1
|
Pektas İC, Budak C, Pektas K, Sahin Cam C, Tasdelen R, Ilgin C, Ergun S. Validity and Reliability of the Turkish Version of Mild Behavioral Impairment Checklist in Patients With Cognitive Impairment. J Geriatr Psychiatry Neurol 2024; 37:387-394. [PMID: 38378176 DOI: 10.1177/08919887231225485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVE The Mild Behavioral Impairment-Checklist (MBI-C) was developed to detect and standardize neuropsychiatric symptoms. The objective of this study was to evaluate the Turkish adaptation, validity, and reliability of the MBI-C. METHODS The sample of our study consisted of 80 patients with cognitive impairment and a control group with 113 participants whose cognitive impairment was not detected in standard tests. Participants were evaluated with the Standardized Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale-15 (GDS-15), MBI-C and Neuropsychiatric Inventory (NPI). RESULTS AND CONCLUSION In the reliability analysis, the Cronbach-alpha value for MBI-C was found to be .810. In the ROC analysis performed with the total MBI-C score, the area under the curve (AUC) was calculated as .821 and the cut-off score was determined as 8.5; sensitivity was calculated as .77 and specificity as .83. A strong positive correlation was found between test-retest MBI-C scores (r = .886, P < .0019). A strong positive correlation was found between MBI-C and NPI scores (r = .964, P < .001). MBI-C scores were significantly negatively correlated with MMSE and MoCA scores and positively correlated with GDS-15 scores. The results of our study showed that the Turkish version of the MBI-C is a valid and reliable measurement.
Collapse
Affiliation(s)
- İmge Coskun Pektas
- Marmara University School of Medicine, Istanbul, Turkey
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Budak
- Marmara University School of Medicine, Istanbul, Turkey
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Kadir Pektas
- Department of Family Medicine, Kocaeli University School of Medicine, Izmit, Turkey
| | - Cansun Sahin Cam
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Rumeysa Tasdelen
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Can Ilgin
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhat Ergun
- Marmara University School of Medicine, Istanbul, Turkey
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Yoon S, Jeong I, Kim JI, Hong D, Kang B. Correlates of Mild Behavioral Impairment in Older Adults: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e60009. [PMID: 39074360 PMCID: PMC11319883 DOI: 10.2196/60009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Understanding mild behavioral impairment, a relatively recent notion in neuropsychological studies, provides significant insights into early behavioral indicators of cognitive decline and predicts the onset of dementia in older adults. Although the importance of understanding mild behavioral impairment is acknowledged, comprehensive reviews of its correlates with older adults are limited. OBJECTIVE This scoping review aims to identify the impact of mild behavioral impairment on health outcomes in older adults and the factors associated with mild behavioral impairment. METHODS The review will adhere to the Joanna Briggs Institute's methodological principles for scoping reviews. We will include studies focusing mainly on mild behavioral impairment in older adults, with the literature on this topic being limited to the period from 2003 to the present. Other clinical diagnoses, such as cognitive impairment, Parkinson disease, and multiple sclerosis, will not be included. We will use databases including PubMed (MEDLINE), CINAHL, Web of Science, Embase, PsycINFO, Cochrane, and Scopus for relevant articles published in English. Both gray literature and peer-reviewed articles will be considered during screening. Three independent reviewers will extract data using a predefined data extraction tool. Extracted data will be presented using tables, figures, and a narrative summary aligned with review questions, accompanied by an analysis of study characteristics and categorization of mild behavioral impairment correlates. RESULTS The results will be presented as a descriptive summary, structured according to the associated factors related to mild behavioral impairment, and the health outcomes. Additionally, the data on study characteristics will be presented in tabular format. An exploratory search was conducted in July 2023 to establish a comprehensive search strategy, and iterative refinements to the scoping review protocol and formalization of methods were completed. A follow-up search is planned for May 2024, with the aim of submitting the findings for publication in peer-reviewed journals. CONCLUSIONS To our knowledge, this would be the first study to map the literature on the health-related factors and outcomes of mild behavioral impairment. The findings will support the development of interventions to prevent the occurrence of mild behavioral impairment and mitigate the negative outcomes of mild behavioral impairment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/60009.
Collapse
Affiliation(s)
- Seolah Yoon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Innhee Jeong
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
- Navy Headquarters, Republic of Korea, Gyeryong, Republic of Korea
| | - Jennifer Ivy Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Dahye Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Bada Kang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| |
Collapse
|
3
|
Naude J, Wang M, Leon R, Smith E, Ismail Z. Tau-PET in early cortical Alzheimer brain regions in relation to mild behavioral impairment in older adults with either normal cognition or mild cognitive impairment. Neurobiol Aging 2024; 138:19-27. [PMID: 38490074 DOI: 10.1016/j.neurobiolaging.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
Mild Behavioral Impairment (MBI) leverages later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high-risk group for incident dementia. Phosphorylated tau (p-tau) is a hallmark biological manifestation of Alzheimer disease (AD). We investigated associations between MBI and tau accumulation in early-stage AD cortical regions. In 442 Alzheimer's Disease Neuroimaging Initiative participants with normal cognition or mild cognitive impairment, MBI status was determined alongside corresponding p-tau and Aβ. Two meta-regions of interest were generated to represent Braak I and III neuropathological stages. Multivariable linear regression modelled the association between MBI as independent variable and tau tracer uptake as dependent variable. Among Aβ positive individuals, MBI was associated with tau uptake in Braak I (β=0.45(0.15), p<.01) and Braak III (β=0.24(0.07), p<.01) regions. In Aβ negative individuals, MBI was not associated with tau in the Braak I region (p=0.11) with a negative association in Braak III (p=.01). These findings suggest MBI may be a sequela of neurodegeneration, and can be implemented as a cost-effective framework to help improve screening efficiency for AD.
Collapse
Affiliation(s)
- James Naude
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rebeca Leon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
| |
Collapse
|
4
|
Liampas I, Siokas V, Zoupa E, Kyriakoulopoulou P, Stamati P, Provatas A, Tsouris Z, Tsimourtou V, Lyketsos CG, Dardiotis E. Neuropsychiatric symptoms and white matter hyperintensities in older adults without dementia. Int Psychogeriatr 2024:1-13. [PMID: 38639110 DOI: 10.1017/s1041610224000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE We aimed to examine associations between neuropsychiatric symptoms (NPS) and white matter hyperintensities (WMH) status in older adults without dementia under the hypothesis that WMH increased the odds of having NPS. DESIGN Longitudinal analysis of data acquired from the National Alzheimer's Coordinating Center Uniform Data Set. SETTINGS Data were derived from 46 National Institute on Aging - funded Alzheimer's Disease Research Centers. PARTICIPANTS NACC participants aged ≥50 years with available data on WMH severity with a diagnosis of mild cognitive impairment (MCI) or who were cognitively unimpaired (CU) were studied. Among 4617 CU participants, 376 had moderate and 54 extensive WMH. Among 3170 participants with MCI, 471 had moderate and 88 had extensive WMH. MEASUREMENTS Using Cardiovascular Health Study (CHS) scores, WMH were coded as no to mild (CHS score: 0-4), moderate (score: 5-6) or extensive (score: 7-8). NPS were quantified on the Neuropsychiatric Inventory Questionnaire. Binary logistic regression models estimated the odds of reporting each of 12 NPS by WMH status separately for individuals with MCI or who were CU. RESULTS Compared to CU individuals with no to mild WMH, the odds of having elation [9.87, (2.63-37.10)], disinhibition [4.42, (1.28-15.32)], agitation [3.51, (1.29-9.54)] or anxiety [2.74, (1.28-5.88)] were higher for the extensive WMH group, whereas the odds of having disinhibition were higher for the moderate WMH group [1.94, (1.05-3.61)]. In the MCI group, he odds of NPS did not vary by WMH status. CONCLUSIONS Extensive WMH were associated with higher odds of NPS in CU older adults but not in those with MCI.
Collapse
Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Elli Zoupa
- Larisa Day Care Center of People with Alzheimer's Disease, Association for Regional Development and Mental Health (EPAPSY), Marousi, Greece
| | | | - Polyxeni Stamati
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Antonios Provatas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vana Tsimourtou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Marrie RA, Maxwell CJ, Rotstein DL, Tsai CC, Tremlett H. Prodromes in demyelinating disorders, amyotrophic lateral sclerosis, Parkinson disease, and Alzheimer's dementia. Rev Neurol (Paris) 2024; 180:125-140. [PMID: 37567819 DOI: 10.1016/j.neurol.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
A prodrome is an early set of symptoms, which indicates the onset of a disease; these symptoms are often non-specific. Prodromal phases are now recognized in multiple central nervous system diseases. The depth of understanding of the prodromal phase varies across diseases, being more nascent for multiple sclerosis for example, than for Parkinson disease or Alzheimer's disease. Key challenges when identifying the prodromal phase of a disease include the lack of specificity of prodromal symptoms, and consequent need for accessible and informative biomarkers. Further, heterogeneity of the prodromal phase may be influenced by age, sex, genetics and other poorly understood factors. Nonetheless, recognition that an individual is in the prodromal phase of disease offers the opportunity for earlier diagnosis and with it the opportunity for earlier intervention.
Collapse
Affiliation(s)
- R A Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max-Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - C J Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - D L Rotstein
- Department of Medicine, University of Toronto, 6, Queen's Park Crescent West, 3rd floor, M5S 3H2 Toronto, Ontario, Canada; Saint-Michael's Hospital, 30, Bond Street, M5B 1W8 Toronto, Ontario, Canada
| | - C-C Tsai
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Tremlett
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
6
|
Naude J, Wang M, Leon R, Smith E, Ismail Z. Tau-PET in early cortical Alzheimer brain regions in relation to mild behavioral impairment in older adults with either normal cognition or mild cognitive impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.11.24302665. [PMID: 38405711 PMCID: PMC10888987 DOI: 10.1101/2024.02.11.24302665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Mild Behavioral Impairment (MBI) leverages later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high-risk group for incident dementia. Phosphorylated tau (p-tau) is a hallmark biological manifestation of Alzheimer disease (AD). We investigated associations between MBI and tau accumulation in early-stage AD cortical regions. In 442 Alzheimer's Disease Neuroimaging Initiative participants with normal cognition or mild cognitive impairment, MBI status was determined alongside corresponding p-tau and Aβ. Two meta-regions of interest were generated to represent Braak I and III neuropathological stages. Multivariable linear regression modelled the association between MBI as independent variable and tau tracer uptake as dependent variable. Among Aβ positive individuals, MBI was associated with tau uptake in Braak I (β =0.45(0.15), p<.01) and Braak III (β =0.24(0.07), p<.01) regions. In Aβ negative individuals, MBI was not associated with tau in the Braak I region (p=.11) with a negative association in Braak III (p=.01). These findings suggest MBI may be a sequela of neurodegeneration, and can be implemented as a cost-effective framework to help improve screening efficiency for AD.
Collapse
Affiliation(s)
- James Naude
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rebeca Leon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
7
|
Fisher DW, Dunn JT, Dong H. Distinguishing features of depression in dementia from primary psychiatric disease. DISCOVER MENTAL HEALTH 2024; 4:3. [PMID: 38175420 PMCID: PMC10767128 DOI: 10.1007/s44192-023-00057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Depression is a common and devastating neuropsychiatric symptom in the elderly and in patients with dementia. In particular, nearly 80% of patients with Alzheimer's Disease dementia experience depression during disease development and progression. However, it is unknown whether the depression in patients with dementia shares the same molecular mechanisms as depression presenting as primary psychiatric disease or occurs and persists through alternative mechanisms. In this review, we discuss how the clinical presentation and treatment differ between depression in dementia and as a primary psychiatric disease, with a focus on major depressive disorder. Then, we hypothesize several molecular mechanisms that may be unique to depression in dementia such as neuropathological changes, inflammation, and vascular events. Finally, we discuss existing issues and future directions for investigation and treatment of depression in dementia.
Collapse
Affiliation(s)
- Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Jeffrey T Dunn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
- Department of Neurology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
| |
Collapse
|
8
|
Rouse HJ, Ismail Z, Andel R, Molinari VA, Schinka JA, Small BJ. Impact of Mild Behavioral Impairment on Longitudinal Changes in Cognition. J Gerontol A Biol Sci Med Sci 2024; 79:glad098. [PMID: 37052173 DOI: 10.1093/gerona/glad098] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND To examine cross-sectional differences and longitudinal changes in cognitive performance based on the presence of mild behavioral impairment (MBI) among older adults who are cognitively healthy or have mild cognitive impairment (MCI). METHODS Secondary data analysis of participants (n = 17 291) who were cognitively healthy (n = 11 771) or diagnosed with MCI (n = 5 520) from the National Alzheimer's Coordinating Center database. Overall, 24.7% of the sample met the criteria for MBI. Cognition was examined through a neuropsychological battery that assessed attention, episodic memory, executive function, language, visuospatial ability, and processing speed. RESULTS Older adults with MBI, regardless of whether they were cognitively healthy or diagnosed with MCI, performed significantly worse at baseline on tasks for attention, episodic memory, executive function, language, and processing speed and exhibited greater longitudinal declines on tasks of attention, episodic memory, language, and processing speed. Cognitively healthy older adults with MBI performed significantly worse than those who were cognitively healthy without MBI on tasks of visuospatial ability at baseline and on tasks of processing speed across time. Older adults with MCI and MBI performed significantly worse than those with only MCI on executive function at baseline and visuospatial ability and processing speed tasks across time. CONCLUSIONS This study found evidence that MBI is related to poorer cognitive performance cross-sectionally and longitudinally. Additionally, those with MBI and MCI performed worse across multiple tasks of cognition both cross-sectionally and across time. These results provide support for MBI being uniquely associated with different aspects of cognition.
Collapse
Affiliation(s)
- Hillary J Rouse
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Department of Neurology, Charles University, Prague, Czech Republic
| | - Victor A Molinari
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - John A Schinka
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
9
|
Sannemann L, Bartels C, Brosseron F, Buerger K, Fliessbach K, Freiesleben SD, Frommann I, Glanz W, Heneka MT, Janowitz D, Kilimann I, Kleineidam L, Lammerding D, Laske C, Munk MHJ, Perneczky R, Peters O, Priller J, Rauchmann BS, Rostamzadeh A, Roy-Kluth N, Schild AK, Schneider A, Schneider LS, Spottke A, Spruth EJ, Teipel S, Wagner M, Wiltfang J, Wolfsgruber S, Duezel E, Jessen F. Symptomatic Clusters Related to Amyloid Positivity in Cognitively Unimpaired Individuals. J Alzheimers Dis 2024; 100:193-205. [PMID: 38848176 DOI: 10.3233/jad-231335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background The NIA-AA Research Framework on Alzheimer's disease (AD) proposes a transitional stage (stage 2) characterized by subtle cognitive decline, subjective cognitive decline (SCD) and mild neurobehavioral symptoms (NPS). Objective To identify participant clusters based on stage 2 features and assess their association with amyloid positivity in cognitively unimpaired individuals. Methods We included baseline data of N = 338 cognitively unimpaired participants from the DELCODE cohort with data on cerebrospinal fluid biomarkers for AD. Classification into the AD continuum (i.e., amyloid positivity, A+) was based on Aβ42/40 status. Neuropsychological test data were used to assess subtle objective cognitive dysfunction (OBJ), the subjective cognitive decline interview (SCD-I) was used to detect SCD, and the Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess NPS. A two-step cluster analysis was carried out and differences in AD biomarkers between clusters were analyzed. Results We identified three distinct participant clusters based on presented symptoms. The highest rate of A+ participants (47.6%) was found in a cluster characterized by both OBJ and SCD. A cluster of participants that presented with SCD and NPS (A+:26.6%) and a cluster of participants with overall few symptoms (A+:19.7%) showed amyloid positivity in a range that was not higher than the expected A+ rate for the age group. Across the full sample, participants with a combination of SCD and OBJ in the memory domain showed a lower Aβ42/ptau181 ratio compared to those with neither SCD nor OBJ. Conclusions The cluster characterized by participants with OBJ and concomitant SCD was enriched for amyloid pathology.
Collapse
Affiliation(s)
- Lena Sannemann
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Göttingen, Germany
| | | | - Katharina Buerger
- German Center for Neurodegenerative Diseases - DZNE, Munich, Germany
- Institute for Stroke and Dementia Research - ISD, University Hospital, LMU Munich, Munich, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Silka Dawn Freiesleben
- German Center for Neurodegenerative Diseases - DZNE, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Ingo Frommann
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases - DZNE, Magdeburg, Germany
| | - Michael T Heneka
- Luxembourg Centre for Systems Biomedicine - LCSB, University of Luxembourg, Belvaux, Luxembourg
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research - ISD, University Hospital, LMU Munich, Munich, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases - DZNE, Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Dominik Lammerding
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases - DZNE, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Section for Dementia Research, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Matthias H J Munk
- German Center for Neurodegenerative Diseases - DZNE, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases - DZNE, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology - SyNergy, Munich, Munich, Germany
- Ageing Epidemiology Research Unit - AGE, School of Public Health, Imperial College London, London, UK
| | - Oliver Peters
- German Center for Neurodegenerative Diseases - DZNE, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases - DZNE, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, Berlin, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- University of Edinburgh and UK DRI, Edinburgh, UK
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Sheffield Institute for Translational Neuroscience - SITraN, University of Sheffield, Sheffield, UK
- Department of Neuroradiology, University Hospital LMU, Munich, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Nina Roy-Kluth
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
| | - Ann-Katrin Schild
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Luisa-Sophie Schneider
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Eike Jakob Spruth
- German Center for Neurodegenerative Diseases - DZNE, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, Berlin, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases - DZNE, Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Michael Wagner
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases - DZNE, Göttingen, Germany
- Department of Medical Sciences, Neurosciences and Signaling Group, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Steffen Wolfsgruber
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Emrah Duezel
- German Center for Neurodegenerative Diseases - DZNE, Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research - IKND, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
- German Center for Neurodegenerative Diseases - DZNE, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases - CECAD, University of Cologne, Cologne, Germany
| |
Collapse
|
10
|
Singh AK, Malviya R, Prakash A, Verma S. Neuropsychiatric Manifestations in Alzheimer's Disease Patients: Genetics and Treatment Options. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:39-54. [PMID: 36856177 DOI: 10.2174/1871527322666230301111216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/03/2022] [Accepted: 12/27/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by neuropsychiatric symptoms (NPS), which cause great misery to those with dementia and those who care for them and may lead to early institutionalization. OBJECTIVE The present systematic review aims to discuss the various aspects of Alzheimer's, including treatment options. METHODS The databases Embase, PubMed, and Web of Science were searched to collect data. RESULTS Incipient cognitive deterioration is commonly accompanied by these early warning signals of neurocognitive diseases. The neurobiology of NPSs in Alzheimer's disease, as well as particular symptoms, including psychosis, agitation, apathy, sadness, and sleep disorders, will be examined in this review. For NPSs in Alzheimer's disease, clinical trial designs, as well as regulatory issues, were also addressed. A fresh wave of research, however, is helping to push the discipline ahead. For medication development and repurposing, we highlight the most recent results in genetics, neuroimaging, and neurobiology. Even though identifying and treating psychosis in adults with dementia is still a challenging endeavor, new options are coming up that give the field fresh focus and hope. Conclsuion: It can be concluded from the complete literature survey that Alzheimer's-related psychosis as well as other symptoms that are not psychotic, have made significant progress in the last decade. These milestones in the development of safer, more effective treatments have been achieved as a consequence of great focus on non-pharmacological interventions like DICE or WHELD; the investigation into ways to improve existing drugs like aripiprazole, risperidone, amisulpride, and Escitalopram for safer precision-based treatment; and the development of a clinical trial program for pimavanserin.
Collapse
Affiliation(s)
- Arun Kumar Singh
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| | - Anuj Prakash
- Reference Standard Division, Indian Pharmacopoeia Commission, Sec-23, Raj Nagar, Ghaziabad, Uttar Pradesh, India
| | - Swati Verma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University Greater Noida, Uttar Pradesh, India
| |
Collapse
|
11
|
Matsuoka T, Ismail Z, Imai A, Shibata K, Nakamura K, Nishimura Y, Rubinstein E, Uchida H, Mimura M, Narumoto J. Relationship between Loneliness and Mild Behavioral Impairment: Validation of the Japanese Version of the MBI Checklist and a Cross-Sectional Study. J Alzheimers Dis 2024; 97:1951-1960. [PMID: 38306041 PMCID: PMC10894585 DOI: 10.3233/jad-230923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Abstract
Background Mild behavioral impairment (MBI) and loneliness are associated with cognitive decline and an increased risk of dementia. Objective Our aim was to examine the validity of the Japanese version of the MBI checklist (MBI-C) and investigate the relationship between loneliness and MBI. Methods The participants in this cross-sectional study included 5 cognitively normal persons and 75 persons with mild cognitive impairment. MBI-C and the revised University of California at Los Angeles loneliness scale (LS) were used to assess MBI and loneliness, respectively. Diagnostic performance of MBI-C was examined using receiver operating characteristic analysis. The relationship between MBI-C and LS was examined using multiple linear regression in 67 subjects who were assessed with both scales, with MBI-C total or domain score as the dependent variable and LS as the independent variable, adjusted for age, gender, living situation, presence of visual and hearing impairment, and Mini-Mental State Examination score. Results Per the Youden index, in this mostly MCI sample, the optimal MBI-C cut-off score was 5.5 with sensitivity 0.917 and specificity 0.949. In multiple linear regression analysis, LS score was detected as a significant predictor of MBI-C total scores, and MBI-C decreased motivation, affective dysregulation, and abnormal thought and perception scores. Conclusions The caregiver-rated Japanese MBI-C has excellent diagnostic performance. Loneliness is associated with a greater MBI burden, especially in the decreased motivation, affective dysregulation, and abnormal thought and perception domains. Interventions for loneliness in older people may have the potential to improve MBI.
Collapse
Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Psychiatry, NHO Maizuru Medical Center, Maizuru, Japan
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O’BrienInstitute for Public Health, University of Calgary, Calgary, Canada
- NIHR Exeter Biomedical Research Centre, University of Exeter, UK
| | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keisuke Shibata
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukihide Nishimura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ellen Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
12
|
Siafarikas N. Neuropsychiatric and Cognitive Symptoms: Two Sides of the Same Coin? J Alzheimers Dis 2024; 98:75-78. [PMID: 38393917 DOI: 10.3233/jad-231418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Neuropsychiatric symptoms (NPS) are increasingly being recognized as clinical markers for incipient dementia in Alzheimer's disease (AD dementia). NPS may reinforce cognitive impairment or decline and vice versa. Although NPS are frequent already in mild cognitive impairment, their mechanisms are poorly understood. It is unclear if they share biological mechanisms with cognitive symptoms and how they are associated to structural brain changes, but evidence suggests associations of NPS to cerebral atrophy. An additional NPS dimension in AD dementia concepts might add valuable information to detect patients at risk for AD dementia.
Collapse
Affiliation(s)
- Nikias Siafarikas
- Department of Geriatric Psychiatry, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
13
|
Teixeira AL, Rocha NP, Gatchel J. Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1152-1162. [PMID: 38157881 PMCID: PMC10756775 DOI: 10.1055/s-0043-1777774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.
Collapse
Affiliation(s)
- Antonio Lucio Teixeira
- University of Texas University of Texas Health Science Center, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Houston, Texas, United States.
- Faculdade Santa Casa Belo Horizonte, Belo Horizonte MG, Brazil.
| | - Natalia Pessoa Rocha
- University of Texas Health Science Center, McGovern Medical School, Department of Neurology, Houston, Texas, United States.
| | - Jennifer Gatchel
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts, United States.
- Baylor College of Medicine, Department of Psychiatry, Houston, Texas, United States.
- Michael E. Debakey VA Medical Center, Houston, Texas, United States.
| |
Collapse
|
14
|
Kassam F, Chen H, Nosheny R, McGirr A, Williams T, Ng N, Camacho M, Mackin R, Weiner M, Ismail Z. Cognitive profile of people with mild behavioral impairment in Brain Health Registry participants. Int Psychogeriatr 2023; 35:643-652. [PMID: 35130991 PMCID: PMC10063171 DOI: 10.1017/s1041610221002878] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR). DESIGN Observational cohort study. SETTING Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal. PARTICIPANTS The final sample included 499 participant-informant dyads. MEASUREMENTS Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/- individuals, as was the association between cognitive scores and MBI symptom severity. RESULTS Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity. CONCLUSION These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.
Collapse
Affiliation(s)
- F. Kassam
- University of Calgary, Hotchkiss Brain Institute
| | - H. Chen
- University of Calgary, Hotchkiss Brain Institute
| | - R.L. Nosheny
- University of California, San Francisco, Department of Psychiatry
| | - A. McGirr
- University of Calgary, Department of Psychiatry
| | - T. Williams
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | | | - Monica Camacho
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - R.S. Mackin
- University of California, San Francisco, Department of Psychiatry
| | - M.W. Weiner
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - Z. Ismail
- University of Calgary, Hotchkiss Brain Institute
- University of Calgary, Department of Psychiatry
| |
Collapse
|
15
|
Cozza M, Boccardi V. A narrative review on mild behavioural impairment: an exploration into its scientific perspectives. Aging Clin Exp Res 2023; 35:1807-1821. [PMID: 37392350 DOI: 10.1007/s40520-023-02472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
In clinical practice, the admission of patients with late-onset psychological and behavioural symptoms is frequent, regardless of the presence or absence of cognitive decline. These symptoms commonly occur in the prodromal stage of dementia and can precede the onset of dementia. While the concept of Mild Cognitive Impairment (MCI) -which is defined as a level of cognitive impairment insufficient to impact daily functioning- is well established, the notion of Mild Behavioural Impairment (MBI) is not yet widely recognized. However, studies have demonstrated that the presence of MBI in both cognitively normal patients and individuals with MCI is associated with an increased risk of dementia progression. Thus, MBI may serve as a neurobehavioral indicator of pre-dementia risk states. This narrative review aims to discuss the evolution of the term, the relevant clinical aspects, and potential biomarkers that may contribute to the clinical definition of MBI. The objective is to assist clinicians in recognizing the diagnosis and differentiating it from psychiatric syndromes, as well as identifying possible etiologies of neurodegeneration.
Collapse
Affiliation(s)
- Mariagiovanna Cozza
- Department of Integration, Intermediate Care Programme, AUSL Bologna, Bologna, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Piazzale Gambuli 1, 06132, Perugia, Italy.
| |
Collapse
|
16
|
Ismail Z, Leon R, Creese B, Ballard C, Robert P, Smith EE. Optimizing detection of Alzheimer's disease in mild cognitive impairment: a 4-year biomarker study of mild behavioral impairment in ADNI and MEMENTO. Mol Neurodegener 2023; 18:50. [PMID: 37516848 PMCID: PMC10386685 DOI: 10.1186/s13024-023-00631-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/05/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Disease-modifying drug use necessitates better Alzheimer disease (AD) detection. Mild cognitive impairment (MCI) leverages cognitive decline to identify the risk group; similarly, mild behavioral impairment (MBI) leverages behavioral change. Adding MBI to MCI improves dementia prognostication over conventional approaches of incorporating neuropsychiatric symptoms (NPS). Here, to determine if adding MBI would better identify AD, we interrogated associations between MBI in MCI, and cerebrospinal fluid biomarkers [β-amyloid (Aβ), phosphorylated-tau (p-tau), and total-tau (tau)-ATN], cross-sectionally and longitudinally. METHODS Data were from two independent referral-based cohorts, ADNI (mean[SD] follow-up 3.14[1.07] years) and MEMENTO (4.25[1.40] years), collected 2003-2021. Exposure was based on three-group stratification: 1) NPS meeting MBI criteria; 2) conventionally measured NPS (NPSnotMBI); and 3) noNPS. Cohorts were analyzed separately for: 1) cross-sectional associations between NPS status and ATN biomarkers (linear regressions); 2) 4-year longitudinal repeated-measures associations of MBI and NPSnotMBI with ATN biomarkers (hierarchical linear mixed-effects models-LMEs); and 3) rates of incident dementia (Cox proportional hazards regressions). RESULTS Of 510 MCI participants, 352 were from ADNI (43.5% females; mean [SD] age, 71.68 [7.40] years), and 158 from MEMENTO (46.2% females; 68.98 [8.18] years). In ADNI, MBI was associated with lower Aβ42 (standardized β [95%CI], -5.52% [-10.48-(-0.29)%]; p = 0.039), and Aβ42/40 (p = 0.01); higher p-tau (9.67% [3.96-15.70%]; p = 0.001), t-tau (7.71% [2.70-12.97%]; p = 0.002), p-tau/Aβ42 (p < 0.001), and t-tau/Aβ42 (p = 0.001). NPSnotMBI was associated only with lower Aβ42/40 (p = 0.045). LMEs revealed a similar 4-year AD-specific biomarker profile for MBI, with NPSnotMBI associated only with higher t-tau. MBI had a greater rate of incident dementia (HR [95%CI], 3.50 [1.99-6.17; p < 0.001). NPSnotMBI did not differ from noNPS (HR 0.96 [0.49-1.89]; p = 0.916). In MEMENTO, MBI demonstrated a similar magnitude and direction of effect for all biomarkers, but with a greater reduction in Aβ40. HR for incident dementia was 3.93 (p = 0.004) in MBI, and 1.83 (p = 0.266) in NPSnotMBI. Of MBI progressors to dementia, 81% developed AD dementia. CONCLUSIONS These findings support a biological basis for NPS that meet MBI criteria, the continued inclusion of MBI in NIA-AA ATN clinical staging, and the utility of MBI criteria to improve identification of patients for enrollment in disease-modifying drug trials or for clinical care.
Collapse
Affiliation(s)
- Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK.
| | - Rebeca Leon
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK
| | - Clive Ballard
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, B3183, Exeter, EX1 2HZ, UK
| | | | - Eric E Smith
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| |
Collapse
|
17
|
Ebrahim IM, Ghahremani M, Camicioli R, Smith EE, Ismail Z. Effects of race, baseline cognition, and APOE on the association of affective dysregulation with incident dementia: A longitudinal study of dementia-free older adults. J Affect Disord 2023; 332:9-18. [PMID: 36997127 DOI: 10.1016/j.jad.2023.03.074] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Affective symptoms are dementia risk factors. Mild behavioral impairment (MBI) is a neurobehavioral syndrome that refines incorporation of psychiatric symptomatology into dementia prognostication by stipulating symptoms must emerge de novo in later life and persist for ≥6 months. Here, we investigated the longitudinal association of MBI-affective dysregulation with incident dementia. METHODS National Alzheimer Coordinating Centre participants with normal cognition (NC) or mild cognitive impairment (MCI) were included. MBI-affective dysregulation was operationalized as Neuropsychiatric Inventory Questionnaire-measured depression, anxiety, and elation at two consecutive visits. Comparators had no neuropsychiatric symptoms (no NPS) in advance of dementia. Cox proportional hazard models were implemented to assess the risk of dementia, adjusted for age, sex, years of education, race, cognitive diagnosis, and APOE-ε4 status, with interaction terms as appropriate. RESULTS The final sample included 3698 no-NPS (age:72.8; 62.7 % female), and 1286 MBI-affective dysregulation participants (age:75; 54.5 % female). MBI-affective dysregulation had lower dementia-free survival (p < 0.0001) and greater incidence of dementia (HR = 1.76, CI:1.48-2.08, p < 0.001) versus no NPS. Interaction analyses revealed that MBI-affective dysregulation was associated with higher dementia incidence in Black participants than White (HR = 1.70, CI:1.00-2.87, p = 0.046), NC than MCI (HR = 1.73, CI:1.21-2.48, p = 0.0028), and APOE-ε4 noncarriers than carriers (HR = 1.47, CI:1.06-2.02, p = 0.0195). Of MBI-affective dysregulation converters to dementia, 85.5 % developed Alzheimer's disease, which increased to 91.4 % in those with amnestic MCI. LIMITATIONS MBI-affective dysregulation was not stratified by symptom to further examine dementia risk. CONCLUSIONS Emergent and persistent affective dysregulation in dementia-free older adults is associated with substantial risk for dementia and should be considered in clinical assessments.
Collapse
Affiliation(s)
- Inaara M Ebrahim
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Maryam Ghahremani
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada; Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; School of Medicine and Health, University of Exeter, Exeter, UK.
| |
Collapse
|
18
|
Jin P, Xu J, Liao Z, Zhang Y, Wang Y, Sun W, Yu E. A review of current evidence for mild behavioral impairment as an early potential novel marker of Alzheimer's disease. Front Psychiatry 2023; 14:1099333. [PMID: 37293396 PMCID: PMC10246741 DOI: 10.3389/fpsyt.2023.1099333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/31/2023] [Indexed: 06/10/2023] Open
Abstract
Mild behavioral impairment (MBI) is a neurobehavioral syndrome that occurs in the absence of cognitive impairment later in life (≥50 years of age). MBI is widespread in the pre-dementia stage and is closely associated with the progression of cognitive impairment, reflecting the neurobehavioral axis of pre-dementia risk states and complementing the traditional neurocognitive axis. Despite being the most common type of dementia, Alzheimer's disease (AD) does not yet have an effective treatment; therefore, early recognition and intervention are crucial. The Mild Behavioral Impairment Checklist is an effective tool for identifying MBI cases and helps identify people at risk of developing dementia. However, because the concept of MBI is still quite new, the overall understanding of it is relatively insufficient, especially in AD. Therefore, this review examines the current evidence from cognitive function, neuroimaging, and neuropathology that suggests the potential use of MBI as a risk indicator in preclinical AD.
Collapse
Affiliation(s)
- Piaopiao Jin
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaxi Xu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhengluan Liao
- Department of Geriatric VIP No. 3 (Department of Clinical Psychology), Rehabilitation Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yuhan Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wangdi Sun
- Department of Psychiatry, Zhejiang Hospital, Hangzhou, China
| | - Enyan Yu
- Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| |
Collapse
|
19
|
Imai A, Matsuoka T, Narumoto J. Emotional Dysregulation in Mild Behavioral Impairment Is Associated with Reduced Cortical Thickness in the Right Supramarginal Gyrus. J Alzheimers Dis 2023; 93:521-532. [PMID: 37038811 DOI: 10.3233/jad-220948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Mild behavioral impairment (MBI) has attracted attention as a possible precursor symptom of dementia, but its neural basis has not been fully investigated. OBJECTIVE We aimed to investigate the relationship between MBI and surface area, cortical thickness, and volume in the temporal and parietal lobes, which are strongly associated with dementia and emotional disorders. METHODS This retrospective study evaluated 123 participants: 90 with mild cognitive impairment (MCI), 13 with subjective cognitive decline (SCD), and 20 cognitively healthy (CH). Using analysis of covariance (ANCOVA) with sex, age, and MMSE score as covariates, cortical thickness, surface area, and volume in 10 regions were compared between groups with and without MBI. Groups with MBI emotional dysregulation were also compared with groups without MBI. RESULTS ANCOVA revealed significantly smaller cortical thickness in the MBI group's right parahippocampal (p = 0.01) and supramarginal gyri (p = 0.002). After multiple comparison correction, only the right supramarginal gyrus was significantly smaller (p = 0.02). When considering only MBI emotional dysregulation, the right parahippocampal and supramarginal gyrus' cortical thicknesses were significantly smaller in this MBI group (p = 0.03, 0.01). However, multiple comparison correction identified no significant differences (p = 0.14, 0.11). CONCLUSION Overall MBI and the emotional dysregulation domains were associated with reduced cortical thickness in the right parahippocampal and supramarginal gyri. Since neurodegeneration in the medial temporal and parietal lobe precedes early Alzheimer's disease (AD), MBI, particularly emotion dysregulation, may predict early AD below the diagnostic threshold.
Collapse
Affiliation(s)
- Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
20
|
Hu S, Patten S, Charlton A, Fischer K, Fick G, Smith EE, Ismail Z. Validating the Mild Behavioral Impairment Checklist in a Cognitive Clinic: Comparisons With the Neuropsychiatric Inventory Questionnaire. J Geriatr Psychiatry Neurol 2023; 36:107-120. [PMID: 35430902 PMCID: PMC9941652 DOI: 10.1177/08919887221093353] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the utility of the Mild Behavioral Impairment-Checklist (MBI-C) and Neuropsychiatric Inventory Questionnaire (NPI-Q) to capture NPS in subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. METHODS In this cross-sectional memory clinic study, linear regression models compared MBI-C (n = 474) and NPI-Q (n = 1040) scores in relation to Montreal Cognitive Assessment (MoCA) score. RESULTS MBI prevalence was 37% in subjective cognitive decline, 54% in mild cognitive impairment, and 62% in dementia. Worse diagnostic status was associated with higher MBI-C and NPI-Q score (P < .001), lower MoCA (P < .001), and greater age (P < .001). Higher MBI-C (β -.09; 95% CI -.13, -.05) and NPI-Q (β -.17; 95% CI -.23, -.10) scores were associated with lower MoCA scores, with psychosis most strongly associated (β -1.11; 95% CI -1.56, -.65 vs β -1.14; 95% CI -1.55, -.73). CONCLUSIONS The MBI-C captures global and domain-specific NPS across cognitive stages. Both the MBI-C and NPI-Q have utility in characterizing NPS.
Collapse
Affiliation(s)
- Sophie Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Anna Charlton
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Karyn Fischer
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Gordon Fick
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Eric E. Smith
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Zahinoor Ismail, MD, Hotchkiss Brain Institute, University of Calgary, 3280 Hospital Drive NW, TRW Building 1st Floor Calgary, AB T2N 4Z6, Canada.
| |
Collapse
|
21
|
Matsuoka T, Imai A, Narumoto J. Neuroimaging of mild behavioral impairment: A systematic review. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e81. [PMID: 38868411 PMCID: PMC11114318 DOI: 10.1002/pcn5.81] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/30/2023] [Indexed: 06/14/2024]
Abstract
There are many neuroimaging studies of mild behavioral impairment (MBI), but the results have been somewhat inconsistent. Moreover, it remains unclear whether MBI is a risk factor or prodromal symptom of dementia. Therefore, a systematic review was conducted to summarize the results of neuroimaging studies of MBI and consider whether MBI is a prodromal symptom of dementia in terms of its neural correlates. A systematic review supported by a JSPS Grant-in-Aid for Scientific Research (C) was conducted using MBI neuroimaging studies identified using PubMed, PsycINFO, CINAHL, and Google Scholar on November 1, 2022. The inclusion criteria were (i) neuroimaging study; (ii) research on human subjects; (iii) papers written in English; and (iv) not a case study, review, book, comments, or abstract only. Joanna Briggs Institute critical appraisal checklists were used to assess the quality of selected studies, and 23 structural and functional imaging studies were ultimately included in the systematic review. The structural studies suggested an association of MBI with atrophy in the hippocampus, parahippocampal gyrus, entorhinal cortex, and temporal lobe, whereas the functional studies indicated involvement of an altered default mode network, frontoparietal control network, and salience network in MBI. A limitation in many studies was the use of region-of-interest analysis. The brain areas detected as neural correlates of MBI are considered to be alterations in the early stage of each dementia. Therefore, MBI may emerge against a background of pathological changes in dementia.
Collapse
Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| |
Collapse
|
22
|
Pépin É, Tanguay N, Roy MP, Macoir J, Bruneau MA, Ismail Z, Hudon C. Preliminary Validation Study of the French-Quebec Version of the Mild Behavioral Impairment Checklist. Cogn Behav Neurol 2023; 36:9-18. [PMID: 36201620 DOI: 10.1097/wnn.0000000000000321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alzheimer disease dementia may be preceded by cognitive stages during which behavioral and psychological changes can occur. More precisely, behavioral symptoms may be observed during the subjective cognitive decline (SCD) or the mild cognitive impairment (MCI) stages; these symptoms can be measured using the Mild Behavioral Impairment Checklist (MBI-C). OBJECTIVE To validate the French-Quebec version of the MBI-C in individuals ages 60-85 years. METHOD The sample included 60 participants (20 MCI, 20 SCD, 20 cognitively healthy) and their informants. To assess the discriminant validity of the MBI-C, a Kruskal-Wallis analysis with a multiple comparisons test was performed on the MBI-C Total score. To determine convergent validity, Spearman correlations were calculated between the MBI-C subscales and a set of validation tools. Finally, test-retest reliability was assessed with Spearman correlations of MBI-C scores between two test sessions. RESULTS All of the analyses indicated satisfactory psychometric properties for the French-Quebec version of the MBI-C. CONCLUSION This validation study reveals that the MBI-C can be used successfully in dementia risk assessments. From now on, the use of a validated MBI-C will be possible in the French-Quebec population.
Collapse
Affiliation(s)
- Émilie Pépin
- Universite du Quebec à Trois-Rivières, Trois-Rivières, Québec, Canada
- CERVO Brain Research Center, Québec, Québec, Canada
| | - Noémie Tanguay
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
| | - Marie-Pier Roy
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
| | - Joël Macoir
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
| | - Marie-Andrée Bruneau
- Research Center of the University Institute of Geriatrics of Montreal, Montréal, Québec, Canada
- Department of Psychiatry and Addictology, University of Montreal, Montréal, Québec, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- College of Health and Medicine, University of Exeter, Exeter, UK
| | - Carol Hudon
- CERVO Brain Research Center, Québec, Québec, Canada
- Universite Laval, Québec, Québec, Canada
- VITAM Research Center, Québec, Québec, Canada
| |
Collapse
|
23
|
Ghahremani M, Wang M, Chen HY, Zetterberg H, Smith E, Ismail Z. Plasma Phosphorylated Tau at Threonine 181 and Neuropsychiatric Symptoms in Preclinical and Prodromal Alzheimer Disease. Neurology 2023; 100:e683-e693. [PMID: 36323521 PMCID: PMC9969916 DOI: 10.1212/wnl.0000000000201517] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Plasma phosphorylated tau at threonine 181 (p-tau181), a well-validated marker of Alzheimer disease (AD) pathologic change, could be a more efficient way to diagnose AD than invasive or expensive biomarkers requiring CSF or PET. In some individuals, neuropsychiatric symptoms (NPS) are the earliest manifestation of AD, observed in advance of clear cognitive decline. However, the few studies assessing AD biomarkers in association with NPS have often had imprecision in capturing behavioral symptoms that represent sequelae of neurodegenerative disease. Thus, the mild behavioral impairment (MBI) construct was developed, framing NPS in a way to improve the precision of risk estimates for disease. MBI core criteria stipulate that NPS emerge de novo in later life and persist for at least 6 months. Here, cross-sectionally and longitudinally, we investigated associations of MBI with p-tau181, neuropsychological test performance, and incident AD. METHODS Cognitively unimpaired and mild cognitive impairment (MCI) Alzheimer's Disease Neuroimaging Initiative participants were selected. MBI status was derived from the Neuropsychiatric Inventory (NPI) using a published algorithm. NPI total scores at baseline and year 1 visits were used to operationalize MBI (score >0 at both visits), NPS not meeting the MBI criteria (NPS-not-MBI, score >0 at only 1 visit), and no NPS (score = 0 at both visits). Linear regressions were fitted for cross-sectional analyses; multilevel linear mixed-effects and Cox proportional hazards models were implemented to examine the longitudinal associations of MBI with changes in p-tau181 and cognition and incident dementia. RESULTS The sample included 571 participants (age 72.2 years, 46.8% female, 64.8% MCI). Cross-sectionally (β = 8.1%, 95% CI 1.4%-15.2%, p = 0.02), MBI was associated with higher plasma p-tau181 levels compared with no NPS; NPS-not-MBI was not. Longitudinally, MBI was associated with higher p-tau181 (β = 0.014%, 95% CI 0.003-0.026, p = 0.02), in addition to a decline in memory and executive function. Survival analyses demonstrated a 3.92-fold greater dementia incidence in MBI, with no significant differences between NPS-not-MBI and no NPS. DISCUSSION These findings extend the evidence base that MBI is associated with elevated risk of cognitive decline and dementia and a sequela of emerging Alzheimer-related proteinopathies. MBI offers a substantial improvement over current approaches that explore behavior as a proxy marker for Alzheimer-related proteinopathies, with both clinical and AD trial enrichment implications.
Collapse
Affiliation(s)
| | | | | | | | | | - Zahinoor Ismail
- From the Department of Psychiatry (M.G., H.-Y.C., Z.I.), Hotchkiss Brain Institute (M.G., M.W., H.-Y.C., E.S., Z.I.), Department of Clinical Neurosciences (M.W., E.S., Z.I.), Cumming School of Medicine, and Department of Community Health Sciences (M.W., E.S., Z.I.), University of Calgary, Alberta, Canada; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology, Queen Square; UK Dementia Research Institute at UCL (H.Z.); Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Mathison Centre for Mental Health Research & Education (Z.I.), University of Calgary, Alberta, Canada; and College of Medicine and Health (Z.I.), University of Exeter, United Kingdom.
| | | |
Collapse
|
24
|
The Fuzzy Border between the Functional and Dysfunctional Effects of Beta-Amyloid: A Synaptocentric View of Neuron-Glia Entanglement. Biomedicines 2023; 11:biomedicines11020484. [PMID: 36831020 PMCID: PMC9953143 DOI: 10.3390/biomedicines11020484] [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: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Recent observations from clinical trials using monoclonal antibodies against Aβ seem to suggest that Aβ-targeting is modestly effective and not sufficiently based on an effective challenge of the role of Aβ from physiological to pathological. After an accelerated approval procedure for aducanumab, and more recently lecanemab, their efficacy and safety remain to be fully defined despite previous attempts with various monoclonal antibodies, and both academic institutions and pharmaceutical companies are actively searching for novel treatments. Aβ needs to be clarified further in a more complicated context, taking into account both its accumulation and its biological functions during the course of the disease. In this review, we discuss the border between activities affecting early, potentially reversible dysfunctions of the synapse and events trespassing the threshold of inflammatory, self-sustaining glial activation, leading to irreversible damage. We detail a clear understanding of the biological mechanisms underlying the derangement from function to dysfunction and the switch of the of Aβ role from physiological to pathological. A picture is emerging where the optimal therapeutic strategy against AD should involve a number of allied molecular processes, displaying efficacy not only in reducing the well-known AD pathogenesis players, such as Aβ or neuroinflammation, but also in preventing their adverse effects.
Collapse
|
25
|
Yoon EJ, Lee JY, Kwak S, Kim YK. Mild behavioral impairment linked to progression to Alzheimer's disease and cortical thinning in amnestic mild cognitive impairment. Front Aging Neurosci 2023; 14:1051621. [PMID: 36688162 PMCID: PMC9846631 DOI: 10.3389/fnagi.2022.1051621] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Background Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later life emergence of sustained neuropsychiatric symptoms, as an at-risk state for dementia. However, the associations between MBI and a risk of progression to Alzheimer's disease (AD) and its neuroanatomical correlates in mild cognitive impairment (MCI) are still unclear. Method A total 1,184 older adults with amnestic MCI was followed for a mean of 3.1 ± 2.0 years. MBI was approximated using a transformation algorithm for the Neuropsychiatric Inventory at baseline. A two-step cluster analysis was used to identify subgroups of individuals with amnestic MCI based on profiles of 5 MBI domain symptoms (decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, abnormal perception/thought content). A Cox regression analysis was applied to investigate differences in the risk of progression to AD between subgroups. A subset of participants (n = 202) underwent 3D T1-weighted MRI scans at baseline and cortical thickness was compared between the subgroups of amnestic MCI patients. Result The cluster analysis classified the patients into 3 groups: (1) patients without any MBI domain symptoms (47.4%, asymptomatic group); (2) those with only affective dysregulation (29.4%, affective dysregulation group); (3) those with multiple MBI domain symptoms, particularly affective dysregulation, decreased motivation and impulse dyscontrol (23.2%, complex group). Compared to the asymptomatic group, the complex group was associated with a higher risk of progression to AD (hazard ratio = 2.541 [1.904-3.392], p < 0.001), but the affective dysregulation group was not (1.214 [0.883-1.670], p = 0.232). In cortical thickness analysis, the complex group revealed cortical thinning bilaterally in the inferior parietal, lateral occipital, lateral superior temporal, and frontopolar regions compared with the affective dysregulation group. Conclusion The multiple co-occuring MBI domains in individuals with amnestic MCI are associated with a higher risk of progression to AD and cortical thinning in temporal, parietal and frontal areas. These results suggest that evaluation of MBI could be useful for risk stratification for AD and appropriate intervention in MCI individuals.
Collapse
Affiliation(s)
- Eun Jin Yoon
- Memory Network Medical Research Center, Seoul National University, Seoul, South Korea,Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, South Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea,Department of Medical Device Development, Seoul National University College of Medicine, Seoul, South Korea
| | - Seyul Kwak
- Department of Psychology, Pusan National University, Busan, South Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea,*Correspondence: Yu Kyeong Kim,
| |
Collapse
|
26
|
Manera V, Fabre R, Daumas L, Zeghari R, Derreumaux A, Payne M, Lemaire J, Sacco G, Gros A, Robert P. Cutoff scores for the "Interest game", an application for the assessment of diminished interest in neurocognitive disorders. Front Psychiatry 2023; 14:1126479. [PMID: 37020737 PMCID: PMC10067876 DOI: 10.3389/fpsyt.2023.1126479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/24/2023] [Indexed: 04/07/2023] Open
Abstract
Diminished interest is a core feature of apathy that shows high prevalence in people with Mild and Major Neurocognitive disorders (NCD). In the clinical setting, apathy is mainly assessed using clinical scales and questionnaires, but new technologies are starting to be employed to complement classical instruments. Here, we explored the performance of the "Interest game," a ludic application that assesses personal interests, in discriminating between persons with and without diminished interest based on the Apathy Diagnostic Criteria. Two hundred and twenty-seven elderly participants (56 healthy controls, 118 persons with mild-NCD, and 53 with major-NCD) completed the Interest game and were assessed by clinicians concerning the presence and the severity of apathy. Results showed that the application scores varied with the presence of apathy, the type of disorder, and the education level. Cutoff scores calculated for persons with Mild-NCD resulted in a sensitivity of 0.68 and a specificity of 0.65 for the main score index, suggesting the interest of employing this application in the clinical setting to complement the classical assessment.
Collapse
Affiliation(s)
- Valeria Manera
- Université Côte d’Azur, CobTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
- Université Côte d’Azur, Department of Speech Therapy (Departement d’Orthophonie, DON), Nice, France
- *Correspondence: Valeria Manera,
| | - Roxane Fabre
- Université Côte d’Azur, CobTeK, Nice, France
- Université Cote d’Azur, Nice University Hospital (CHU), Public Health Department, Nice, France
| | - Lyne Daumas
- Université Côte d’Azur, CobTeK, Nice, France
- Université Côte d’Azur, LAMHESS, Nice, France
| | - Radia Zeghari
- Université Côte d’Azur, CobTeK, Nice, France
- Centre Hospitalier Universitaire-Lenval, Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Hôpitaux Pédiatriques de Nice, Nice, France
| | - Alexandre Derreumaux
- Université Côte d’Azur, CobTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Magali Payne
- Université Côte d’Azur, CobTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
- Université Côte d’Azur, Department of Speech Therapy (Departement d’Orthophonie, DON), Nice, France
| | - Justine Lemaire
- Université Côte d’Azur, CobTeK, Nice, France
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Guillaume Sacco
- Université Côte d’Azur, CobTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Auriane Gros
- Université Côte d’Azur, CobTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
- Université Côte d’Azur, Department of Speech Therapy (Departement d’Orthophonie, DON), Nice, France
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Philippe Robert
- Université Côte d’Azur, CobTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
- Université Côte d’Azur, Department of Speech Therapy (Departement d’Orthophonie, DON), Nice, France
| |
Collapse
|
27
|
Warren SL, Hamza EA, Tindle R, Reid E, Whitfield P, Doumit A, Moustafa AA. Common Neuropsychiatric S ymptoms in Alzheimer's Disease, Mild Cognitive Impairment, and Subjective Memory Complaints: A Unified Framework. Curr Alzheimer Res 2023; 20:459-470. [PMID: 37873914 DOI: 10.2174/0115672050255489231012072014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/25/2023]
Abstract
The Alzheimer's disease (AD) continuum is a unique spectrum of cognitive impairment that typically involves the stages of subjective memory complaints (SMC), mild cognitive impairment (MCI), and AD dementia. Neuropsychiatric symptoms (NPS), such as apathy, anxiety, stress, and depression, are highly common throughout the AD continuum. However, there is a dearth of research on how these NPS vary across the AD continuum, especially SMC. There is also disagreement on the effects of specific NPS on each stage of the AD continuum due to their collinearity with other NPS, cognitive decline, and environmental factors (e.g., stress). In this article, we conduct a novel perspective review of the scientific literature to understand the presence of NPS across the AD continuum. Specifically, we review the effects of apathy, depression, anxiety, and stress in AD, MCI, and SMC. We then build on this knowledge by proposing two theories of NPS' occurrence across the AD continuum. Consequently, we highlight the current landscape, limitations (e.g., differing operationalization), and contentions surrounding the NPS literature. We also outline theories that could clear up contention and inspire future NPS research.
Collapse
Affiliation(s)
- Samuel L Warren
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
| | - Eid Abo Hamza
- Faculty of Education, Tanta University, Tanta, Egypt
- College of Education, Humanities & Social Sciences, Al Ain University, Al Ain, UAE
| | - Richard Tindle
- School of Psychology, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Edwina Reid
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Paige Whitfield
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Adam Doumit
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Ahmed A Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
28
|
Ferraro PM, Gervino E, De Maria E, Meo G, Ponzano M, Pardini M, Signori A, Schenone A, Roccatagliata L, Caponnetto C. Mild behavioral impairment as a potential marker of predementia risk states in motor neuron diseases. Eur J Neurol 2023; 30:47-56. [PMID: 36148819 PMCID: PMC10091712 DOI: 10.1111/ene.15570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Mild behavioral impairment (MBI) has been increasingly regarded as the neurobehavioral axis of predementia risk states, but a specific investigation of its detection as a potential marker of prodromal dementia in motor neuron diseases (MNDs) is still lacking. The aims of our study were therefore to explore MBI in MNDs both at onset and over the disease course, and to evaluate its relationship with baseline and longitudinal cognitive features. METHODS Sixty MND patients with cognitive/behavioral, mood, and motor examinations were recruited and followed longitudinally for up to 15 months. Associations between baseline MBI symptoms and clinical features were tested using the Spearman correlation coefficient. Based on longitudinal data, relative deltas of variation for each cognitive measure were generated, and linear regression models were then used to evaluate the role of baseline MBI symptoms in predicting longitudinal rates of cognitive decline. RESULTS At disease onset, the most impaired MBI domain was affective/emotional dysregulation, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms correlated with more severe baseline motor, cognitive/behavioral, and mood disturbances (p values from <0.001 to 0.05). Longitudinally, the greatest decline was observed in the affective/emotional dysregulation domain, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms at onset were significant predictors of more severe longitudinal cognitive decline in both amyotrophic lateral sclerosis (ALS)-specific and ALS-nonspecific functions (p values from <0.001 to 0.03). CONCLUSIONS MBI represents a valuable clinical marker of incident cognitive decline in MNDs, and its evaluation has good potential for detecting dementia in its preclinical/prodromal phase.
Collapse
Affiliation(s)
- Pilar M Ferraro
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ester Gervino
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emiliano De Maria
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Meo
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Angelo Schenone
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | |
Collapse
|
29
|
Clark C, Rabl M, Dayon L, Popp J. The promise of multi-omics approaches to discover biological alterations with clinical relevance in Alzheimer's disease. Front Aging Neurosci 2022; 14:1065904. [PMID: 36570537 PMCID: PMC9768448 DOI: 10.3389/fnagi.2022.1065904] [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: 10/10/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Beyond the core features of Alzheimer's disease (AD) pathology, i.e. amyloid pathology, tau-related neurodegeneration and microglia response, multiple other molecular alterations and pathway dysregulations have been observed in AD. Their inter-individual variations, complex interactions and relevance for clinical manifestation and disease progression remain poorly understood, however. Heterogeneity at both pathophysiological and clinical levels complicates diagnosis, prognosis, treatment and drug design and testing. High-throughput "omics" comprise unbiased and untargeted data-driven methods which allow the exploration of a wide spectrum of disease-related changes at different endophenotype levels without focussing a priori on specific molecular pathways or molecules. Crucially, new methodological and statistical advances now allow for the integrative analysis of data resulting from multiple and different omics methods. These multi-omics approaches offer the unique advantage of providing a more comprehensive characterisation of the AD endophenotype and to capture molecular signatures and interactions spanning various biological levels. These new insights can then help decipher disease mechanisms more deeply. In this review, we describe the different multi-omics tools and approaches currently available and how they have been applied in AD research so far. We discuss how multi-omics can be used to explore molecular alterations related to core features of the AD pathologies and how they interact with comorbid pathological alterations. We further discuss whether the identified pathophysiological changes are relevant for the clinical manifestation of AD, in terms of both cognitive impairment and neuropsychiatric symptoms, and for clinical disease progression over time. Finally, we address the opportunities for multi-omics approaches to help discover novel biomarkers for diagnosis and monitoring of relevant pathophysiological processes, along with personalised intervention strategies in AD.
Collapse
Affiliation(s)
- Christopher Clark
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland,Geriatric Psychiatry, University Hospital of Psychiatry Zürich, Zürich, Switzerland,*Correspondence: Christopher Clark,
| | - Miriam Rabl
- Geriatric Psychiatry, University Hospital of Psychiatry Zürich, Zürich, Switzerland,University of Lausanne, Lausanne, Switzerland
| | - Loïc Dayon
- Nestlé Institute of Food Safety and Analytical Sciences, Nestlé Research, Lausanne, Switzerland,Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julius Popp
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland,Geriatric Psychiatry, University Hospital of Psychiatry Zürich, Zürich, Switzerland,Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
30
|
Chen TH, Yeh YC, Huang MF, Chen HM, Lee JI, Chen CS. Validation and Comparison of the Informant-Rated and Self-Rated Versions of the Mild Behavioral Impairment Checklist. J Alzheimers Dis 2022; 90:1203-1213. [DOI: 10.3233/jad-220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The Mild Behavioral Impairment Checklist (MBI-C) has been developed to assess mild behavioral impairment (MBI). However, no study has validated the use of MBI-C using a promising translation method in Taiwan. Thus, consistency and discrepancy between informant-rated and self-rated scores have not been extensively researched. Objective: This study validated and compared the informant- and self-rated versions of the MBI-C among community-dwelling people in Taiwan. Method: We recruited 202 pairs of individuals without dementia aged ≥50 years and their cohabitating informants. The participants completed the MBI-C (MBI-C-self), and the informants completed the MBI-C (MBI-C-informant) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) independently. Internal consistency, inter-rater reliability, and convergent validity were examined. Results: Both MBI-C-self and MBI-C-informant exhibited satisfactory Cronbach’s α values (0.92 and 0.88, respectively). The MBI-C-informant total scorewas correlated with the NPI-Q total score (r = 0.83, p < 0.001). Inter-rater reliability between the two versions, as represented by the inter-rater correlation coefficient, was 0.57 (p < 0.001). The prevalence of MBI based on the MBI-C-informant scores was 1.5% higher than that based on the MBI-C-self scores according to the suggested cut-off score of 8.5. The affective dysregulation domain score of MBI-C-informant was significantly lower than that of MBI-C-self. Conclusion: MBI-C-informant exhibited both high reliability and validity. Discrepancies between MBI-C-informant and MBI-C-self related to the detection rates and affective dysregulation domain scores were noted. The level of consistency and discrepancy between these two versions provide implications for the use of MBI-C in clinical practice and future research.
Collapse
Affiliation(s)
- Ting-Hsiang Chen
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduated Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Mei Chen
- Department of Occupational Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-In Lee
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduated Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
31
|
McGirr A, Nathan S, Ghahremani M, Gill S, Smith EE, Ismail Z. Progression to Dementia or Reversion to Normal Cognition in Mild Cognitive Impairment as a Function of Late-Onset Neuropsychiatric Symptoms. Neurology 2022; 98:e2132-e2139. [PMID: 35351783 PMCID: PMC9169943 DOI: 10.1212/wnl.0000000000200256] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mild cognitive impairment (MCI) is an at-risk state for dementia; however, not all individuals with MCI transition to dementia, and some revert to normal cognition (NC). Here, we investigate whether mild behavioral impairment (MBI), the late-life onset of persistent neuropsychiatric symptoms (NPS), improves the prognostic specificity of MCI. METHODS Participants with MCI from the National Alzheimer's Coordinating Center Uniform Data Set were included. NPS were operationalized with the Neuropsychiatric Inventory Questionnaire to identify participants without NPS and those with MBI (persistent, late-onset NPS). Individuals with late-onset NPS not meeting the MBI persistence criterion (NPS_NOT_MBI) were retained for secondary analyses. Progression to dementia, stable MCI, and reversion to NC after 3 years of follow-up were defined per National Institute on Aging-Alzheimer's Association and Petersen criteria. RESULTS The primary sample consisted of 739 participants (NPS- n = 409 and MBI+ n = 330; 75.16 ± 8.6 years old, 40.5% female). After 3 years, 238 participants (33.6%) progressed to dementia, and 90 (12.2%) reverted to NC. Compared to participants without NPS, participants with MBI were significantly more likely to progress to dementia (adjusted odds ratio [AOR] 2.13, 95% CI 1.52-2.99), with an annual progression rate of 14.7% (vs 8.3% for participants with MCI without NPS). Compared to participants without NPS, participants with MBI were less likely to revert to NC (AOR 0.48, 95% CI 0.28-0.83, 2.5% vs 5.3% annual reversion rate). The NPS_NOT_MBI group (n = 331, 76.5 ± 8.6 years old, 45.9% female) were more likely to progress to dementia (AOR 2.18, 95% CI 1.56-3.03, 14.3% annual progression rate) but not less likely to revert to NC than those without NPS. Accordingly, both NPS_NOT_MBI and MBI+ participants had lower Mini-Mental State Examination scores than NPS- participants after 3 years. DISCUSSION Late-onset NPS improve the specificity of MCI as an at-risk state for progression to dementia. However, only persistent late-onset NPS are associated with a lower likelihood of reversion to NC, with transient NPS (i.e., NPS_NOT_MBI) not differing from the NPS- group. Clinical prognostication can be improved by incorporating late-onset NPS, especially those that persist (i.e., MBI), into risk assessments. Clinical trials may benefit from enrichment with these higher-risk participants with MCI.
Collapse
Affiliation(s)
- Alexander McGirr
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Santhosh Nathan
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Maryam Ghahremani
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sascha Gill
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Eric E Smith
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Zahinoor Ismail
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
32
|
Miao R, Chen HY, Gill S, Naude J, Smith EE, Ismail Z. Plasma β-Amyloid in Mild Behavioural Impairment - Neuropsychiatric Symptoms on the Alzheimer's Continuum. J Geriatr Psychiatry Neurol 2022; 35:434-441. [PMID: 34036829 DOI: 10.1177/08919887211016068] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Simple markers are required to recognize older adults at higher risk for neurodegenerative disease. Mild behavioural impairment (MBI) and plasma β-amyloid (Aβ) have been independently implicated in the development of incident cognitive decline and dementia. Here we studied the associations between MBI and plasma Aβ42/Aβ40. METHODS Participants with normal cognition (n = 86) or mild cognitive impairment (n = 53) were selected from the Alzheimer's Disease Neuroimaging Initiative. MBI scores were derived from Neuropsychiatric Inventory items. Plasma Aβ42/Aβ40 ratios were assayed using mass spectrometry. Linear regressions were fitted to assess the association between MBI total score as well as MBI domain scores with plasma Aβ42/Aβ40. RESULTS Lower plasma Aβ42/Aβ40 was associated with higher MBI total score (p = 0.04) and greater affective dysregulation (p = 0.04), but not with impaired drive/motivation (p = 0.095) or impulse dyscontrol (p = 0.29) MBI domains. CONCLUSION In persons with normal cognition or mild cognitive impairment, MBI was associated with low plasma Aβ42/Aβ40. Incorporating MBI into case detection may help capture preclinical and prodromal Alzheimer's disease.
Collapse
Affiliation(s)
- Ruxin Miao
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hung-Yu Chen
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Sascha Gill
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - James Naude
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
33
|
Inamura K, Shinagawa S, Nagata T, Tagai K, Nukariya K, Shigeta M. Education level is associated with neuropsychiatric symptoms in patients with amnestic-mild cognitive impairment. Psychogeriatrics 2022; 22:343-352. [PMID: 35181960 DOI: 10.1111/psyg.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined differences in the severity of neuropsychiatric symptom (NPS) subsyndromes according to education level among patients with amnestic-mild cognitive impairment (a-MCI) with the aim of identifying patient demographics related to NPS subsyndromes. METHODS Overall, 140 patients with a-MCI were included. We divided the patients into three groups according to their educational level (primary education, middle education, and high education) and compared their demographics. To explore the severity of NPS subsyndromes according to educational level, we used the Neuropsychiatric Inventory (NPI) after adjustments for the Mini-Mental State Examination (MMSE) score. Finally, NPS subsyndromes that were identified as being related to educational level were further explored using a general linear model (GLM). RESULTS Significant differences in several demographics were observed among the three groups. Among the NPS subsyndromes, the scores for aggressiveness were significantly higher in the primary and high education groups than in the middle education group, while the apathy/eating problem scores were significantly higher in the primary education group than in the other groups. The GLM analyses showed that aggressiveness was related to marital status and the Zarit Caregiver Burden Interview (ZBI-J) score, while apathy/eating problems were related to the instrumental activities of daily living (IADL) percentage, the ZBI-J score, and the education level in years. CONCLUSIONS Among NPS subsyndromes, aggressiveness and apathy/eating problems differed according to education level in patients with a-MCI. A GLM analysis suggested that not only education level, but also various other factors should be considered when determining the need for NPS interventions.
Collapse
Affiliation(s)
- Keisuke Inamura
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
34
|
Ismail Z, Creese B, Aarsland D, Kales HC, Lyketsos CG, Sweet RA, Ballard C. Psychosis in Alzheimer disease - mechanisms, genetics and therapeutic opportunities. Nat Rev Neurol 2022; 18:131-144. [PMID: 34983978 PMCID: PMC9074132 DOI: 10.1038/s41582-021-00597-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
Psychosis is a common and distressing symptom in people with Alzheimer disease, and few safe and effective treatments are available. However, new approaches to symptom assessment and treatment are beginning to drive the field forward. New nosological perspectives have been provided by incorporating the emergence of psychotic symptoms in older adults - even in advance of dementia - into epidemiological and neurobiological frameworks as well as into diagnostic and research criteria such as the International Psychogeriatric Association criteria for psychosis in neurocognitive disorders, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) research criteria for psychosis in neurodegenerative disease, and the ISTAART criteria for mild behavioural impairment. Here, we highlight the latest findings in genomics, neuroimaging and neurobiology that are informing approaches to drug discovery and repurposing. Current pharmacological and non-pharmacological treatment options are discussed, with a focus on safety and precision medicine. We also explore trial data for pimavanserin, a novel agent that shows promise for the treatment of psychosis in people with dementia, and discuss existing agents that might be useful but need further exploration such as escitalopram, lithium, cholinesterase inhibitors and vitamin D. Although the assessment and management of psychosis in people with dementia remain challenging, new opportunities are providing direction and hope to the field.
Collapse
Affiliation(s)
- Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology, Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Byron Creese
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Science, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Robert A Sweet
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clive Ballard
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| |
Collapse
|
35
|
Guan DX, Chen HY, Camicioli R, Montero-Odasso M, Smith EE, Ismail Z. Dual-task gait and mild behavioral impairment: The Interface between non-cognitive dementia markers. Exp Gerontol 2022; 162:111743. [PMID: 35182610 DOI: 10.1016/j.exger.2022.111743] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mild behavioral impairment (MBI) and dual-task gait cost (DTGC) are two non-cognitive markers of dementia that capture behavioral and motor symptoms. We investigated the relationship between MBI and DTGC in a sample of non-demented older adults. METHODS This was a cross-sectional observational study of 193 participants (10 cognitively normal, 48 subjective cognitive decline (SCD), 135 mild cognitive impairment (MCI); 52.8% female) from 13 Canadian sites from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study. The Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to define MBI severity using a published algorithm. DTGC, the percentage difference between dual-task and preferred walking speeds, was assessed under three cognitive tasks: animal naming, counting backwards, and serial seven subtractions. Associations were tested in the entire cohort and in the MCI subgroup using multivariable linear regression adjusted for age, sex, education, and diagnosis. The role of global cognition, executive function, verbal and working memory in the association were investigated using tests of mediation and moderation. RESULTS MBI symptoms were present in 46.6% of participants (mean age = 72.4 years). Greater overall MBI burden was associated with lower gait speed across all conditions. Furthermore, a one-point increase in global MBI symptom severity was associated with a 0.8% increase in DTGC in the animal fluency condition, a 0.9% increase in the counting backwards condition and a 1.1% increase in the serial sevens condition. These associations were strongest in the subgroup of MCI participants. Executive function but not global cognition or verbal and working memory mediated the association between MBI and DTGC in all three conditions. CONCLUSIONS MBI is associated with gait speed and DTGC in this group of non-demented individuals, independent of the presence or absence of MCI. These findings provide evidence of the relationship between these non-cognitive dementia markers of behavior and gait beyond cognitive impairment.
Collapse
Affiliation(s)
| | | | | | - Manuel Montero-Odasso
- Schulich School of Medicine& Dentistry, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
36
|
RETRACTED - Risk factors for mild behavioral impairment in non-demented geriatrics: a population-based survey in Taiwan. Int Psychogeriatr 2022; 34:191-199. [PMID: 33966688 DOI: 10.1017/s1041610221000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate potential risk factors for mild behavioral impairment (MBI) among non-demented geriatrics. DESIGN Population-based, cross-sectional survey. SETTING Taiwan Alzheimer Disease Association (TADA) Database. PARTICIPANTS Participants were selected by multistage random sampling of all Taiwan counties. They received in-person interviews between December 2011 and March 2013. MEASUREMENTS Demographic data, lifestyle and habits, medical comorbidities, cognitive status measured by the Taiwanese Mini-Mental Status Examination (TMSE) and presence of MCI of the participants were collected. Subjects were distributed to the MBI and non-MBI groups. These factors had been evaluated for their effects on MBI in the univariate and multivariable logistic regression models. RESULTS In total, 6,196 non-demented participants aged 65 years or older, including 409 MBI and 5,787 non-MBI participants, were recruited. After adjustment for age, sex, education, body mass index, lifestyle and habits, medical comorbidities, and MCI, good sleep was associated with lower risk of MBI (OR 0.09, 95% CI 0.07 - 0.12). Low body weight (OR 2.01, 95% CI 1.21-3.33), low-to-medium education (OR 1.40, 95%CI 1.06-1.85; OR 2.32, 95% CI 1.67-3.21), medical comorbidities of hypertension (OR 1.56, 95% CI 1.25-1.95), hyperlipidemia (OR 1.29, 95% CI 1.00-1.67), cancer (OR 2.05, 95% CI 1.37-3.06) were significantly associated with increased MBI risk. MCI neither increased nor decreased risk of MBI (OR 1.00, 95% CI 0.76-1.32). CONCLUSIONS Good sleep was associated with lower MBI risk. Underweight, lower education, medical comorbidities of cancer, hypertension, hyperlipidemia were predictive of MBI.
Collapse
|
37
|
Apathy as a Treatment Target in Alzheimer's Disease: Implications for Clinical Trials. Am J Geriatr Psychiatry 2022; 30:119-147. [PMID: 34315645 DOI: 10.1016/j.jagp.2021.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
Apathy is one of the most prevalent, stable and persistent neuropsychiatric symptom across the neurocognitive disorders spectrum. Recent advances in understanding of phenomenology, neurobiology and intervention trials highlight apathy as an important target for clinical intervention. We conducted a comprehensive review and critical evaluation of recent advances to determine the evidence-based suggestions for future trial designs. This review focused on 4 key areas: 1) pre-dementia states; 2) assessment; 3) mechanisms/biomarkers and 4) treatment/intervention efficacy. Considerable progress has been made in understanding apathy as a treatment target and appreciating pharmacological and non-pharmacological apathy treatment interventions. Areas requiring greater investigation include: diagnostic procedures, symptom measurement, understanding the biological mechanisms/biomarkers of apathy, and a well-formed approach to the development of treatment strategies. A better understanding of the subdomains and biological mechanisms of apathy will advance apathy as a treatment target for clinical trials.
Collapse
|
38
|
Creese B, Ismail Z. Mild behavioral impairment: measurement and clinical correlates of a novel marker of preclinical Alzheimer's disease. Alzheimers Res Ther 2022; 14:2. [PMID: 34986891 PMCID: PMC8734161 DOI: 10.1186/s13195-021-00949-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/14/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Late-life onset neuropsychiatric symptoms are established risk factors for dementia. The mild behavioral impairment (MBI) diagnostic framework was designed to standardize assessment to determine dementia risk better. In this Mini Review, we summarize the emerging clinical and biomarker evidence, which suggests that for some, MBI is a marker of preclinical Alzheimer's disease. MAIN: MBI is generally more common in those with greater cognitive impairment. In community and clinical samples, frequency is around 10-15%. Mounting evidence in cognitively normal samples links MBI symptoms with known AD biomarkers for amyloid, tau, and neurodegeneration, as well as AD risk genes. Clinical studies have found detectable differences in cognition associated with MBI in cognitively unimpaired people. CONCLUSION The emerging evidence from biomarker and clinical studies suggests MBI can be an early manifestation of underlying neurodegenerative disease. Future research must now further validate MBI to improve identification of those at the very earliest stages of disease.
Collapse
Affiliation(s)
- Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
39
|
Stella F, Pais MV, Loureiro JC, Radanovic M, Forlenza OV. Neuropsychiatric symptoms and cerebrovascular risk in non-demented elders: cross-sectional study using the mild behavioural impairment checklist (MBI-C). Psychogeriatrics 2022; 22:55-66. [PMID: 34704636 DOI: 10.1111/psyg.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) may represent early clinical manifestations of evolving brain diseases. Studies underpin the occurrence of NPS in the context of mild cognitive impairment (MCI) and prodromal Alzheimer's disease, where symptoms referred to as 'mild behavioural impairment' (MBI) have been shown to predict conversion to dementia and to hasten cognitive/functional decline. However, the association between NPS and cerebrovascular risk factors has been poorly investigated, despite the high prevalence of the latter among individuals with MCI. The aim of the present study was to investigate the association between MBI and cerebrovascular risk in a clinical sample of non-demented elders. METHODS Sixty-five MCI and 15 cognitively unimpaired older adults were cross-sectionally assessed with the Mild Behavioural Impairment Checklist (MBI-C), using the cut-off score > 6.5 to define positive screening. Participants were submitted to the Hachinski Ischaemic Score (HIS) to account for cerebrovascular symptoms, vascular risk, and related comorbidities. Neuroimaging scans (magnetic resonance imaging and/or 18F-fluorodeoxyglucose-positron emission tomography) and apolipoprotein E genotype were obtained. RESULTS Positive associations were found between total MBI-C scores and increasing number of comorbidities present (0-2 comorbidities), but not with three comorbidities. Two domains of the MBI-C-impulse dyscontrol and social inappropriateness-followed the same trend of the MBI-C total score, with higher scores with the increasing numbers of comorbidities. No significant associations were found between MBI symptoms and HIS or cerebrovascular burden in neuroimaging assessment. CONCLUSION We found weak associations between MBI-C total score and the presence of comorbidities with cerebrovascular risk, but not with structural or functional neuroimaging abnormalities or HIS. This finding may represent that the presence of comorbidities adds limited risk to the occurrence of MBI in this sample of non-demented elders.
Collapse
Affiliation(s)
- Florindo Stella
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil.,UNESP-Universidade Estadual Paulista, Instituto de Biociências, Sao Paulo, Brazil
| | - Marcos V Pais
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Júlia C Loureiro
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| |
Collapse
|
40
|
Botero-Rodríguez F, Córdoba Sastoque AM, Escudero JMS, Santamaría-García H. Neuropsychiatric Symptoms in Patients with Neurocognitive Disorder and Their Performance Between Mild and Major Stages. J Alzheimers Dis 2021; 85:1735-1744. [PMID: 34958035 DOI: 10.3233/jad-215283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The neuropsychiatric symptoms (NPS) in patients with neurocognitive disorders (NCD) increases the risk of exhibiting significant cognitive and functional decline. However, to the best of our knowledge, few studies have evaluated to what extent the presence of chronic and early NPS impacts cognition and functionality in patients with minor or major stages of NCD. OBJECTIVE We aimed to assess the interplay between early and chronic NPS and cognitive and functional presentation of patients with mild and major forms of NCD. METHODS We used two NPS tools tracking early and late NPS and assessed to what extent they determine cognitive and functional outcomes in patients with mild and major forms of NCD. RESULTS We found an inverse relationship between the presence of NPS, as measured by the Neuropsychiatric Inventory and Mild Behavioral Impairment Checklist (MBI-C), and cognitive and functional variables in major forms of NCD. In contrast, the minor stage of NCD was associated with increased MBI-C scores. CONCLUSION Our results revealed that NPS are associated with cognitive and functional outcomes in mild and chronic forms of NCD. Crucially our results suggest that NPS could be considered as a pathological marker of the clinical course of dementia. Additionally, our study calls to study early and late forms of NPS as both impact cognition and functionality of NCD.
Collapse
Affiliation(s)
- Felipe Botero-Rodríguez
- Departamento de Epidemiología Clínica yBioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia.,Departamento de Psiquiatría y SaludMental, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - José Manuel Santacruz Escudero
- Departamento de Psiquiatría y SaludMental, Pontificia Universidad Javeriana, Bogotá, Colombia.,Centro de memoria y cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.,Departamento de Psiquiatría y MedicinaForense, Universitat Autònoma de Barcelona, Barcelona, España
| | - Hernando Santamaría-García
- Departamento de Psiquiatría y SaludMental, Pontificia Universidad Javeriana, Bogotá, Colombia.,Centro de memoria y cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.,PhD Program of Neuroscience, Departamento de Psiquiatría y Salud Mental, Departamento de Fisiología Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
41
|
Neuropsychiatric symptoms and mortality among patients with mild cognitive impairment and dementia due to Alzheimer's disease. J Formos Med Assoc 2021; 121:1705-1713. [PMID: 34933801 DOI: 10.1016/j.jfma.2021.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) could increase mortality risk in people with dementia due to Alzheimer's disease (AD). However, whether NPS affects mortality risk in people with mild cognitive impairment (MCI) and whether any specific syndrome of NPS influences this risk are still unclear. METHODS In total, 984 participants with dementia due to AD, 338 with MCI, and 365 controls were enrolled. Over a mean of 5-year follow-up, cause of death data were obtained from the Ministry of Health and Welfare in Taiwan. NPS were assessed using Neuropsychiatric Inventory Questionnaire (NPI-Q), and psychosis, mood, and frontal domain scores were determined. Survival analyses were conducted to determine the hazard ratio (HR) of death. RESULTS In controlled analyses, HR of death for AD was 2.19 (95% confidence interval [CI] = 1.29-3.71) compared with the control group, whereas no statistical significance was noted for the MCI group. A high NPI-Q score (above the median score) increased mortality risk for both the MCI and AD groups, with HRs of 2.32 (95% CI = 1.07-5.03) and 2.60 (95% CI = 1.51-4.47), respectively. Among NPI-Q domain scores, only high mood domain, but not psychosis or frontal domain, scores increased death risk for both the MCI (HR = 2.89, 95% CI = 1.00-8.51) and AD (HR = 2.59, 95% CI = 1.47-4.55) groups. CONCLUSION Mortality risk is high for patients with AD. Not only for AD, patients with MCI presenting with NPS, particularly mood symptoms, have high death risk.
Collapse
|
42
|
Cherkasov NS, Kolykhalov IV. [Non-cognitive psychopathological symptoms in mild cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:41-51. [PMID: 34870913 DOI: 10.17116/jnevro202112110241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Noncognitive psychopathological symptoms (NPS) in elderly patients are increasingly attracting the attention of researchers in the field of neurodegenerative diseases. The question is raised whether these symptoms are risk factors or initial manifestations of the neurodegeneration process. This article provides information on the prevalence of late-onset NPS together with mild cognitive impairment (MCI), combination of which reflects the risk of developing dementia. The characteristic of mild behavioral impairment syndrome, which is currently used along with the concept of MCI, is given. The authors summarized data of the studies published over the past 10 years on the effect of NPS on the progression of cognitive impairment. Topics related to the differential diagnosis of these disorders, as well as existing approaches to treatment, are considered.
Collapse
|
43
|
Tetsuka S. Depression and Dementia in Older Adults: A Neuropsychological Review. Aging Dis 2021; 12:1920-1934. [PMID: 34881077 PMCID: PMC8612610 DOI: 10.14336/ad.2021.0526] [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: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 01/23/2023] Open
Abstract
Depression and dementia are the most common neuropsychiatric disorders in the older adult population. There are a certain number of depressed patients who visit outpatient clinics because they suspect dementia due to similarities in the clinical symptoms in both disorders. Depressive symptoms associated with dementia may be diagnosed with depression, and treatment with antidepressants is continued for a long time. Depression and dementia differ in their treatment approaches and subsequent courses, and it is necessary to carefully differentiate between the two in the clinical practice of dementia treatment. In this review, I describe the similarities between depression and dementia and how to differentiate depression in dementia treatment based on the differences and emphasize that there is a significant potential to cure depression, in contrast to dementia, for which there is currently no fundamental therapy. Therefore, it is important to recognize that depression and dementia may present with common symptoms and to appropriately differentiate depressed patients who are suspected of having dementia. Dementia is a disorder in which cognitive dysfunction is caused by a variety of causative diseases and conditions, resulting in impairment of activities of daily living. However, current medical science has had difficulty finding a cure for the causative disease. Based on clinical findings, it has also been shown that the degree of symptoms for preexisting psychiatric disorders is alleviated as the brain ages. In the presence of dementia, the speed of the alleviation will increase. The importance of focusing on the positive aspects of aging is also discussed.
Collapse
Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, 329-2763, Japan
| |
Collapse
|
44
|
König A, Mallick E, Tröger J, Linz N, Zeghari R, Manera V, Robert P. Measuring neuropsychiatric symptoms in patients with early cognitive decline using speech analysis. Eur Psychiatry 2021; 64:e64. [PMID: 34641989 PMCID: PMC8581700 DOI: 10.1192/j.eurpsy.2021.2236] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Certain neuropsychiatric symptoms (NPS), namely apathy, depression, and anxiety demonstrated great value in predicting dementia progression, representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing. Therefore, the present study aims to investigate the association between automatically extracted speech features and NPS in patients with mild neurocognitive disorders. METHODS Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. NPS were assessed by the neuropsychiatric inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers. RESULTS Different speech variables are associated with specific NPS; apathy correlates with temporal aspects, and anxiety with voice quality-and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy, and depression scores. CONCLUSIONS Different NPS seem to be characterized by distinct speech features, which are easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS in patients with cognitive impairment. This could have great implications for the design of future clinical trials as this cost-effective method could allow more continuous and even remote monitoring of symptoms.
Collapse
Affiliation(s)
- Alexandra König
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Elisa Mallick
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Johannes Tröger
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Nicklas Linz
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Radia Zeghari
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Valeria Manera
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Philippe Robert
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| |
Collapse
|
45
|
Llibre-Guerra JJ, Behrens MI, Hosogi ML, Montero L, Torralva T, Custodio N, Longoria-Ibarrola EM, Giraldo-Chica M, Aguillón D, Hardi A, Maestre GE, Contreras V, Doldan C, Duque-Peñailillo L, Hesse H, Roman N, Santana-Trinidad DA, Schenk C, Ocampo-Barba N, López-Contreras R, Nitrini R. Frontotemporal Dementias in Latin America: History, Epidemiology, Genetics, and Clinical Research. Front Neurol 2021; 12:710332. [PMID: 34552552 PMCID: PMC8450529 DOI: 10.3389/fneur.2021.710332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: The historical development, frequency, and impact of frontotemporal dementia (FTD) are less clear in Latin America than in high-income countries. Although there is a growing number of dementia studies in Latin America, little is known collectively about FTD prevalence studies by country, clinical heterogeneity, risk factors, and genetics in Latin American countries. Methods: A systematic review was completed, aimed at identifying the frequency, clinical heterogeneity, and genetics studies of FTD in Latin American populations. The search strategies used a combination of standardized terms for FTD and related disorders. In addition, at least one author per Latin American country summarized the available literature. Collaborative or regional studies were reviewed during consensus meetings. Results: The first FTD reports published in Latin America were mostly case reports. The last two decades marked a substantial increase in the number of FTD research in Latin American countries. Brazil (165), Argentina (84), Colombia (26), and Chile (23) are the countries with the larger numbers of FTD published studies. Most of the research has focused on clinical and neuropsychological features (n = 247), including the local adaptation of neuropsychological and behavioral assessment batteries. However, there are little to no large studies on prevalence (n = 4), biomarkers (n = 9), or neuropathology (n = 3) of FTD. Conclusions: Future FTD studies will be required in Latin America, albeit with a greater emphasis on clinical diagnosis, genetics, biomarkers, and neuropathological studies. Regional and country-level efforts should seek better estimations of the prevalence, incidence, and economic impact of FTD syndromes.
Collapse
Affiliation(s)
- Jorge J. Llibre-Guerra
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Maria Isabel Behrens
- Departamento de Neurología y Neurocirugía Hospital Clínico Universidad de Chile, Departamento de Neurociencia, Centro de Investigación Clínica Avanzada (CICA), Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
- Departamento de Psiquiatría y Neurología, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Mirna Lie Hosogi
- Departmento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucia Montero
- Laboratory of Neuropsychology (LNPS), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Teresa Torralva
- Laboratory of Neuropsychology (LNPS), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
| | | | - Margarita Giraldo-Chica
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - David Aguillón
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, United States
| | - Gladys E. Maestre
- Departament of Neurosciences and Alzheimer's Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Valeria Contreras
- Departamento de Neuropsicología, Hospital de Clínicas Dr Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Celeste Doldan
- Departamento de Neuropsicología Cognitiva, Clínica Especializada en Neurociencias Física y Cognitiva CEFYC, Asunción, Paraguay
| | | | - Heike Hesse
- Observatorio COVID-19, Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras
| | - Norbel Roman
- Hospital Social Security of Costa Rica, Universidad de Costa Rica, San Jose, Costa Rica
| | | | - Christian Schenk
- Sección de Neurología, Dept. de Medicina. Recinto de Ciencias Médicas- Universidad de Puerto Rico, San Juan, Puerto Rico
| | - Ninoska Ocampo-Barba
- Instituto Boliviano de Neurociencia Cognitiva, Universidad Autónoma Gabriel René Moreno, Santa Cruz de la Sierra, Bolivia
| | - Ricardo López-Contreras
- Clínica de Memoria, Servicio de Neurología, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Ricardo Nitrini
- Departmento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
46
|
Gill S, Wang M, Mouches P, Rajashekar D, Sajobi T, MacMaster FP, Smith EE, Forkert ND, Ismail Z. Neural correlates of the impulse dyscontrol domain of mild behavioral impairment. Int J Geriatr Psychiatry 2021; 36:1398-1406. [PMID: 33778998 PMCID: PMC9292816 DOI: 10.1002/gps.5540] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/21/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Agitation and aggression are common in dementia and pre-dementia. The dementia risk syndrome mild behavioral impairment (MBI) includes these symptoms in the impulse dyscontrol domain. However, the neural circuitry associated with impulse dyscontrol in neurodegenerative disease is not well understood. The objective of this work was to investigate if regional micro- and macro-structural brain properties were associated with impulse dyscontrol symptoms in older adults with normal cognition, mild cognitive impairment, and Alzheimer's disease (AD). METHODS Clinical, neuropsychiatric, and T1-weighted and diffusion-tensor magnetic resonance imaging (DTI) data from 80 individuals with and 123 individuals without impulse dyscontrol were obtained from the AD Neuroimaging Initiative. Linear mixed effect models were used to assess if impulse dyscontrol was related to regional DTI and volumetric parameters. RESULTS Impulse dyscontrol was present in 17% of participants with NC, 43% with MCI, and 66% with AD. Impulse dyscontrol was associated with: (1) lower fractional anisotropy (FA), and greater mean, axial, and radial diffusivity in the fornix; (2) lesser FA and greater radial diffusivity in the superior fronto-occipital fasciculus; (3) greater axial diffusivity in the cingulum; (4) greater axial and radial diffusivity in the uncinate fasciculus; (5) gray matter atrophy, specifically, lower cortical thickness in the parahippocampal gyrus. CONCLUSION Our findings provide evidence that well-established atrophy patterns of AD are prominent in the presence of impulse dyscontrol, even when disease status is controlled for, and possibly in advance of dementia. Our findings support the growing evidence for impulse dyscontrol symptoms as an early manifestation of AD.
Collapse
Affiliation(s)
- Sascha Gill
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Meng Wang
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of Community Health ScienceUniversity of CalgaryCalgaryAlbertaCanada
| | - Pauline Mouches
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Deepthi Rajashekar
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Tolulope Sajobi
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of Community Health ScienceUniversity of CalgaryCalgaryAlbertaCanada
| | - Frank P MacMaster
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of PsychiatryUniversity of CalgaryCalgaryAlbertaCanada,Addiction and Mental Health Strategic Clinical NetworkAlberta Health ServicesAlbertaCanada
| | - Eric E Smith
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Nils D Forkert
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada,Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada,Department of Community Health ScienceUniversity of CalgaryCalgaryAlbertaCanada,Department of PsychiatryUniversity of CalgaryCalgaryAlbertaCanada,O'Brien Institute for Public HealthCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | | |
Collapse
|
47
|
Matsuoka T, Ueno D, Ismail Z, Rubinstein E, Uchida H, Mimura M, Narumoto J. Neural Correlates of Mild Behavioral Impairment: A Functional Brain Connectivity Study Using Resting-State Functional Magnetic Resonance Imaging. J Alzheimers Dis 2021; 83:1221-1231. [PMID: 34420972 PMCID: PMC8543254 DOI: 10.3233/jad-210628] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Mild behavioral impairment (MBI) is associated with accelerated cognitive decline and greater risk of dementia. However, the neural correlates of MBI have not been completely elucidated. Objective: The study aimed to investigate the correlation between cognitively normal participants and participants with amnestic mild cognitive impairment (aMCI) using resting-state functional magnetic resonance imaging. Methods: The study included 30 cognitively normal participants and 13 participants with aMCI (20 men and 23 women; mean age, 76.9 years). The MBI was assessed using the MBI checklist (MBI-C). Region of interest (ROI)-to-ROI analysis was performed to examine the correlation between MBI-C scores and functional connectivity (FC) of the default mode network, salience network, and frontoparietal control network (FPCN). Age, Mini-Mental State Examination score, sex, and education were used as covariates. A p-value of 0.05, with false discovery rate correction, was considered significant. Results: A negative correlation was observed between the MBI-C total score and FC of the left posterior parietal cortex with the right middle frontal gyrus. A similar result was obtained for the MBI-C affective dysregulation domain score. Conclusion: FPCN dysfunction was detected as a neural correlate of MBI, especially in the affective dysregulation domain. This dysfunction may be associated with cognitive impairment in MBI and conversion of MBI to dementia; however, further longitudinal data are needed to examine this relationship.
Collapse
Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Daisuke Ueno
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Ellen Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| |
Collapse
|
48
|
Sweeder LA, Yannuzzi AL, Hill N. Mild Behavioral Impairment: A New At-Risk State for Alzheimer's Disease? J Gerontol Nurs 2021; 47:29-36. [PMID: 33626162 DOI: 10.3928/00989134-20210210-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
Improving our response to Alzheimer's disease (AD), including prevention and early intervention, is critical for maximizing healthy aging outcomes. Identifying older adults at highest risk for AD would provide an opportunity to offer support, plan for the future, and implement strategies to enhance cognitive and functional outcomes. The emergence of neuropsychiatric symptoms may be one indicator of early AD-related cognitive decline, but distinguishing symptoms from those due to other causes can be challenging. Mild behavioral impairment (MBI) describes an at-risk state for cognitive decline characterized by the late-life onset of neuropsychiatric symptoms. In this article, we discuss the current conceptualization of MBI, the potential for its characteristic neuropsychiatric symptoms to indicate risk for future cognitive decline, and present potential clinical implications. [Journal of Gerontological Nursing, 47(3), 29-36.].
Collapse
|
49
|
Xu L, Li T, Xiong L, Wang X, Ismail Z, Fukuda M, Sun Z, Wang J, Gauthier S, Yu X, Wang H. Reliability and Validity of the Chinese Version of Mild Behavioral Impairment Checklist in Mild Cognitive Impairment and Mild Alzheimer's Disease. J Alzheimers Dis 2021; 81:1141-1149. [PMID: 33935092 DOI: 10.3233/jad-210098] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mild behavioral impairment (MBI) has been proposed as an early manifestation of dementia. The Mild Behavioral Impairment Checklist (MBI-C) may help identify MBI in prodromal and preclinical dementia. OBJECTIVE The study aimed to evaluate the reliability and validity of the Chinese version of MBI-C in mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), and to explore the structure of the five factors of the MBI-C in Chinese culture. METHODS Sixty dyads of MCI and mild AD (MCI, n = 33; mild AD, n = 35) were recruited. The informants completed the MBI-C and Neuropsychiatric Inventory Questionnaire (NPI-Q) and were interviewed for clinician rating of the NPI. The Cronbach's coefficient was used to measure the structural reliability of the MBI-C. The criterion-validity was evaluated with the correlation coefficient between the MBI-C and the total scores of NPI-Q and NPI. Exploratory factor analysis was conducted to investigate the structure of the MBI-C. RESULTS The Cronbach's α coefficient was 0.895. The MBI-C total score was positively correlated with all five domains (r = 0.577∼0.840). The total score of MBI-C was significantly correlated with the total scores of NPI-Q (r = 0.714) and NPI (r = 0.749). Similarly, the five domain scores of MBI-C were significantly correlated with the factor and total scores of NPI-Q (r = 0.312∼0.673) and NPI (r = 0.389∼0.673). The components of each factor in Chinese version of MBI-C were slightly different from those of the a priori defined domains (χ2 = 1818.202, df = 496, p < 0.001). CONCLUSION The Chinese version of MBI-C has good reliability and validity, and can be used to evaluate the psychological and behavioral changes in MCI and mild AD.
Collapse
Affiliation(s)
- Lujie Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Tao Li
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Lingchuan Xiong
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Xiao Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Masami Fukuda
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Zhiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Jing Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Serge Gauthier
- McGill Center for Studies in Aging; Douglas Mental Health Research Institute; McGill University, Montreal, Canada
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Huali Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| |
Collapse
|
50
|
Matuskova V, Ismail Z, Nikolai T, Markova H, Cechova K, Nedelska Z, Laczo J, Wang M, Hort J, Vyhnalek M. Mild Behavioral Impairment Is Associated With Atrophy of Entorhinal Cortex and Hippocampus in a Memory Clinic Cohort. Front Aging Neurosci 2021; 13:643271. [PMID: 34108874 PMCID: PMC8180573 DOI: 10.3389/fnagi.2021.643271] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/16/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives Mild behavioral impairment (MBI) is a syndrome describing late-onset persistent neuropsychiatric symptoms (NPS) in non-demented older adults. Few studies to date have investigated the associations of MBI with structural brain changes. Our aim was to explore structural correlates of NPS in a non-demented memory clinic sample using the Mild Behavioral Impairment Checklist (MBI-C) that has been developed to measure MBI. Methods One hundred sixteen non-demented older adults from the Czech Brain Aging Study with subjective cognitive concerns were classified as subjective cognitive decline (n = 37) or mild cognitive impairment (n = 79). Participants underwent neurological and neuropsychological examinations and brain magnetic resonance imaging (MRI) (1.5 T). The Czech version of the MBI-C was administered to participants’ informants. Five a priori selected brain regions were measured, namely, thicknesses of the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and entorhinal cortex (ERC) and volume of the hippocampus (HV), and correlated with MBI-C total and domain scores. Results Entorhinal cortex was associated with MBI-C total score (rS = −0.368, p < 0.001) and with impulse dyscontrol score (rS = −0.284, p = 0.002). HV was associated with decreased motivation (rS = −0.248, p = 0.008) and impulse dyscontrol score (rS = −0.240, p = 0.011). Conclusion Neuropsychiatric symptoms, particularly in the MBI impulse dyscontrol and motivation domains, are associated with medial temporal lobe atrophy in a clinical cohort of non-demented older adults. This study supports earlier involvement of temporal rather than frontal regions in NPS manifestation. Since these regions are typically affected early in the course of Alzheimer’s disease (AD), the MBI-C may potentially help further identify individuals at-risk of developing AD dementia.
Collapse
Affiliation(s)
- Veronika Matuskova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada.,Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Tomas Nikolai
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Hana Markova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Katerina Cechova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Zuzana Nedelska
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Jan Laczo
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Meng Wang
- Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - Jakub Hort
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Martin Vyhnalek
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| |
Collapse
|