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Pressman PS, Molden J, Wortzel HS, Plys E, Woodcock JH, Filley CM, Arciniegas DB. Psychiatric Screening Measures in Behavioral Variant Frontotemporal Dementia. J Neuropsychiatry Clin Neurosci 2023; 36:160-165. [PMID: 37981780 DOI: 10.1176/appi.neuropsych.20230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Behavioral variant frontotemporal dementia (bvFTD) is sometimes misdiagnosed as a primary psychiatric disorder, such as major depressive disorder, bipolar disorder, an anxiety disorder, autism spectrum disorder (ASD), or attention-deficit hyperactivity disorder (ADHD). Nonspecialists often use screening measures for primary psychiatric disorders in early assessments of persons with bvFTD. The investigators aimed to evaluate the manifestations of bvFTD in surveys intended to screen for primary psychiatric disorders. METHODS Patients with bvFTD (N=27) presenting to an academic neurobehavior specialty clinic and their caregivers were provided questionnaire packets including the Mood Disorder Questionnaire (MDQ), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 scale (GAD-7), the Adult ADHD Self-Report Scale, version 1.1, the Ritvo Autism and Asperger Diagnostic Scale, and the Neuropsychiatric Inventory Questionnaire. Established cutoff scores suggesting the presence of a primary psychiatric disorder were used to define a "positive" response. Individual questions from each screening questionnaire were examined for a more granular characterization of bvFTD. RESULTS Overall, 15% of bvFTD patients screened positive for bipolar disorder, 54% screened positive for ADHD, and 89% screened positive for ASD. Hyperactivity or hypersensitivity symptoms were infrequently endorsed. In addition, 57% of respondents screened positive for depressive symptoms on the PHQ-9, and 43% screened positive for anxiety symptoms on the GAD-7. CONCLUSIONS The use of cutoff scores on screening measures for primary psychiatric disorders resulted in potentially problematic positive screens of primary psychiatric disorders among persons with bvFTD. Identifying specific questions that distinguish between bvFTD and primary psychiatric disorders requires further study.
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Affiliation(s)
- Peter S Pressman
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Joie Molden
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Hal S Wortzel
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Evan Plys
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Jonathan H Woodcock
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Christopher M Filley
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - David B Arciniegas
- Behavioral Neurology Section, Department of Neurology (Pressman, Wortzel, Woodcock, Filley, Arciniegas), and Department of Psychiatry (Wortzel, Filley, Arciniegas), University of Colorado School of Medicine, Aurora; Departments of Neurosurgery (Molden) and Psychiatry (Plys) and the Marcus Institute for Brain Health (Filley, Arciniegas), University of Colorado Anschutz Medical Campus, Aurora; Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora (Wortzel); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
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Potter H, Woodcock JH, Boyd TD, Coughlan CM, O'Shaughnessy JR, Borges MT, Thaker AA, Raj BA, Adamszuk K, Scott D, Adame V, Anton P, Chial HJ, Gray H, Daniels J, Stocker ME, Sillau SH. Safety and efficacy of sargramostim (GM-CSF) in the treatment of Alzheimer's disease. Alzheimers Dement (N Y) 2021; 7:e12158. [PMID: 33778150 PMCID: PMC7988877 DOI: 10.1002/trc2.12158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Inflammatory markers have long been observed in the brain, cerebrospinal fluid (CSF), and plasma of Alzheimer's disease (AD) patients, suggesting that inflammation contributes to AD and might be a therapeutic target. However, non-steroidal anti-inflammatory drug trials in AD and mild cognitive impairment (MCI) failed to show benefit. Our previous work seeking to understand why people with the inflammatory disease rheumatoid arthritis are protected from AD found that short-term treatment of transgenic AD mice with the pro-inflammatory cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) led to an increase in activated microglia, a 50% reduction in amyloid load, an increase in synaptic area, and improvement in spatial memory to normal. These results called into question the consensus view that inflammation is solely detrimental in AD. Here, we tested our hypothesis that modulation of the innate immune system might similarly be used to treat AD in humans by investigating the ability of GM-CSF/sargramostim to safely ameliorate AD symptoms/pathology. METHODS A randomized, double-blind, placebo-controlled trial was conducted in mild-to-moderate AD participants (NCT01409915). Treatments (20 participants/group) occurred 5 days/week for 3 weeks plus two follow-up (FU) visits (FU1 at 45 days and FU2 at 90 days) with neurological, neuropsychological, blood biomarker, and imaging assessments. RESULTS Sargramostim treatment expectedly changed innate immune system markers, with no drug-related serious adverse events or amyloid-related imaging abnormalities. At end of treatment (EOT), the Mini-Mental State Examination score of the sargramostim group increased compared to baseline (P = .0074) and compared to placebo (P = .0370); the treatment effect persisted at FU1 (P = .0272). Plasma markers of amyloid beta (Aβ40 [decreased in AD]) increased 10% (P = .0105); plasma markers of neurodegeneration (total tau and UCH-L1) decreased 24% (P = .0174) and 42% (P = .0019), respectively, after sargramostim treatment compared to placebo. DISCUSSION The innate immune system is a viable target for therapeutic intervention in AD. An extended treatment trial testing the long-term safety and efficacy of GM-CSF/sargramostim in AD is warranted.
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Affiliation(s)
- Huntington Potter
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jonathan H. Woodcock
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Timothy D. Boyd
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Christina M. Coughlan
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - John R. O'Shaughnessy
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Manuel T. Borges
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of RadiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Ashesh A. Thaker
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of RadiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | | | | | | | - Vanesa Adame
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Paige Anton
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Heidi J. Chial
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Helen Gray
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Joseph Daniels
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Michelle E. Stocker
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Stefan H. Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
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Affiliation(s)
- C Alan Anderson
- From the Behavioral Neurology Section, Depts. of Neurology and Psychiatry, University of Colorado School of Medicine, Aurora (CAA, JW, CMF); and the Denver Veterans Affairs Medical Center, Denver, CO (CAA, CMF)
| | - Jonathan H Woodcock
- From the Behavioral Neurology Section, Depts. of Neurology and Psychiatry, University of Colorado School of Medicine, Aurora (CAA, JW, CMF); and the Denver Veterans Affairs Medical Center, Denver, CO (CAA, CMF)
| | - Christopher M Filley
- From the Behavioral Neurology Section, Depts. of Neurology and Psychiatry, University of Colorado School of Medicine, Aurora (CAA, JW, CMF); and the Denver Veterans Affairs Medical Center, Denver, CO (CAA, CMF)
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