou V, Bertholon LA, Badr S, Morrone I, Novella JL, Mahmoudi R. Threshold for a Reduction in Anticholinergic Burden to Decrease Behavioral and Psychological Symptoms of Dementia. J Am Med Dir Assoc 2018; 20:159-164.e3. [PMID: 30503588 DOI: 10.1016/j.jamda.2018.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/21/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND A high anticholinergic burden (AB) is associated with the occurrence of behavioral and psychological symptoms (BPSDs), which are frequent in dementia. OBJECTIVES Our aim was to determine the threshold for a reduction in AB that would lead to a clinically significant improvement in BPSDs (in terms of frequency, severity, and disruptiveness). DESIGN A single-center prospective study. SETTINGS Dedicated geriatric care unit specializing in the management of patients with dementia. PARTICIPANTS The study involved older patients with dementia, hospitalized for management of BPSDs. METHODS One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). The AB was assessed using 3 scales, namely, the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden scale (ACB), and the Anticholinergic Risk Scale (ARS). A clinically significant improvement in BPSDs was defined as a reduction of 4 points in the frequency × severity (F×S) score of the Neuropsychiatric Inventory-Nursing Home (NPI-NH) questionnaire. The threshold for a reduction in AB that corresponded to a clinically significant improvement in BPSDs was determined by multiple linear regression. RESULTS One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). Using the ADS, a reduction of 2 points in AB in patients with moderate-intensity BPSDs was associated with a clinically significant improvement in the F×S score of the NPI-NH [6.34, 95% confidence interval (CI) 4.54-8.14], and a reduction of 3 points was associated with a clinically significant improvement in the occupational disruptiveness score (4.26, 95% CI 3.11-5.41). CONCLUSIONS/IMPLICATIONS In older patients with dementia presenting BPSDs, the risk-benefit ratio of anticholinergic drugs is debatable and, where possible, drugs with a lower AB would be preferable. Because BPSDs are a frequent cause of hospitalization, a standardized approach to analysis and reduction of AB is warranted in this population. Depending on the scale used to assess anticholinergic burden (AB), a small reduction in AB is associated with a decrease in frequency, severity, and disruptiveness of moderate-intensity BPSDs. Drugs with a high AB should be avoided where possible in older patients with dementia, and drugs with a lower AB would be preferable. Heterogeneity between the assessment scales for AB precludes generalization of the impact of a reduction in AB on BPSDs.
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Affiliation(s)
- Yacine Jaïdi
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France
| | - Adrien Guilloteau
- Epidemiology and infection control unit, University hospital of Dijon, Dijon, France; INSERM U1231, EPICAD Team, Dijon, France
| | - Vignon Nonnonhou
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France
| | - Laurie-Anne Bertholon
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France
| | - Sarah Badr
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France
| | - Isabella Morrone
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France
| | - Jean-Luc Novella
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France
| | - Rachid Mahmoudi
- Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France.
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Ruiz M, Arias A, Sánchez-Llanos E, Gil MP, López-Ortega R, Dakterzada F, Purroy F, Piñol-Ripoll G. Minor Hallucinations in Alzheimer's Disease. J Alzheimers Dis 2018; 64:543-549. [PMID: 29889069 DOI: 10.3233/jad-180234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hallucinations may have a broad spectrum and include so-called minor hallucinations (MHs). MHs include passage hallucinations (PHs), visual illusions, and presence hallucinations (PrHs). OBJECTIVE To determine the prevalence and characteristics of MHs in Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI) patients, and to describe their potential relationship with cognition, behavioral symptoms, and use of psychoactive drugs. METHODS We have recruited prospectively and consecutively 268 subjects (90 AD mild-moderate drug-naïve patients, 78 aMCI, and 100 controls). All patients responded to a semi-structured questionnaire in order to rate psychotic phenomena. Clinical, neuropsychological, and demographic data of patients with and without MH were compared with those of age, sex, and education-matched controls. RESULTS The prevalence of MHs was 21.1% (19) in AD, 12.8% (10) in aMCI, and 3% (3) in controls (p < 0.01). The most frequent MH was PrH (9.3%), followed by PH (4.9%) and illusion (0.7%). Eight (27.8%) patients had more than one MH. After adjusting for age and gender, there was a negative correlation between the presence of MHs and MMSE score (r = -0.261; p < 0.01) and a positive correlation between MHs and Neuropsychiatric Inventory score (r = 0.237; p < 0.01). We did not observe a significant relationship between presence of MHs and the consumption of psychoactive drugs (p > 0.05). CONCLUSION We have shown that the presence of MHs in patients with newly diagnosed, untreated AD and aMCI is more than controls. MHs were correlated with other behavioral symptoms and a worse cognitive performance. We suggest the specific interrogation for MHs as a clinical feature for this population.
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Affiliation(s)
- Maria Ruiz
- Servicio de Neurología, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Spain
| | - Alfonso Arias
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
| | - Ernesto Sánchez-Llanos
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
| | - Maria Pilar Gil
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
| | | | - Faridé Dakterzada
- Clinical Neuroscience Research Group, IRBLleida-Department of Experimental Medicine, Lleida, Spain
| | - Francisco Purroy
- Servicio de Neurología, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Santa Maria Lleida, Spain
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Abstract
INTRODUCTION Understanding of Alzheimer disease is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of Alzheimer disease among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale. PATIENTS AND METHODS We assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. Alzheimer's Disease Knowledge Scale scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving. RESULTS A total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall Alzheimer's Disease Knowledge Scale score (19.1 vs. 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse Alzheimer's Disease Knowledge Scale scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers' knowledge of Alzheimer disease symptoms (P = .00) and diagnosis (P = .05). CONCLUSION Assessing the degree of understanding of Alzheimer disease is essential to the development of health education strategies both in the general population and among caregivers.
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Cortés N, Andrade V, Maccioni RB. Behavioral and Neuropsychiatric Disorders in Alzheimer’s Disease. J Alzheimers Dis 2018; 63:899-910. [DOI: 10.3233/jad-180005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Nicole Cortés
- International Center for Biomedicine (ICC), Santiago, Chile
- Laboratory of Cellular and Molecular Neurosciences, Faculty of Sciences, University of Chile, Santiago, Chile
| | - Víctor Andrade
- International Center for Biomedicine (ICC), Santiago, Chile
- Laboratory of Cellular and Molecular Neurosciences, Faculty of Sciences, University of Chile, Santiago, Chile
| | - Ricardo B. Maccioni
- International Center for Biomedicine (ICC), Santiago, Chile
- Laboratory of Cellular and Molecular Neurosciences, Faculty of Sciences, University of Chile, Santiago, Chile
- Department of Neurological Sciences, Faculty of Medicine, East Campus, University of Chile, Santiago, Chile
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Connors MH, Ames D, Woodward M, Brodaty H. Psychosis and Clinical Outcomes in Alzheimer Disease: A Longitudinal Study. Am J Geriatr Psychiatry 2018; 26:304-313. [PMID: 29174998 DOI: 10.1016/j.jagp.2017.10.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Psychotic symptoms are a common feature in Alzheimer disease (AD), occurring in approximately 40% of patients. These symptoms are associated with worse clinical outcomes. Comparatively little research, however, has distinguished delusions and hallucinations, which may have distinct clinical, neuropathological, and genetic correlates. To address this, the current study examined the clinical outcomes associated with delusions and hallucinations in AD. DESIGN Three-year observational study. SETTING Nine memory clinics in Australia. PARTICIPANTS A total of 445 patients with AD. MEASUREMENTS Measures of neuropsychiatric symptoms, dementia severity, cognition, function, caregiver burden, and medication use were completed annually for 3 years with additional assessments at 3 months and 6 months in the first year. Mortality data were obtained from state registries approximately 5 years after the study. RESULTS Of 445 patients, 102 (22.9%) developed only delusions, 39 (8.8%) developed only hallucinations, and 84 (18.9%) developed both symptoms. Delusions and hallucinations were both associated with greater dementia severity, poorer cognition and function, higher levels of other neuropsychiatric symptoms, and greater caregiver burden. The presence of both symptoms was associated with worse outcomes than only one of these symptoms. Delusions, both by themselves and in combination with hallucinations, predicted institutionalization. Antipsychotic medication use predicted mortality. CONCLUSIONS Delusions and hallucinations independently and in combination are associated with poor clinical outcomes. The findings highlight the challenges managing these patients, particularly given the high levels of caregiver burden associated with psychotic symptoms and the likely mortality arising from antipsychotic medication.
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Affiliation(s)
- Michael H Connors
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
| | - David Ames
- National Ageing Research Institute, Melbourne, Australia; University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia
| | - Michael Woodward
- Aged Care, Austin Hospital, Heidelberg, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia.
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Veldwijk-Rouwenhorst AE, Smalbrugge M, Wetzels R, Bor H, Zuidema SU, Koopmans RTCM, Gerritsen DL. Nursing Home Residents with Dementia and Very Frequent Agitation: A Particular Group. Am J Geriatr Psychiatry 2017; 25:1339-1348. [PMID: 28886978 DOI: 10.1016/j.jagp.2017.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/17/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although many nursing home residents with dementia show agitation, hardly any literature is published about very frequent agitation. The WAALBED-III study focuses on the 2-week prevalence and correlates of very frequent agitation in these residents. DESIGN Cross-sectional study using combined data of four studies. SETTING One hundred nineteen dementia special care units in twenty-six nursing homes in The Netherlands. PARTICIPANTS Two thousand seventy-four residents with dementia. MEASUREMENTS We operationally defined very frequent agitation as having a score of 6 (several times a day) or 7 (several times an hour) on at least five items of the Cohen Mansfield Agitation Inventory (CMAI) combined with a CMAI total score above the 90th percentile. To assess the association of demographic and behavioral characteristics with very frequent agitation, we performed a multivariate multilevel logistic regression analysis. RESULTS The 2-week prevalence of very frequent agitation was 7.4% (95% CI: 6.374-8.634). Correlates for very frequent agitation were age (OR: 0.967, 95% CI: 0.942-0.992), dementia severity (GDS 6 = OR: 3.636, 95% CI: 1.929-6.875; GDS 7 = OR: 2.951, 95% CI: 1.321-6.588), delusions (OR: 2.480, 95% CI: 1.555-3.956), anxiety (OR: 1.904, 95% CI: 1.259-2.881), euphoria (OR: 3.712, 95% CI: 2.171-6.337) and irritability (OR: 4.411, 95% CI: 2.854-6.816). CONCLUSIONS To our knowledge, this study is the first to report prevalence data and correlates about nursing home residents with very frequent agitation. We found several correlated factors for very frequent agitation. Still, further research is needed for a better understanding of the behavior of this group, and to identify good treatment options.
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Affiliation(s)
- Annelies E Veldwijk-Rouwenhorst
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland Wetzels
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; De Waalboog, Center for Specialized Geriatric Care "Joachim en Anna", Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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