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Celis K, Zaman A, Adams LD, Gardner O, Farid R, Starks TD, Lacroix FC, Hamilton-Nelson K, Mena P, Tejada S, Laux R, Song YE, Caban-Holt A, Feliciano-Astacio B, Vance JM, Haines JL, Byrd GS, Beecham GW, Pericak-Vance MA, Cuccaro ML. Neuropsychiatric features in a multi-ethnic population with Alzheimer disease and mild cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e5992. [PMID: 37655494 PMCID: PMC10518518 DOI: 10.1002/gps.5992] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Alzheimer disease (AD) is more prevalent in African American (AA) and Hispanic White (HIW) compared to Non-Hispanic White (NHW) individuals. Similarly, neuropsychiatric symptoms (NPS) vary by population in AD. This is likely the result of both sociocultural and genetic ancestral differences. However, the impact of these NPS on AD in different groups is not well understood. METHODS Self-declared AA, HIW, and NHW individuals were ascertained as part of ongoing AD genetics studies. Participants who scored higher than 0.5 on the Clinical Dementia Rating (CDR) Scale (CDR) were included. Group similarities and differences on Neuropsychiatric Inventory Questionnaire (NPI-Q) outcomes (NPI-Q total score, NPI-Q items) were evaluated using univariate ANOVAs and post hoc comparisons after controlling for sex and CDR stage. RESULTS Our sample consisted of 498 participants (26% AA; 30% HIW; 44% NHW). Overall, NPI-Q total scores differed significantly between our groups, with HIW having the highest NPI-Q total scores, and by AD stage as measured by CDR. We found no significant difference in NPI-Q total score by sex. There were six NPI-Q items with comparable prevalence in all groups and six items that significantly differed between the groups (Anxiety, Apathy, Depression, Disinhibition, Elation, and Irritability). Further, within the HIW group, differences were found between Puerto Rican and Cuban American Hispanics across several NPI-Q items. Finally, Six NPI-Q items were more prevalent in the later stages of AD including Agitation, Appetite, Hallucinations, Irritability, Motor Disturbance, and Nighttime Behavior. CONCLUSIONS We identified differences in NPS among HIW, AA, and NHW individuals. Most striking was the high burden of NPS in HIW, particularly for mood and anxiety symptoms. We suggest that NPS differences may represent the impact of sociocultural influences on symptom presentation as well as potential genetic factors rooted in ancestral background. Given the complex relationship between AD and NPS it is crucial to discern the presence of NPS to ensure appropriate interventions.
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Affiliation(s)
- Katrina Celis
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olivia Gardner
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rajabli Farid
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Faina C Lacroix
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kara Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pedro Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Renee Laux
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yeunjoo E Song
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan L Haines
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Institute for Computational Biology, Cleveland, Ohio, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
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Goodwin GJ, Moeller S, Nguyen A, Cummings JL, John SE. Network analysis of neuropsychiatric symptoms in Alzheimer's disease. Alzheimers Res Ther 2023; 15:135. [PMID: 37568209 PMCID: PMC10416506 DOI: 10.1186/s13195-023-01279-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms due to Alzheimer's disease (AD) and mild cognitive impairment (MCI) can decrease quality of life for patients and increase caregiver burden. Better characterization of neuropsychiatric symptoms and methods of analysis are needed to identify effective treatment targets. The current investigation leveraged the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) to examine the network structure of neuropsychiatric symptoms among symptomatic older adults with cognitive impairment. METHODS The network relationships of behavioral symptoms were estimated from Neuropsychiatric Inventory Questionnaire (NPI-Q) data acquired from 12,494 older adults with MCI and AD during their initial visit. Network analysis provides insight into the relationships among sets of symptoms and allows calculation of the strengths of the relationships. Nodes represented individual NPI-Q symptoms and edges represented the pairwise dependency between symptoms. Node centrality was calculated to determine the relative importance of each symptom in the network. RESULTS The analysis showed patterns of connectivity among the symptoms of the NPI-Q. The network (M = .28) consisted of mostly positive edges. The strongest edges connected nodes within symptom domain. Disinhibition and agitation/aggression were the most central symptoms in the network. Depression/dysphoria was the most frequently endorsed symptom, but it was not central in the network. CONCLUSIONS Neuropsychiatric symptoms in MCI and AD are highly comorbid and mutually reinforcing. The presence of disinhibition and agitation/aggression yielded a higher probability of additional neuropsychiatric symptoms. Interventions targeting these symptoms may lead to greater neuropsychiatric symptom improvement overall. Future work will compare neuropsychiatric symptom networks across dementia etiologies, informant relationships, and ethnic/racial groups, and will explore the utility of network analysis as a means of interrogating treatment effects.
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Affiliation(s)
- Grace J Goodwin
- Department of Psychology, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
| | - Stacey Moeller
- Department of Psychology, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
| | - Amy Nguyen
- Department of Brain Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
| | - Jeffrey L Cummings
- Department of Brain Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
| | - Samantha E John
- Department of Brain Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA.
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Driver-Dunckley ED, Zhang N, Shill HA, Mehta SH, Belden CM, Zamrini EY, Davis K, Beach TG, Adler CH. Correlation Between the Movement Disorder Society's Unified Parkinson's Disease Rating Scale and Nonmotor Scales in Patients with Parkinson's Disease. Innov Clin Neurosci 2019; 16:27-29. [PMID: 32082946 PMCID: PMC7009327] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: The Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDSUPDRS), Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), Mayo Sleep Questionnaire, Epworth Sleepiness Scale, and Neuropsychiatric Inventory Questionnaire (NPI-Q) are validated instruments for assessing signs and symptoms of Parkinson's disease (PD). Objective: We sought to determine whether responses on the MDS-UPDRS correlate with responses to other scales used in patients with PD. Design: Study subjects were enrolled in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND). Participants were selected if they had completed all scales within a one-month window. Spearman's rank correlation coefficients were calculated. Results: A total of 96 eligible subjects were identified. High correlation (r-values) was found between the SCOPA-AUT and MDS-UPDRS excessive saliva (0.73; p<0.001), constipation (0.62; p<0.001), and swallowing (0.59; p<0.001) questions. The r-values for the NPI-Q and MDS-UPDRS depression and anxiety questions were 0.53 (p<0.001), and 0.67 (p<0.001). Conclusion: MDS-UPDRS correlates well with some but not all questions from the SCOPA-AUT and NPI-Q. This work emphasizes the importance of employing multiple methods for assessing nonmotor symptoms in patients with PD.
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Affiliation(s)
- Erika D Driver-Dunckley
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Nan Zhang
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Holly A Shill
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Shyamal H Mehta
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Christine M Belden
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Edward Y Zamrini
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Kathryn Davis
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Thomas G Beach
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
| | - Charles H Adler
- Drs. Driver-Dunckley, Mehta, and Adler are with the Department of Neurology of the Parkinson's Disease and Movement Disorders Center at the Mayo Clinic in Scottsdale, Arizona. Zhang is with the Section of Biostatistics at the Mayo Clinic in Scottsdale, Arizona. Shill is with the Barrow Neurological Institute in Phoenix, Arizona. Belden, Zamrini, Davis, and Beach are with the Banner Sun Health Research Institute in Sun City, Arizona
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