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Ahmadi N, Dratva MA, Heyworth N, Wang X, Blennow K, Banks SJ, Sudermann EE. Moving Beyond Depression: Mood Symptoms Across the Spectrum Relate to Tau Pathology in Older Women at Risk for Alzheimer's Disease. Int J Aging Hum Dev 2024:914150241253257. [PMID: 38751054 DOI: 10.1177/00914150241253257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
We examined how symptoms across the mood spectrum relate to Alzheimer's disease (AD) biomarkers in older women at high risk for AD. Participants included 25 women aged 65+ with mild cognitive deficits and elevated AD genetic risk. The Profile of Mood States Questionnaire measured mood symptoms and a total mood disturbance (TMD) score. Tau burden in the meta-temporal region of interest was measured using MK-6240 Tau positron emission tomography (PET) imaging. A subset (n = 12) also had p-Tau181, and Aß40/42 levels measured in plasma. Higher TMD scores related to higher tau PET standardized uptake value ratio (SUVR). Greater negative mood symptoms correlated with higher tau PET SUVR, while greater vigor correlated with lower SUVR. Similar results were seen with plasma p-Tau181 levels, but not with Aβ40/42 levels. In conclusion, positive and negative mood symptoms related to tau pathology in older women at high risk for AD, highlighting a role of mental well-being in AD risk.
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Affiliation(s)
| | - Melanie A Dratva
- Department of Neurosciences, University of California, San Diego, USA
| | - Nadine Heyworth
- Department of Neurosciences, University of California, San Diego, USA
| | - Xin Wang
- Department of Neurosciences, University of California, San Diego, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, and Department of Neurology, Institute on Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, P.R. China
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, USA
- Department of Psychiatry, University of California, San Diego, USA
| | - Erin E Sudermann
- Department of Psychiatry, University of California, San Diego, USA
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Ehrenkranz R, Zhu X, Glynn NW, Bertolet M, Berman SB, Hengenius JB, Rosano C. Longitudinal Associations Between Higher Self-Reported Energy, Gait Speed, and Cognition in Older Adults With Fatigue. J Gerontol A Biol Sci Med Sci 2023; 78:2407-2414. [PMID: 37774505 PMCID: PMC10692418 DOI: 10.1093/gerona/glad234] [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] [Received: 08/01/2022] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Older adults reporting higher energy levels have better physical function. It is not known if these associations persist among older adults reporting fatigue or if higher energy is associated with cognitive function. We examined longitudinal associations between self-reported energy, gait speed, and cognition, stratified by fatigue, in 2 613 participants (aged 74.6 ± 2.87 years) in the Health, Aging and Body Composition Study. METHODS Self-reported energy (0-10, dichotomized at median) and fatigue (present/absent) were measured at baseline. Usual and rapid-paced gait speed (m/s), modified Mini-Mental State Examination (3MS), and Digit Symbol Substitution Test (DSST) were measured at baseline and annually over 8 years. Linear mixed effect models compared changes in gait speed, 3MS, and DSST between higher and lower energy groups within fatigue strata. RESULTS At baseline, 724 participants (27%) were fatigued; 240 (33%) coreported higher energy (9% of total). The remaining 1 889 participants were fatigue-free (73%); 1 221 (65%) coreported higher energy (47% of total). Those with fatigue and higher energy had average rapid gait declines of 0.007 m/s per year (p = .04) after adjustment for demographics, comorbidities, depressive symptoms, and exercise. DSST declines were found among only fatigue-free participants (β = 0.17, p = .01). No statistically significant associations with energy were found for fatigue-free participants, or for usual gait or 3MS. CONCLUSIONS Asking about older adults' energy levels as well as fatigue may identify a subgroup of older adults protected against physical and cognitive decline, even among those with fatigue.
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Affiliation(s)
- Rebecca Ehrenkranz
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marnie Bertolet
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James B Hengenius
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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Angioni D, Raffin J, Ousset PJ, Delrieu J, de Souto Barreto P. Fatigue in Alzheimer's disease: biological basis and clinical management-a narrative review. Aging Clin Exp Res 2023; 35:1981-1989. [PMID: 37395951 DOI: 10.1007/s40520-023-02482-z] [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: 11/11/2022] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Fatigue is a common symptom in neurodegenerative diseases and is associated with decreased cognitive performances. A full knowledge of the causes and physiopathological pathways leading to fatigue in Alzheimer's disease could help treating this symptom and obtain positive effects on cognitive functions. OBJECTIVES To provide an overview of the clinical conditions and the biological mechanisms leading to fatigue in Alzheimer's disease patients. To review the recent advances on fatigue management and describe the landscape of future possibilities. METHODS We performed a narrative review including all type of studies (e.g. cross-sectional and longitudinal analysis, reviews, clinical trials). RESULTS We found very few studies considering the symptom fatigue in Alzheimer's disease patients. Populations, designs, and objectives varied across studies rendering comparability across studies difficult to perform. Results from cross-sectional and longitudinal analysis suggest that the amyloid cascade may be involved in the pathogenesis of fatigue and that fatigue may be a prodromal manifestation of Alzheimer's disease. Fatigue and neurodegeneration of Alzheimer's disease could share common brain signatures (i.e. hippocampal atrophy and periventricular leukoaraiosis). Some mechanisms of aging (i.e. inflammation, mitochondrial dysfunction, telomere shortening) may be proposed to play a common underlying role in Alzheimer's disease neurodegeneration and muscle fatigability. Considering treatments, donepezil has been found to reduce cognitive fatigue in a 6-week randomized controlled study. Fatigue is frequently reported as an adverse event in patients treated by anti-amyloid agents in clinical trials. CONCLUSION The literature is actually inconclusive about the main causes of fatigue in Alzheimer's disease individuals and its potential treatments. Further research is needed to disentangle the role of several components such as comorbidities, depressive symptoms, iatrogenic factors, physical decline and neurodegeneration itself. Given the clinical relevance of this symptom, it seems to be important to systematically assess fatigue by validated tools in Alzheimer's disease clinical trials.
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Affiliation(s)
- Davide Angioni
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - Jeremy Raffin
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Pierre-Jean Ousset
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Julien Delrieu
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
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Demnitz-King H, Saba L, Lau Y, Munns L, Zabihi S, Schlosser M, Del-Pino-Casado R, Orgeta V, Marchant NL. Association between anxiety symptoms and Alzheimer's disease biomarkers in cognitively healthy adults: A systematic review and meta-analysis. J Psychosom Res 2023; 166:111159. [PMID: 36709611 DOI: 10.1016/j.jpsychores.2023.111159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Anxiety has been identified as both a risk factor and prodromal symptom for Alzheimer's disease (AD) and related dementias, however, the underlying neurobiological correlates remain unknown. The aim of this systematic review and meta-analysis was to examine the association between anxiety symptoms and two defining markers of AD neuropathology: amyloid-beta (Aβ) and tau. METHODS Systematic literature searches were conducted across 5 databases. Studies investigating the relationship between anxiety and AD neuropathology (i.e., Aβ and/or tau) in cognitively healthy adults were eligible. Where possible, effect sizes were combined across studies, for Aβ and tau separately, using random-effects meta-analyses. Sensitivity analyses were performed to assess whether results differed according to anxiety type (i.e., state and trait) and biomarker assessment modality (i.e., positron emission tomography and cerebrospinal fluid). RESULTS Twenty-seven studies reporting data from 14 unique cohorts met eligibility criteria. Random-effects meta-analyses revealed no associations between self-reported anxiety symptoms and either Aβ (13 studies, Fisher's z = 0.02, 95% confidence interval [CI] -0.01-0.05, p = 0.194) or tau (4 studies, Fisher's z = 0.04, 95% CI -0.02-0.09, p = 0.235). Results remained unchanged across sensitivity analyses. CONCLUSIONS In cognitively healthy adults, meta-analytic syntheses revealed no associations between anxiety symptoms and either Aβ or tau. There is a critical need, however, for larger studies with follow-up periods to examine the effect of anxiety symptom onset, severity, and chronicity on AD neuropathology. Additionally, further research investigating other potential neurobiological correlates is crucial to advance scientific understanding of the relationship between anxiety and dementia.
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Affiliation(s)
| | - Lisa Saba
- Division of Psychiatry, University College London, London, United Kingdom
| | - Yolanda Lau
- Division of Psychiatry, University College London, London, United Kingdom
| | - Lydia Munns
- Division of Psychiatry, University College London, London, United Kingdom; Department of Psychology, University of York, York, United Kingdom
| | - Sedigheh Zabihi
- Division of Psychiatry, University College London, London, United Kingdom
| | - Marco Schlosser
- Division of Psychiatry, University College London, London, United Kingdom; Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom
| | - Natalie L Marchant
- Division of Psychiatry, University College London, London, United Kingdom.
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Lin FV. A Multi-Dimensional Model of Fatigue in Old Age: Implications for Brain Aging. Am J Geriatr Psychiatry 2023; 31:152-161. [PMID: 36435711 PMCID: PMC10653728 DOI: 10.1016/j.jagp.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
As the most reported symptom in old age, fatigue is understudied in terms of both mechanisms and measures. Population heterogeneity and methodological inconsistency makes understanding the relationship between fatigue and brain aging challenging. The present article comprehensively reviews existing conceptual and operational frameworks of fatigue, as well as mechanistic heterogeneities of fatigue that exist in the aging literature. Then, I propose a Multi-Dimensional Model of fatigue to provide theoretical cohesion to the study of fatigue in old age, along with a "fatigue circuit" addressing brain profiles across dimensions of fatigue. The potential relationships between fatigue dimensions, the fatigue circuit, and brain aging are discussed to inform the direction of future research.
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Affiliation(s)
- Feng V Lin
- Department of Psychiatry and Behavioral Sciences(FVL), Stanford University, Palo Alto, CA, 94304; Wu Tsai Neuroscience Institute, Stanford University(FVL), Palo Alto, CA, 94304.
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Temporal Appearance of Enhanced Innate Anxiety in Alzheimer Model Mice. Biomedicines 2023; 11:biomedicines11020262. [PMID: 36830799 PMCID: PMC9953677 DOI: 10.3390/biomedicines11020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The prevalence of Alzheimer's disorder (AD) is increasing worldwide, and the co-morbid anxiety is an important, albeit often neglected problem, which might appear early during disease development. Animal models can be used to study this question. Mice, as prey animals, show an innate defensive response against a predator odor, providing a valuable tool for anxiety research. Our aim was to test whether the triple-transgenic mice model of AD shows signs of innate anxiety, with specific focus on the temporal appearance of the symptoms. We compared 3xTg-AD mice bearing human mutations of amyloid precursor protein, presenilin 1, and tau with age-matched controls. First, separate age-groups (between 2 and 18 months) were tested for the avoidance of 2-methyl-2-thiazoline, a fox odor component. To test whether hypolocomotion is a general sign of innate anxiety, open-field behavior was subsequently followed monthly in both sexes. The 3xTg-AD mice showed more immobility, approached the fox odor container less often, and spent more time in the avoidance zone. This effect was detectable already in two-month-old animals irrespective of sex, not visible around six months of age, and was more pronounced in aged females than males. The 3xTg-AD animals moved generally less. They also spent less time in the center of the open-field, which was detectable mainly in females older than five months. In contrast to controls, the aged 3xTg-AD was not able to habituate to the arena during a 30-min observation period irrespective of their sex. Amyloid beta and phospho-Tau accumulated gradually in the hippocampus, amygdala, olfactory bulb, and piriform cortex. In conclusion, the early appearance of predator odor- and open space-induced innate anxiety detected already in two-month-old 3xTg-AD mice make this genetically predisposed strain a good model for testing anxiety both before the onset of AD-related symptoms as well as during the later phase. Synaptic dysfunction by protein deposits might contribute to these disturbances.
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Gupta R, Patel V, McGinnis SM, Silbersweig D, Miller MB, Feany MB, Daffner K, Gale SA. Case Study 4: A 68-Year-Old Woman With Progressive Cognitive Decline and Anxiety. J Neuropsychiatry Clin Neurosci 2023; 35:4-11. [PMID: 36633473 DOI: 10.1176/appi.neuropsych.20220151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rishab Gupta
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - Vihar Patel
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - Scott M McGinnis
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - David Silbersweig
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - Michael B Miller
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - Mel B Feany
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - Kirk Daffner
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
| | - Seth A Gale
- Department of Psychiatry (Gupta, Silbersweig) and Division of Cognitive and Behavioral Neurology, Department of Neurology (McGinnis, Daffner, Gale), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (Patel, Miller, Feany); Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School (McGinnis)
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Ismail Z, Babulal GM. Attitudinal adjustment about dementia awareness and assessment: finetuning inclusion, diversity, and measurement of behavioral and psychological symptoms. Int Psychogeriatr 2023; 35:7-10. [PMID: 36193702 PMCID: PMC9905302 DOI: 10.1017/s1041610222000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology and Laboratory Medicine, Hotchkiss Brain Institute & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ganesh M Babulal
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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