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Vilarello BJ, Jacobson PT, Tervo JP, Gallagher LW, Caruana FF, Gary JB, Saak TM, Gudis DA, Joseph PV, Goldberg TE, Devanand D, Overdevest JB. BMI Increases in Individuals with COVID-19-Associated Olfactory Dysfunction. Nutrients 2023; 15:4538. [PMID: 37960191 PMCID: PMC10648323 DOI: 10.3390/nu15214538] [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: 09/23/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Reports suggest COVID-19-associated olfactory dysfunction (OD) may result in alterations in dietary behaviors and perceived weight change, but few studies using psychophysical evaluation of post-COVID-19-associated chemosensory dysfunction and body mass index (BMI) exist. The purpose of this study is to assess the impact of both quantitative and qualitative features of COVID-19-associated OD on BMI; (2) Methods: Recruitment of thirty-one participants with self-reported OD in the form of quantitative loss with and without qualitative features. Surveys with questions specific to qualitative olfactory function, Sniffin' Sticks tests, and BMI measures were completed at two visits, one year apart. Group differences were assessed with Wilcoxon signed-rank tests and the Holm-Bonferroni method; (3) Results: Individuals with persistent quantitative OD (n = 15) and self-reported parosmia (n = 19) showed statistically significant increases in BMI after 1 year (p = 0.004, adjusted α = 0.0125; p = 0.011, adjusted α = 0.0167). Controls with transient quantitative OD (n = 16) and participants without self-reported parosmia (n = 12) showed no statistically significant changes in BMI over the same time period (p = 0.079, adjusted α = 0.05; p = 0.028, adjusted α = 0.025); (4) Conclusions: This study shows an association between COVID-19-associated OD and BMI, suggesting olfaction may play a role in altering dietary habits and nutrition in this population. Larger study cohorts are needed to further evaluate this relationship.
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Affiliation(s)
- Brandon J. Vilarello
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Patricia T. Jacobson
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jeremy P. Tervo
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Liam W. Gallagher
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Francesco F. Caruana
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Joseph B. Gary
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Tiana M. Saak
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - David A. Gudis
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Paule V. Joseph
- National Institute of Alcohol Abuse and Alcoholism, Section of Sensory Science and Metabolism & National Institute of Nursing Research, Bethesda, MD 20892, USA
| | - Terry E. Goldberg
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - D.P. Devanand
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jonathan B. Overdevest
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
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Devanand D, Masurkar AV, Wisniewski T. Vigorous, regular physical exercise may slow disease progression in Alzheimer's disease. Alzheimers Dement 2023; 19:1592-1597. [PMID: 36722738 PMCID: PMC10101862 DOI: 10.1002/alz.12946] [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: 10/10/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mild to moderate exercise may decrease Alzheimer's disease (AD) risk, but the effects of vigorous, regular physical exercise remain unclear. METHODS Two patients with initial diagnoses of amnestic mild cognitive impairment (MCI) demonstrated positive AD biomarkers throughout 16 and 8 years of follow-up, with final diagnoses of mild AD and amnestic MCI, respectively. RESULTS Patient 1 was diagnosed with amnestic MCI at age 64. Neuropsychological testing, magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), amyloid imaging PET, and cerebrospinal fluid (CSF) biomarkers during follow-ups remained consistent with AD. By age 80, progression was minimal with Montreal Cognitive Assessment (MoCA) 26 of 30. Patient 2 was diagnosed with amnestic MCI at age 72. Neuropsychological testing, MRI, FDG-PET, and amyloid imaging PET during follow-ups remained consistent with AD. At age 80, MoCA was 27 of 30 with no clinical progression. Both patients regularly performed vigorous, regular exercise that increased after retirement/work reduction. DISCUSSION Vigorous, regular exercise may slow disease progression in biomarker-positive amnestic MCI and mild AD.
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Affiliation(s)
- D.P. Devanand
- Area Brain Aging and Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University
| | - Arjun V. Masurkar
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Departments of Psychiatry and Pathology, New York University Grossman School of Medicine, New York, NY, USA
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Dave BR, Kulkarni M, Patidar V, Devanand D, Mayi S, Reddy C, Singh M, Rai RR, Krishnan A. Results of in situ fixation of Andersson lesion by posterior approach in 35 cases. Musculoskelet Surg 2022; 106:385-395. [PMID: 34037925 DOI: 10.1007/s12306-021-00712-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/11/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE Due to the rarity of the Andersson lesion (AL), the literature is ambiguous regarding the type of surgical fixation, need for debridement and deformity correction. The purpose of this retrospective study is to evaluate the efficacy, feasibility and functional outcome of posterior fixation in AL. MATERIALS AND METHODS This study included 35 patients having thoracolumbar AL operated for in situ fixation and fusion with minimum of 24-month follow-up. VAS (Visual Analogue Score) back pain, ODI (Oswestry Disability Index), Frankel's grade were compared and analyzed. Union status was noted with complications. RESULTS The mean age of 35 patients was 56.34(± 11.3) years with average follow-up of 51.49 months. Two patients had AL at two levels. 27/37 AL were at discal level. Average estimated blood loss (EBL) was 276.43 ml and duration of surgery was 130.43 min. On an average, operated segments needed 7.77 screws. There were ten minor complications without long-term sequel. Neurological improvement was noted in 30 patients. Average preoperative VAS score improved from 8.69 to 3.14, ODI score improved from 68.76 to 18.77 at final follow-up which were significant (p < 0.05). There was significant improvement in Frankel's grading (Z = - 4.354, P = 0.00). CONCLUSIONS Surgical management of AL by posterior approach and posterior stabilization can give satisfactory results without the need of extensive anterior reconstruction, bone grafting or deformity correction procedures without added morbidity and complications.
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Affiliation(s)
- B R Dave
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - M Kulkarni
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - V Patidar
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - D Devanand
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - S Mayi
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - C Reddy
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - M Singh
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - R R Rai
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - A Krishnan
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India.
- BIMS Hospital, Opp. Sir T Hospital, Near Charan Boarding, Jail Rd, Bhavnagar, Gujarat, 364001, India.
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Stein E, Chern A, Chen H, Shiroma EJ, Devanand D, Gudis DA, Overdevest JB. Association between social determinants of health and olfactory dysfunction in older adults: A population‐based analysis. Int Forum Allergy Rhinol 2022; 13:910-923. [PMID: 36102027 DOI: 10.1002/alr.23088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Social determinants of health (SDoH) are environmental conditions that influence health outcomes. As olfactory dysfunction (OD) in older individuals is associated with increased morbidity and mortality, we sought to investigate the impact of specific SDoH on olfactory function. METHODS A cross-sectional analysis of the Health, Aging and Body Composition Study, a US population-based epidemiologic cohort study, was performed. Olfactory function was assessed utilizing both a self-report and a psychophysical olfactory test (CC-SIT test). Multivariable logistic regressions were performed to examine associations between specific SDoH with self-reported anosmia (sOD) and objective anosmia (oOD) as assessed by psychophysical testing. Differences in sensitivity and specificity were evaluated with sample tests for equality of proportions. RESULTS Of 2219 participants, 13% had oOD and 18% had objective hyposmia; only 10% had sOD. Individuals identifying as Black race had higher odds of oOD (odds ratio [OR]:1.41, 95% confidence interval [CI]:1.02-1.95), while females and those reporting family incomes ≥$50,000 had lower odds of oOD (OR: 0.46, CI:0.34-0.62; OR:0.52, CI:0.29-0.93), adjusting for covariates. No specific SDoH was significantly associated with sOD. The sensitivity and specificity of sOD for oOD was 23.1% and 92.0%, respectively. sOD had greater sensitivity in females than males (30.8% vs. 18.8%, p = 0.030), while specificity varied significantly depending on family income (range: 90.0%-94.8%, p = 0.033). CONCLUSIONS Utilizing a large population-based study, we find disparities in the prevalence and self-recognition of OD among individuals of different gender, race, and income levels. Further effort is needed to evaluate factors propagating these disparities and to raise awareness of OD across all patient populations.
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Affiliation(s)
- Eli Stein
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Alexander Chern
- Department of Otolaryngology—Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York NY USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics College of Human Medicine Michigan State University East Lansing
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Science Intramural Research Program of the National Institutes of Health National Institute on Aging Baltimore Maryland USA
| | - D.P. Devanand
- Columbia University Irving Medical Center New York NY USA
| | - David A. Gudis
- Department of Otolaryngology—Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York NY USA
| | - Jonathan B. Overdevest
- Department of Otolaryngology—Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York NY USA
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Klein J, Yan X, Johnson A, Tomljanovic Z, Zou J, Polly K, Honig LS, Brickman AM, Stern Y, Devanand D, Lee S, Kreisl WC. Olfactory Impairment Is Related to Tau Pathology and Neuroinflammation in Alzheimer's Disease. J Alzheimers Dis 2021; 80:1051-1065. [PMID: 33646153 PMCID: PMC8044007 DOI: 10.3233/jad-201149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Olfactory impairment is evident in Alzheimer's disease (AD); however, its precise relationships with clinical biomarker measures of tau pathology and neuroinflammation are not well understood. OBJECTIVE To determine if odor identification performance measured with the University of Pennsylvania Smell Identification Test (UPSIT) is related to in vivo measures of tau pathology and neuroinflammation. METHODS Cognitively normal and cognitively impaired participants were selected from an established research cohort of adults aged 50 and older who underwent neuropsychological testing, brain MRI, and amyloid PET. Fifty-four participants were administered the UPSIT. Forty-one underwent 18F-MK-6240 PET (measuring tau pathology) and fifty-three underwent 11C-PBR28 PET (measuring TSPO, present in activated microglia). Twenty-three participants had lumbar puncture to measure CSF concentrations of total tau (t-tau), phosphorylated tau (p-tau), and amyloid-β (Aβ42). RESULTS Low UPSIT performance was associated with greater18F-MK-6240 binding in medial temporal cortex, hippocampus, middle/inferior temporal gyri, inferior parietal cortex, and posterior cingulate cortex (p < 0.05). Similar relationships were seen for 11C-PBR28. These relationships were primarily driven by amyloid-positive participants. Lower UPSIT performance was associated with greater CSF concentrations of t-tau and p-tau (p < 0.05). Amyloid status and cognitive status exhibited independent effects on UPSIT performance (p < 0.01). CONCLUSION Olfactory identification deficits are related to extent of tau pathology and neuroinflammation, particularly in those with amyloid pathophysiology. The independent association of amyloid-positivity and cognitive impairment with odor identification suggests that low UPSIT performance may be a marker for AD pathophysiology in cognitive normal individuals, although impaired odor identification is associated with both AD and non-AD related neurodegeneration.NCT Registration Numbers: NCT03373604; NCT02831283.
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Affiliation(s)
- Julia Klein
- Taub Institute, Columbia University Irving Medical Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Xinyu Yan
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Aubrey Johnson
- Taub Institute, Columbia University Irving Medical Center, New York, NY
| | | | - James Zou
- Taub Institute, Columbia University Irving Medical Center, New York, NY
| | - Krista Polly
- Taub Institute, Columbia University Irving Medical Center, New York, NY
| | - Lawrence S. Honig
- Taub Institute, Columbia University Irving Medical Center, New York, NY
| | - Adam M. Brickman
- Taub Institute, Columbia University Irving Medical Center, New York, NY
| | - Yaakov Stern
- Taub Institute, Columbia University Irving Medical Center, New York, NY,Gertrude H. Sergievsky Center, Columbia University Irving Medical Center
| | - D.P. Devanand
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center
| | - Seonjoo Lee
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY,The Research Foundation for Mental Hygiene, Inc, New York, NY
| | - William C. Kreisl
- Taub Institute, Columbia University Irving Medical Center, New York, NY
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Fischer CE, Ismail Z, Youakim JM, Creese B, Kumar S, Nuñez N, Ryan Darby R, Di Vita A, D’Antonio F, de Lena C, McGeown WJ, Ramit R, Rasmussen J, Bell J, Wang H, Bruneau MA, Panegyres PK, Lanctôt KL, Agüera-Ortiz L, Lyketsos C, Cummings J, Jeste DV, Sano M, Devanand D, Sweet RA, Ballard C. Revisiting Criteria for Psychosis in Alzheimer’s Disease and Related Dementias: Toward Better Phenotypic Classification and Biomarker Research. J Alzheimers Dis 2020; 73:1143-1156. [DOI: 10.3233/jad-190828] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - 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
| | | | - Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicolas Nuñez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - R. Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Antonella Di Vita
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabrizia D’Antonio
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carlo de Lena
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - William J. McGeown
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Ravona Ramit
- Memory and Geriatric Psychiatry Clinic, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, Beijing, China
| | - Marie-Andrée Bruneau
- Department of Psychiatry, University of Montreal, Centre de Recherche de l’Institut Universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - Peter K. Panegyres
- Director, Neurodegenerative Disorders Research Pty Ltd, West Perth, WA, Australia
| | - Krista L. Lanctôt
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Luis Agüera-Ortiz
- Department of Psychiatry Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, & Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jeffrey Cummings
- UNLV Department of Brain Health and the Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Dilip V. Jeste
- Departments of Psychiatry and Neurosciences, and Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - Mary Sano
- Mt Sinai School of Medicine, Manhattan, NY, USA
| | - D.P. Devanand
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Robert A. Sweet
- Departments of Psychiatry and Neurology, University of Pittsburgh, PA, USA
| | - Clive Ballard
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
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Devanand D, Lee S, Luchsinger JA, Andrews H, Goldberg T, Huey ED, Schupf N, Manly J, Stern Y, Kreisl WC, Mayeux R. Intact global cognitive and olfactory ability predicts lack of transition to dementia. Alzheimers Dement 2020; 16:326-334. [PMID: 31676234 PMCID: PMC7007828 DOI: 10.1016/j.jalz.2019.08.200] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Odor identification deficits characterize Alzheimer's disease and other dementias. We examined if intact performance on brief cognitive and odor identification tests predicts lack of transition to dementia. METHODS In an urban community, 1037 older adults without dementia completed the 40-item University of Pennsylvania Smell Identification Test, which includes the 12-item Brief Smell Identification Test (B-SIT). Data from 749 participants followed up for 4 years were analyzed. RESULTS In covariate-adjusted survival analyses, impairment on the Blessed Orientation Memory Concentration Test and B-SIT each predicted dementia (n = 109), primarily Alzheimer's disease (n = 101). Among participants with intact olfactory (B-SIT ≥ 11/12 correct) and cognitive (Blessed Orientation Memory Concentration Test ≤ 5/28 incorrect) ability, 3.4% (4/117) transitioned to dementia during follow-up with no transitions in the 70-75 and 81-83 years age group quartiles. DISCUSSION Odor identification testing adds value to global cognitive testing, and together can identify individuals who rarely transition to dementia, thereby avoiding unnecessary diagnostic investigation.
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Affiliation(s)
- D.P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Research Foundation for Mental Hygiene and the Department of Biostatics, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Terry Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Edward D. Huey
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Department of Neurology Columbia University and the New York Presbyterian Hospital, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Jennifer Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Department of Neurology Columbia University and the New York Presbyterian Hospital, New York, NY, USA
- The Gertrude H. Sergievsky Center, Columbia University, New York,NY, USA
| | - Yaakov Stern
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - William C. Kreisl
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- The Gertrude H. Sergievsky Center, Columbia University, New York,NY, USA
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Krishnan A, Kulkarni M, Singh M, Reddy C, Mayi S, Devanand D, Rai RR, Dave BR. Trans-foraminal endoscopic uniportal decompression in degenerative lumbar spondylolisthesis: a technical and case report. Egypt J Neurosurg 2019. [DOI: 10.1186/s41984-019-0065-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Degenerative spondylolisthesis is a common spinal pathology. Traditionally, spinal fusion is an accepted standard surgical treatment for listhesis. But fusion is a major intervention with its known pitfalls. With technological progression, minimally invasive spinal fusion (MISF) procedures are becoming mainstream. Percutaneous trans-foraminal endoscopic lumbar discectomy/decompressions (PTELD) without stabilization has many advantages over even a MISF for select group of patients.
Case presentation
In this case report, we describe using a uniportal unilateral trans-foraminal approach (TFA) for stable listhesis with lumbar disc herniation (LDH) causing chronic bilateral radicular symptoms and back pain with acute exacerbation. Under local anesthesia, we used a flat entry for PTELD, which facilitates an approach to both disc sides ventrally and even dorsal aspect lateral recess decompression on the dominant ipsilateral side. No fixation was done. An excellent outcome is obtained immediately at 6 weeks and maintained at 39 months of follow-up.
Conclusion
PTELD is worth considering as an intermediate procedure before fusion is offered in lateral recess stenosis in stable listhesis patients who have consented and understand the progressive cascade of spinal degeneration.
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Rushia S, Motter J, Sneed J, Doraiswamy P, Devanand D. COGNITIVE CHANGE AND ANTIDEPRESSANT TREATMENT IN DEP-MCI: DO RACE AND GENDER MATTER? Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Rushia
- The Graduate Center, City University of New York
| | - J Motter
- The Graduate Center, City University of New York
| | - J Sneed
- The Graduate Center, City University of New York
| | - P Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - D Devanand
- Division of Geriatric Psychiatry, Columbia University and the New York State Psychiatric Institute
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Krishnan A, Barot M, Dave B, Bang P, Devanand D, Patel D, Jain A. Percutaneous transforaminal endoscopic discectomy and drainage for spondylodiscitis: A technical note and review of literature. J Orthop Allied Sci 2018. [DOI: 10.4103/joas.joas_57_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gulisano W, Maugeri D, Baltrons MA, Fà M, Amato A, Palmeri A, D’Adamio L, Grassi C, Devanand D, Honig LS, Puzzo D, Arancio O. Role of Amyloid-β and Tau Proteins in Alzheimer's Disease: Confuting the Amyloid Cascade. J Alzheimers Dis 2018; 64:S611-S631. [PMID: 29865055 PMCID: PMC8371153 DOI: 10.3233/jad-179935] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [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] [Indexed: 12/11/2022]
Abstract
The "Amyloid Cascade Hypothesis" has dominated the Alzheimer's disease (AD) field in the last 25 years. It posits that the increase of amyloid-β (Aβ) is the key event in AD that triggers tau pathology followed by neuronal death and eventually, the disease. However, therapeutic approaches aimed at decreasing Aβ levels have so far failed, and tau-based clinical trials have not yet produced positive findings. This begs the question of whether the hypothesis is correct. Here we have examined literature on the role of Aβ and tau in synaptic dysfunction, memory loss, and seeding and spreading of AD, highlighting important parallelisms between the two proteins in all of these phenomena. We discuss novel findings showing binding of both Aβ and tau oligomers to amyloid-β protein precursor (AβPP), and the requirement for the presence of this protein for both Aβ and tau to enter neurons and induce abnormal synaptic function and memory. Most importantly, we propose a novel view of AD pathogenesis in which extracellular oligomers of Aβ and tau act in parallel and upstream of AβPP. Such a view will call for a reconsideration of therapeutic approaches directed against Aβ and tau, paving the way to an increased interest toward AβPP, both for understanding the pathogenesis of the disease and elaborating new therapeutic strategies.
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Affiliation(s)
- Walter Gulisano
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Catania, Italy
| | - Daniele Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Catania, Italy
| | - Marian A. Baltrons
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Biochemistry and Molecular Biology and Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mauro Fà
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Arianna Amato
- Department of Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Agostino Palmeri
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Catania, Italy
| | - Luciano D’Adamio
- Department of Pharmacology, Physiology and Neuroscience, Rutgers University, Newark, NJ, USA
| | - Claudio Grassi
- Institute of Human Physiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D.P. Devanand
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Lawrence S. Honig
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Daniela Puzzo
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Catania, Italy
| | - Ottavio Arancio
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
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Krishnan A, Barot M, Dave B, Bang P, Devanand D, Patel D, Jain A. Percutaneous transforaminal endoscopic decompression and cageless percutaneous bone graft transforaminal lumbar interbody fusion: A feasibility study. J Orthop Allied Sci 2018. [DOI: 10.4103/joas.joas_62_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Devanand D, Lentz C, Chunga RE, Ciarleglio A, Scodes JM, Andrews H, Schofield PW, Stern Y, Huey ED, Bell K, Pelton GH. Change in Odor Identification Impairment is Associated with Improvement with Cholinesterase Inhibitor Treatment in Mild Cognitive Impairment. J Alzheimers Dis 2017; 60:1525-1531. [DOI: 10.3233/jad-170497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D.P. Devanand
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
| | - Cody Lentz
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
| | - Richard E. Chunga
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
| | - Adam Ciarleglio
- Columbia University Medical Center, New York, NY, USA
- Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Jennifer M. Scodes
- Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Howard Andrews
- Columbia University Medical Center, New York, NY, USA
- Mailman School of Public Health of Columbia University, New York, NY, USA
| | | | - Yaakov Stern
- Columbia University Medical Center, New York, NY, USA
| | | | - Karen Bell
- Columbia University Medical Center, New York, NY, USA
| | - Gregory H. Pelton
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
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Reijs BL, Ramakers IH, Elias-Sonnenschein L, Teunissen CE, Koel-Simmelink M, Tsolaki M, Wahlund LO, Waldemar G, Hausner L, Johannsen P, Vanderstichele H, Verhey F, Devanand D, Visser PJ. Relation of Odor Identification with Alzheimer’s Disease Markers in Cerebrospinal Fluid and Cognition. J Alzheimers Dis 2017; 60:1025-1034. [DOI: 10.3233/jad-170564] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Babette L.R. Reijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez H.G.B. Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Lyzel Elias-Sonnenschein
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| | - Marleen Koel-Simmelink
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lars-Olof Wahlund
- Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, Germany
| | - Peter Johannsen
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - D.P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York, NY, USA
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
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Patel AN, Lee S, Andrews HF, Pelton GH, Schultz SK, Sultzer DL, Mintzer J, de la Pena D, Gupta S, Colon S, Schimming C, Levin B, Devanand D. Prediction of Relapse After Discontinuation of Antipsychotic Treatment in Alzheimer's Disease: The Role of Hallucinations. Am J Psychiatry 2017; 174:362-369. [PMID: 27855483 PMCID: PMC5378647 DOI: 10.1176/appi.ajp.2016.16020226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In Alzheimer's disease, antipsychotic medications are often used for a period, with relief of symptoms, and then discontinued, after which relapse may occur. The authors sought to determine which neuropsychiatric symptoms predict relapse. METHOD In the Antipsychotic Discontinuation in Alzheimer's Disease trial, 180 patients with Alzheimer's disease and symptoms of agitation or psychosis were treated with risperidone for 16 weeks, after which patients who responded (N=110) were randomly assigned to continue risperidone for 32 weeks, to continue risperidone for 16 weeks followed by switch to placebo for 16 weeks, or to receive placebo for 32 weeks. As reported previously, discontinuation of risperidone was associated with a two- to fourfold increased risk of relapse over 16-32 weeks. In planned post hoc analyses, the authors examined associations between the 12 symptom domains in the Neuropsychiatric Inventory (NPI) and relapse in the first 16-week phase after randomization. RESULTS Compared with patients with mild hallucinations or no hallucinations, patients with severe hallucinations as a presenting symptom at baseline had a higher likelihood of relapse (hazard ratio=2.96, 95% CI=1.52, 5.76). This effect was present for the subgroup with auditory hallucinations, but not the subgroup with visual hallucinations. Among patients with baseline hallucinations, 13 of 17 (76.5%) who discontinued risperidone relapsed, compared with 10 of 26 (38.5%) who continued risperidone (p<0.02). This group difference remained significant for severe (77.8%) compared with mild (36%) hallucinations. NPI domain scores after the initial open-treatment phase were not associated with relapse. CONCLUSIONS Patients with severe baseline hallucinations were more likely to relapse after randomization, and the presence of baseline hallucinations was associated with a higher risk of relapse after discontinuation of risperidone compared with continued risperidone treatment. For patients with hallucinations, particularly auditory hallucinations, antipsychotic discontinuation should be approached cautiously because of high relapse risk.
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Affiliation(s)
- Anjali N. Patel
- Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University and the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York
| | - Seonjoo Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Howard F. Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Gregory H. Pelton
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York
| | - Susan K. Schultz
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - David L. Sultzer
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jacobo Mintzer
- Division of Translational Research, Department of Neuroscience, Medical University of South Carolina and the Ralph H. Johnson VA Medical Center, Charleston, South Carolina,Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston, South Carolina
| | | | - Sanjay Gupta
- Department of Psychiatry State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Sylvia Colon
- Department of Psychiatry, VA Medical Center, Tuscaloosa, Alabama
| | - Corbett Schimming
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - D.P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York,Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University and the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York
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16
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Devanand D. Olfactory Identification Deficits, Cognitive Decline, and Dementia in Older Adults. Am J Geriatr Psychiatry 2016; 24:1151-1157. [PMID: 27745824 PMCID: PMC5136312 DOI: 10.1016/j.jagp.2016.08.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/02/2023]
Abstract
Several recently developed biomarkers of Alzheimer disease (AD) are invasive, expensive, and difficult to obtain in most clinical settings. Olfactory identification test performance represents a noninvasive, inexpensive biomarker of AD that may have predictive accuracy comparable with neuroimaging measures and biomarkers assessed in cerebrospinal fluid. Neurofibrillary tangles in the olfactory bulb are among the earliest pathologic features of AD and are also seen in the projection pathways from the olfactory bulb to secondary olfactory brain regions, including the piriform and medial temporal cortex, orbitofrontal cortex, and other limbic regions. Odor identification impairment characterizes AD and predicts the clinical transition from mild cognitive impairment to AD in both clinical and community samples. Epidemiologic data indicate that in cognitively intact older adults, impairment in odor identification predicts cognitive decline but that episodic verbal memory impairment does not predict cognitive decline. Odor identification impairment has also been shown to predict mortality in older subjects with mortality risk increasing with greater severity of impairment in odor identification. The exact cause of this association is not known, but olfactory deficits may lead to an increase in accidents in the home, because of the inability to smell and taste food that is unsafe or not smelling a gas leak or fire, and this may increase mortality risk. Standardized tests of odor identification ability are widely available and may provide a useful tool to improve diagnostic and predictive accuracy for cognitive decline, AD, and mortality in older adults.
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Affiliation(s)
- D.P. Devanand
- Departments of Psychiatry and Neurology, Division of Geriatric Psychiatry, Columbia University Medical Center, New York, NY
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17
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Schneider LS, Frangakis C, Drye LT, Devanand D, Marano CM, Mintzer J, Mulsant BH, Munro CA, Newell JA, Pawluczyk S, Pelton G, Pollock BG, Porsteinsson AP, Rabins PV, Rein L, Rosenberg PB, Shade D, Weintraub D, Yesavage J, Lyketsos CG. Heterogeneity of Treatment Response to Citalopram for Patients With Alzheimer's Disease With Aggression or Agitation: The CitAD Randomized Clinical Trial. Am J Psychiatry 2016; 173:465-72. [PMID: 26771737 PMCID: PMC6419726 DOI: 10.1176/appi.ajp.2015.15050648] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pharmacological treatments for agitation and aggression in patients with Alzheimer's disease have shown limited efficacy. The authors assessed the heterogeneity of response to citalopram in the Citalopram for Agitation in Alzheimer Disease (CitAD) study to identify individuals who may be helped or harmed. METHOD In this double-blind parallel-group multicenter trial of 186 patients with Alzheimer's disease and clinically significant agitation, participants were randomly assigned to receive citalopram or placebo for 9 weeks, with the dosage titrated to 30 mg/day over the first 3 weeks. Five planned potential predictors of treatment outcome were assessed, along with six additional predictors. The authors then used a two-stage multivariate method to select the most likely predictors; grouped participants into 10 subgroups by their index scores; and estimated the citalopram treatment effect for each. RESULTS Five covariates were likely predictors, and treatment effect was heterogeneous across the subgroups. Patients for whom citalopram was more effective were more likely to be outpatients, have the least cognitive impairment, have moderate agitation, and be within the middle age range (76-82 years). Patients for whom placebo was more effective were more likely to be in long-term care, have more severe cognitive impairment, have more severe agitation, and be treated with lorazepam. CONCLUSIONS Considering several covariates together allowed the identification of responders. Those with moderate agitation and with lower levels of cognitive impairment were more likely to benefit from citalopram, and those with more severe agitation and greater cognitive impairment were at greater risk for adverse responses. Considering the dosages used and the association of citalopram with cardiac QT prolongation, use of this agent to treat agitation may be limited to a subgroup of people with dementia.
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Affiliation(s)
- Lon S. Schneider
- Department of psychiatry and the behavioral sciences, and department of neurology, Keck School of Medicine of the University of Southern California
| | | | - Lea T Drye
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health
| | - D.P. Devanand
- Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center
| | - Christopher M. Marano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine
| | - Jacob Mintzer
- Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston, South Carolina
| | - Benoit H. Mulsant
- Campbell Institute, Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto
| | - Cynthia A. Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Jeffery A. Newell
- Culture and Mental Health Laboratory, University of Southern California
| | - Sonia Pawluczyk
- Department of psychiatry and the behavioral sciences, and department of neurology, Keck School of Medicine of the University of Southern California
| | - Gregory Pelton
- Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center
| | - Bruce G Pollock
- Campbell Institute, Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto
| | | | - Peter V. Rabins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Lisa Rein
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Paul B. Rosenberg
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - David Shade
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Jerome Yesavage
- Department of Veterans Affairs Health Care System, Palo Alto, California, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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18
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Rosenberg PB, Drye LT, Porsteinsson AP, Pollock BG, Devanand D, Frangakis C, Ismail Z, Marano C, Meinert CL, Mintzer JE, Munro CA, Pelton G, Rabins PV, Schneider LS, Shade DM, Weintraub D, Newell J, Yesavage J, Lyketsos CG. Change in agitation in Alzheimer's disease in the placebo arm of a nine-week controlled trial. Int Psychogeriatr 2015; 27:2059-67. [PMID: 26305876 PMCID: PMC4669064 DOI: 10.1017/s1041610215001106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Placebo responses raise significant challenges for the design of clinical trials. We report changes in agitation outcomes in the placebo arm of a recent trial of citalopram for agitation in Alzheimer's disease (CitAD). METHODS In the CitAD study, all participants and caregivers received a psychosocial intervention and 92 were assigned to placebo for nine weeks. Outcomes included Neurobehavioral Rating Scale agitation subscale (NBRS-A), modified AD Cooperative Study-Clinical Global Impression of Change (CGIC), Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (NPI A/A) and Total (NPI-Total) and ADLs. Continuous outcomes were analyzed with mixed-effects modeling and dichotomous outcomes with logistic regression. RESULTS Agitation outcomes improved over nine weeks: NBRS-A mean (SD) decreased from 7.8 (3.0) at baseline to 5.4 (3.2), CMAI from 28.7 (6.7) to 26.7 (7.4), NPI A/A from 8.0 (2.4) to 4.9 (3.8), and NPI-Total from 37.3 (17.7) to 28.4 (22.1). The proportion of CGI-C agitation responders ranged from 21 to 29% and was significantly different from zero. MMSE improved from 14.4 (6.9) to 15.7 (7.2) and ADLs similarly improved. Most of the improvement was observed by three weeks and was sustained through nine weeks. The major predictor of improvement in each agitation measure was a higher baseline score in that measure. CONCLUSIONS We observed significant placebo response which may be due to regression to the mean, response to a psychosocial intervention, natural course of symptoms, or nonspecific benefits of participation in a trial.
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Affiliation(s)
- Paul B. Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Johns Hopkins Bay view Medical Center, 5300 Alpha Commons Dr. #429, Baltimore, MD 21224, Phone: (410) 550 9883, Fax: (410) 550 1407
| | - Lea T. Drye
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 911 S. Ann St, Baltimore, MD 21231
| | - Anton P. Porsteinsson
- University of Rochester School of Medicine and Dentistry, 435 East Henrietta Road, Rochester, N.Y. 14620
| | - Bruce G. Pollock
- Campbell Institute, CAMH, University of Toronto, Toronto, ON, Canada, University of Toronto, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1
| | - D.P. Devanand
- College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 126, New York, NY 10032
| | - Constantine Frangakis
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E3642, Baltimore, MD, 21205-2179
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada, University of Toronto, Toronto, ON, Canada, 1403 29 Street NW, Calgary Canada, T2N 2T9
| | - Christopher Marano
- Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Drive, 4th floor, Baltimore, MD 21224
| | - Curtis L. Meinert
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., W5010, Baltimore, MD, 21205-2179
| | - Jacobo E. Mintzer
- Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston SC, Department of Health Studies, Medical University of South Carolina, Charleston SC, Ralph H. Johnson VA Medical Center, Charleston SC, 316 Calhoun Street, 5th Floor- CBRI, Charleston, SC 29401
| | - Cynthia A. Munro
- Department of Psychiatry and Behavioral Sciences, Department of Neurology, Johns Hopkins Bayview and Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 218, Baltimore, MD 21287-7218
| | - Gregory Pelton
- Clinical Psychiatry and Neurology, Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 126, New York, New York 10032-2695
| | - Peter V. Rabins
- Johns Hopkins School of Medicine, Johns Hopkins Hospital, Meyer 279, 600 North Wolfe Street, Baltimore, MD 21287
| | - Lon S. Schneider
- Keck School of Medicine, University of Southern California, 1540 Alcazar St, CHP-216, Los Angeles, CA
| | - David M. Shade
- Departments of Medicine (Pulmonary) and Epidemiology (Center for Clinical Trials), Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St Rm 5025-D, Baltimore, MD 21205
| | - Daniel Weintraub
- Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Parkinson's Disease Research, Education and Clinical Center (PADRECC), Mental Illness Research, Education and Clinical Center (MIRECC), Philadelphia Veterans Affairs Medical Center, 3615 Chestnut Street, #330, Philadelphia, PA 19104-2676
| | - Jeffery Newell
- Clinical Science, University of Southern California, Culture and Mental Health Lab, 3620 McClintock Ave., Los Angeles, CA 90089-1011
| | - Jerome Yesavage
- Director Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Mail Code 151-Y, 3801 Miranda Avenue, Palo Alto, California 94304
| | - Constantine G. Lyketsos
- Johns Hopkins School of Medicine, Department of Psychiatry, Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Dr. #429, Baltimore, MD 21224
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19
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Weintraub D, Drye LT, Porsteinsson AP, Rosenberg PB, Pollock BG, Devanand D, Frangakis C, Ismail Z, Marano C, Meinert CL, Mintzer JE, Munro CA, Pelton G, Rabins PV, Schneider LS, Shade DM, Yesavage J, Lyketsos CG. Time to Response to Citalopram Treatment for Agitation in Alzheimer Disease. Am J Geriatr Psychiatry 2015; 23:1127-33. [PMID: 26238225 PMCID: PMC4653092 DOI: 10.1016/j.jagp.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Agitation is a common and significant problem in Alzheimer disease (AD). In the recent Citalopram for Agitation in Alzheimer's Disease (CitAD) study, citalopram was efficacious for the treatment of AD agitation. Here we examined the time course and predictors of response to treatment. METHODS Response in CitAD was defined as a modified Alzheimer Disease Cooperative Study Clinical Global Impression of Change (CGIC) score of 1 or 2 or a Neurobehavioral Rating Scale agitation subscale (NBRS-A) score reduction ≥ 50% from baseline. "Stable early response" was defined as meeting the aforementioned criteria at both weeks 3 and 9, "late response" was response at week 9 but not at week 3, and "unstable response" was response at week 3 but not at week 9. RESULTS In the primary analyses, citalopram was superior to placebo on both the CGIC and the NBRS-A response measures. Little between-group differences were found in response rates in the first 3 weeks of the study (21% versus 19% on the CGIC). Citalopram patients were more likely than placebo patients to be a late responder (18% versus 8% on CGIC, Fisher's exact p = 0.09; 31% versus 15% on NBRS-A, Fisher's exact p = 0.02). Approximately half of citalopram responders (45%-56%) at end of study achieved response later in the study compared with 30%-44% of placebo responders. CONCLUSION Treatment with citalopram for agitation in AD needs to be at least 9 weeks in duration to allow sufficient time for full response. Study duration is an important factor to consider in the design of clinical trials for agitation in AD.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Lea T. Drye
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Paul B. Rosenberg
- Johns Hopkins Bayview and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bruce G. Pollock
- Campbell Institute, CAMH, University of Toronto, Toronto, ON, Canada
| | - D.P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | - Zahinoor Ismail
- Departments of Psychiatry and Neurology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Christopher Marano
- Johns Hopkins Bayview and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Jacobo E. Mintzer
- Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston, SC, USA
| | - Cynthia A. Munro
- Johns Hopkins Bayview and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory Pelton
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Peter V. Rabins
- Johns Hopkins Bayview and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lon S. Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - David M. Shade
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jerome Yesavage
- Stanford University School of Medicine and VA Palo Alto Health Care System, Stanford, CA, USA
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Reijs BL, Ramakers IH, Teunissen CE, Devanand D, Verhey FR, Tsolaki M, Wahlund LO, Waldemar G, Hausner L, Johannsen P, Visser PJ. O1‐03‐03: Olfactory dysfunction may predict Alzheimer's disease related tau pathology in cerebrospinal fluid (CSF). Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Babette L.R. Reijs
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
| | | | - D.P. Devanand
- Columbia UniversityCollege of Physicians and SurgeonsColumbiaNYUSA
| | - Frans R.J. Verhey
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
| | - Magda Tsolaki
- Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Gunhild Waldemar
- Danish Dementia Research Centre, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Lucrezia Hausner
- Heidelberg UniversityCentral Institute of Mental HealthMannheimGermany
| | - Peter Johannsen
- Danish Dementia Research Centre, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Pieter Jelle Visser
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
- VU University Medical CenterAmsterdamNetherlands
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Brown PJ, Sneed JR, Rutherford B, Devanand D, Roose SP. The nuances of cognition and depression in older adults: the need for a comprehensive assessment. Int J Geriatr Psychiatry 2014; 29:506-14. [PMID: 24123357 PMCID: PMC3975802 DOI: 10.1002/gps.4033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/21/2013] [Accepted: 09/06/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to examine the confluence of depression, cognitive impairment, and vascular risk factors in older individuals. METHODS The study uses baseline data from the National Alzheimer's Coordinating Center. Data were collected across Alzheimer's Disease Centers in the USA. The sample included 12,634 individuals (cognitive intact = 8022; amnestic mild cognitive impairment [aMCI] = 3652; nonamnestic MCI [nonaMCI] = 960). The Geriatric Depression Scale assessed depression; the Trail Making Test assessed executive function. RESULTS The proportion of participants with depression was higher in the aMCI (18%) and nonaMCI group (21%) as compared with that in the cognitively intact group (8%); there was no difference in rates of depression between aMCI and nonaMCI groups. The proportion of participants with executive dysfunction differed between nondepressed and depressed individuals for the cognitively intact (8% vs. 12%) and aMCI groups (28% vs. 35%), but not for the nonaMCI group (37% vs. 41%). Nine percent of the cognitively intact group had executive dysfunction compared with 31% of the aMCI group and 40% of the nonaMCI group. The proportion of participants with hypertension was greater in individuals with executive dysfunction compared with those with no executive deficits; the presence of hypertension was not associated with depression severity. CONCLUSIONS The confluence of vascular risk factors, episodic memory impairment, and depression and executive dysfunction highlights the need for comprehensive assessment of depressed older adults that can aid clinicians in the formulation of treatment planning and inform clinicians and researchers about long-term prognosis.
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Affiliation(s)
- Patrick J. Brown
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
| | - Joel R. Sneed
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA,Queens College, City University of New York,The Graduate Center, City University of New York
| | - Bret Rutherford
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
| | - D.P. Devanand
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
| | - Steven P. Roose
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
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Porsteinsson AP, Drye LT, Pollock BG, Devanand D, Frangakis C, Ismail Z, Marano C, Meinert CL, Mintzer JE, Munro CA, Pelton G, Rabins PV, Rosenberg PB, Schneider LS, Shade DM, Weintraub D, Yesavage J, Lyketsos CG. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 2014; 311:682-91. [PMID: 24549548 PMCID: PMC4086818 DOI: 10.1001/jama.2014.93] [Citation(s) in RCA: 315] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Agitation is common, persistent, and associated with adverse consequences for patients with Alzheimer disease. Pharmacological treatment options, including antipsychotics are not satisfactory. OBJECTIVE The primary objective was to evaluate the efficacy of citalopram for agitation in patients with Alzheimer disease. Key secondary objectives examined effects of citalopram on function, caregiver distress, safety, cognitive safety, and tolerability. DESIGN, SETTING, AND PARTICIPANTS The Citalopram for Agitation in Alzheimer Disease Study (CitAD) was a randomized, placebo-controlled, double-blind, parallel group trial that enrolled 186 patients with probable Alzheimer disease and clinically significant agitation from 8 academic centers in the United States and Canada from August 2009 to January 2013. INTERVENTIONS Participants (n = 186) were randomized to receive a psychosocial intervention plus either citalopram (n = 94) or placebo (n = 92) for 9 weeks. Dosage began at 10 mg per day with planned titration to 30 mg per day over 3 weeks based on response and tolerability. MAIN OUTCOMES AND MEASURES Primary outcome measures were based on scores from the 18-point Neurobehavioral Rating Scale agitation subscale (NBRS-A) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC). Other outcomes were based on scores from the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI), ability to complete activities of daily living (ADLs), caregiver distress, cognitive safety (based on scores from the 30-point Mini Mental State Examination [MMSE]), and adverse events. RESULTS Participants who received citalopram showed significant improvement compared with those who received placebo on both primary outcome measures. The NBRS-A estimated treatment difference at week 9 (citalopram minus placebo) was -0.93 (95% CI, -1.80 to -0.06), P = .04. Results from the mADCS-CGIC showed 40% of citalopram participants having moderate or marked improvement from baseline compared with 26% of placebo recipients, with estimated treatment effect (odds ratio [OR] of being at or better than a given CGIC category) of 2.13 (95% CI, 1.23-3.69), P = .01. Participants who received citalopram showed significant improvement on the CMAI, total NPI, and caregiver distress scores but not on the NPI agitation subscale, ADLs, or in less use of rescue lorazepam. Worsening of cognition (-1.05 points; 95% CI, -1.97 to -0.13; P = .03) and QT interval prolongation (18.1 ms; 95% CI, 6.1-30.1; P = .01) were seen in the citalopram group. CONCLUSIONS AND RELEVANCE Among patients with probable Alzheimer disease and agitation who were receiving psychosocial intervention, the addition of citalopram compared with placebo significantly reduced agitation and caregiver distress; however, cognitive and cardiac adverse effects of citalopram may limit its practical application at the dosage of 30 mg per day. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00898807.
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Affiliation(s)
- Anton P. Porsteinsson
- University of Rochester School of Medicine and Dentistry,
Rochester, NY, USA
- Corresponding author Anton P. Porsteinsson,
M.D., Department of Psychiatry, University of Rochester School of Medicine and
Dentistry, 435 East Henrietta Road, Rochester, NY 14620 Phone (585) 760-6550 Fax
(585) 760-6572 ()
| | - Lea T. Drye
- Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA
| | - Bruce G. Pollock
- Campbell Institute, CAMH, University of Toronto, Toronto,
ON, Canada
| | - D.P. Devanand
- Division of Geriatric Psychiatry, New York State
Psychiatric Institute and College of Physicians and Surgeons of Columbia University,
New York, NY, USA
| | | | - Zahinoor Ismail
- Departments of Psychiatry and Neurology, Hotchkiss Brain
Institute, University of Calgary, Calgary, AB, Canada
| | - Christopher Marano
- Johns Hopkins Bayview and Johns Hopkins School of Medicine,
Baltimore, MD, USA
| | | | - Jacobo E. Mintzer
- Clinical Biotechnology Research Institute, Roper St.
Francis Healthcare, Charleston, SC, USA
| | - Cynthia A. Munro
- Johns Hopkins Bayview and Johns Hopkins School of Medicine,
Baltimore, MD, USA
| | - Gregory Pelton
- Division of Geriatric Psychiatry, New York State
Psychiatric Institute and College of Physicians and Surgeons of Columbia University,
New York, NY, USA
| | - Peter V. Rabins
- Johns Hopkins Bayview and Johns Hopkins School of Medicine,
Baltimore, MD, USA
| | - Paul B. Rosenberg
- Johns Hopkins Bayview and Johns Hopkins School of Medicine,
Baltimore, MD, USA
| | - Lon S. Schneider
- University of Southern California Keck School of Medicine,
Los Angeles, CA, USA
| | - David M. Shade
- Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA
| | - Daniel Weintraub
- Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
| | - Jerome Yesavage
- Stanford University School of Medicine and VA Palo Alto
Health Care System, Stanford, CA, USA
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Brown PJ, Liu X, Sneed JR, Pimontel MA, Devanand D, Roose SP. Speed of processing and depression affect function in older adults with mild cognitive impairment. Am J Geriatr Psychiatry 2013; 21:675-84. [PMID: 23567401 PMCID: PMC3410965 DOI: 10.1016/j.jagp.2013.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 12/05/2011] [Accepted: 12/27/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effect of depression and cognition on function in older adults with amnestic and nonamnestic mild cognitive impairment (aMCI and nonaMCI). DESIGN The study uses baseline data from the National Alzheimer's Coordinating Center. SETTING Data were collected at multiple Alzheimer's Disease Centers in the United States. PARTICIPANTS The sample included a total of 3,117 individuals with MCI, mean age = 74.37 years, SD: 9.37 (aMCI, n = 2,488; non-aMCI, n = 629). MEASUREMENTS The 10-item Pfeffer Functional Activities Questionnaire assessed function. RESULTS Depressive symptoms (Geriatric Depression Scale), memory impairment (Logical Memory II), and processing speed decrements (Digit Symbol Substitution Test) were significantly associated with functional impairment (p <0.001). Processing speed partially mediated the effect of depression on function and fully mediated the effect of executive dysfunction on function (p <0.001) in the total MCI and aMCI subsample, while in the non-aMCI subsample, processing speed mediated the effect of executive function but not the effect of depression (p = 0.20) on function. CONCLUSIONS The findings show that processing speed is central to the effect that depression and executive dysfunction have on functional impairment in cognitively impaired older adults. Future studies are needed to better understand the physiologic underpinnings in age-related and disease-specific decrements in processing speed, and to address the problems in the assessment of processing speed in clinical samples.
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Affiliation(s)
- Patrick J. Brown
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
| | - Xinhua Liu
- Columbia University Mailman School of Public Health, New York, NY
| | - Joel R. Sneed
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA,Queens College, City University of New York,The Graduate Center, City University of New York
| | | | - D.P. Devanand
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
| | - Steven P. Roose
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
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Nahas Z, Short B, Burns C, Archer M, Schmidt M, Prudic J, Nobler MS, Devanand D, Fitzsimons L, Lisanby SH, Payne N, Perera T, George MS, Sackeim HA. A Feasibility Study of a New Method for Electrically Producing Seizures in Man: Focal Electrically Administered Seizure Therapy [FEAST]. Brain Stimul 2013; 6:403-8. [DOI: 10.1016/j.brs.2013.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/09/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022] Open
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Abstract
BACKGROUND This study is a randomized, prospective, investigation of the relationships between clinical trial design, patient expectancy and the outcome of treatment with antidepressant medication. Method Adult out-patients with major depressive disorder (MDD) were randomized to either placebo-controlled (PC, 50% probability of receiving active medication) or comparator (COMP, 100% probability of receiving active medication) administration of antidepressant medication. Independent-samples t tests and analysis of covariance (ANCOVA) were used to determine whether the probability of receiving active medication influenced patient expectancy and to compare medication response in the PC v. COMP conditions. We also tested the correlations between baseline expectancy score and final improvement in depressive symptoms across study groups. RESULTS Subjects randomized to the COMP condition reported greater expectancy of improvement compared to subjects in the PC condition (t = 2.60, df = 27, p = 0.015). There were no statistically significant differences in the analyses comparing antidepressant outcomes between subjects receiving medication in the COMP condition and those receiving medication in the PC condition. Higher baseline expectancy of improvement was correlated with lower final depression severity scores (r = 0.53, p = 0.021) and greater improvement in depressive symptoms over the course of the study (r = 0.44, p = 0.058). CONCLUSIONS The methods described represent a promising way of subjecting patient expectancy to scientific study. Expectancy of improvement is affected by the probability of receiving active antidepressant medication and seems to influence antidepressant response.
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Affiliation(s)
- B R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY 10032, USA.
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Devier D, Knaus T, Ramos A, Foundas A, Kangarlu A, Small S, Devanand D. Left Hippocampal Volume and Verbal Memory Predict Depression in Older Adults (P02.038). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Devier DJ, Villemarette-Pittman N, Brown P, Pelton G, Stern Y, Sano M, Devanand D. Predictive utility of type and duration of symptoms at initial presentation in patients with mild cognitive impairment. Dement Geriatr Cogn Disord 2010; 30:238-44. [PMID: 20847554 PMCID: PMC2948660 DOI: 10.1159/000320137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To assess (1) the duration and symptoms present in participants with mild cognitive impairment (MCI) and (2) the impact of these variables on predicting conversion to Alzheimer's disease (AD). METHODS Participants with MCI (n = 148) were assessed and followed systematically. RESULTS Decline in memory was reported as the first symptom in 118 of the cases. Converters had more symptoms (e.g. language decline, depression), and the combination of decline in memory and in performance of high-order social/cognitive activities as well as disorientation more often than nonconverters (p = 0.036). In an age-stratified Cox model, predictors of conversion to AD were shorter time since onset of memory decline and lower baseline MMSE score. CONCLUSIONS Recent onset of memory decline with older age, decreased MMSE score, change in performance and disorientation indicate a greater likelihood of short-term conversion to AD.
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Affiliation(s)
- Deidre J. Devier
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, La., USA,*Deidre J. Devier, PhD, Department of Neurology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Floor 7, New Orleans, LA 70112 (USA), Tel. +1 504 939 8906, Fax +1 504 285 8078, E-Mail
| | | | - Patrick Brown
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Bronx, N.Y., USA,Department of Neurology, Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Bronx, N.Y., USA
| | - Gregory Pelton
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Bronx, N.Y., USA,Department of Neurology, Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Bronx, N.Y., USA
| | - Yaakov Stern
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Bronx, N.Y., USA,Department of Neurology, Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Bronx, N.Y., USA
| | - Mary Sano
- Department of Psychiatry, and Alzheimer's Disease Research Center, Mount Sinai School of Medicine, New York, N.Y., USA,Department of Neurology, James J. Peters VA Medical Center, Bronx, N.Y., USA
| | - D.P. Devanand
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Bronx, N.Y., USA,Department of Neurology, Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Bronx, N.Y., USA
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Devanand D, Brown PJ. P2‐456: Utility of evaluating specific functional deficits in distinguishing subgroups in elderly subjects with cognitive impairment. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Response to antidepressant medication is higher in comparator versus placebo-controlled randomized controlled trials (RCTs). Patient expectancy is an important influence on clinical outcome in the treatment of depression and may explain this finding. The results are reported from a pilot RCT studying expectancy and depression outcome in placebo-controlled versus comparator treatment conditions.MethodOut-patients aged 18-65 years with major depressive disorder (MDD) were enrolled in this 8-week RCT. Subjects were randomized to placebo-controlled (escitalopram or placebo) or comparator (escitalopram or citalopram) administration of antidepressant medication. Subjects reported their expected likelihood and magnitude of depression improvement before and after randomization using questions from the Credibility and Expectancy Scale (CES). A regressed change model of post-randomization expectancy of improvement was fit to the data to determine whether subjects in the comparator group reported greater expectancies of improvement than subjects in the placebo-controlled group. RESULTS Twenty subjects with mean age 56.5+/-11.7 years, a baseline Hamilton Depression Rating Scale (HAMD) score of 24.2+/-5.3, baseline Beck Depression Inventory (BDI) score of 24.9+/-6.4 and baseline Clinical Global Impressions (CGI) - Severity score of 4.0+/-0.3 were enrolled in the study. Adjusting for other factors, the effect of group assignment on expected magnitude of improvement was significant and large (effect size 1.5). No group differences in expected likelihood of improvement were found. CONCLUSIONS Randomization to comparator versus placebo-controlled administration of antidepressant medication produced greater expectancies of how much patients would improve during the trial. This expectancy difference may explain the higher response and remission rates that are observed in comparator versus placebo-controlled trials.
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Affiliation(s)
- B Rutherford
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
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Devier DJ, Pelton GH, Tabert MH, Liu X, Cuasay K, Eisenstadt R, Marder K, Stern Y, Devanand D. The impact of anxiety on conversion from mild cognitive impairment to Alzheimer's disease. Int J Geriatr Psychiatry 2009; 24:1335-42. [PMID: 19319929 PMCID: PMC2787890 DOI: 10.1002/gps.2263] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare state and trait anxiety in mild cognitive impairment (MCI) patients and matched control subjects, and to assess the impact of these variables in predicting conversion to Alzheimer's disease. METHODS One hundred and forty-eight patients with MCI, broadly defined, were assessed and followed systematically. Baseline predictors for follow-up conversion to AD (entire sample: 39/148 converted to Alzheimer's disease (AD)) included the Spielberger State-Trait Anxiety Inventory (STAI). RESULTS At baseline evaluation, MCI patients had higher levels of state and trait anxiety than controls, with no differences between future AD converters (n = 39) and non-converters. In age-stratified Cox proportional hazards model analyses, STAI State was not a significant predictor of conversion to AD (STAI State < or =30 vs. > 30 risk ratio, 1.68; 95% CI, 0.75, 3.77; p = 0.21), but higher Trait scores indicated a lower risk of conversion when STAI State, education, the Folstein Mini-Mental State Examination and HAM-D (depression score) were also included in the model (STAI Trait < or =30 vs. > 30 risk ratio, 0.36; 95% CI, 0.16, 0.82; p = 0.015). CONCLUSIONS In contrast to two other recent studies that showed anxiety predicted cognitive decline or conversion to AD, in this clinic-based sample, state anxiety was not a significant predictor. However, higher Trait anxiety predicted a lower risk of future conversion to AD. Further research with systematic long-term follow-up in larger samples is needed to clarify the role of state and trait anxiety in predicting MCI conversion to AD.
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Affiliation(s)
- Deidre J. Devier
- Louisiana State University Health Sciences Center, Department of Neurology, New Orleans, LA, USA,Correspondence to: D. J. Devier, PhD, LSUHSC/Neurology, 1542 Tulane Avenue, Room 763, New Orleans, LA 70112, USA. E-mail:
| | - Gregory H. Pelton
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - Matthias H. Tabert
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - Xinhua Liu
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - Katrina Cuasay
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - Rachel Eisenstadt
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - Karen Marder
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
| | - D.P. Devanand
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA,Department of Neurology, Sergievsky Center, Taub Institute, New York, NY, USA
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Devanand D, Van Heertum RL, Kegeles LS, Liu X, Jin ZH, Mikhno A, Pelton GH, Pradhaban G, Pratap M, Scarmeas N, Rusinek H, Mann JJ, Parsey RV. IC‐P‐073: 99mTc HMPAO SPECT prediction of conversion from mild cognitive impairment to Alzheimer's disease. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.05.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pelton GH, Tabert M, Devanand D. P2‐403: Olfactory performance predicts donepezil response in the high risk to dement elderly with depression and cognitive impairment. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Matthias Tabert
- Columbia U. and New York State Psychiatric Inst.New YorkNYUSA
| | - D.P. Devanand
- Columbia U. and New York State Psychiatric Inst.New YorkNYUSA
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Vishwanath P, Prashant A, Devanand D, Nayak N, D'souza V, Venkatesh T. Screening of school children for blood lead levels and attempts to reduce them by nonpharmacological means in a coastal city of India. Indian J Med Sci 2008; 62:185-192. [PMID: 18579977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT Lead is a major health hazard, especially in children. Impact of lead poisoning on our society is not known. Effectiveness of environmental interventions in reducing blood lead levels is not exactly known, though the Center for Disease Control and Prevention strongly advocates use of such means. AIMS We aimed at screening school children for blood lead levels (BLLs) and reducing the BLLs of children with preliminary BLL> 20 microg/dL by environmental intervention and intensive education. MATERIALS AND METHODS To assess the extent of lead poisoning, a screening of 106 children was done, which showed that children belonging to a particular government primary school had higher BLLs. A second screening program of 87 children conducted in that school showed that only 19% had BLL < 10 microg/dL; whereas 44% had BLL between 10 and 20 microg/dL, and 37% had BLL> 20 microg/dL. Thirty-eight children having BLL> 20 microg/dL were selected from the two screening programs. After removing all potential sources of lead from their environment and educating them about the ways to prevent exposure to lead, follow-up of their BLLs was carried out at an interval of 6 months for a period of 1 year. STATISTICAL ANALYSIS Values of the different follow-up studies were compared using repeated-measure ANOVA. RESULTS Our results showed that there was a significant (P < 0.0001) reduction in the BLLs in the first and second follow-up studies. CONCLUSIONS The study is a proof of the concept that a decline in the BLLs can be achieved by intense education and avoiding the potential environmental sources of lead.
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Vishwanath P, Prashant A, Devanand D, Nayak N, D′souza V, Venkatesh T. Screening of school children for blood lead levels and attempts to reduce them by nonpharmacological means in a coastal city of India. ACTA ACUST UNITED AC 2008. [DOI: 10.4103/0019-5359.40983] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pelton GH, Tabert M, Devanand D. P‐098: Olfactory deficits predict donepezil response in depressed cognitively impaired patients. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Matthias Tabert
- Columbia U. and New York State Psychiatric Inst.New YorkNYUSA
| | - D.P. Devanand
- Columbia U. and New York State Psychiatric Inst.New YorkNYUSA
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Tabert MH, Steffener JR, Albers MW, Devanand D. P‐062: Neural correlates of olfactory deficits in Alzheimer's disease patients: An fMRI study. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Schofield PW, Padilla M, Tabert M, Pelton GH, Stern Y, Devanand D. P2–112: Correlates of subjective memory complaints in a clinical sample: Relationship to level of impairment. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Devanand D, Tabert MH, Pelton GH, Stern Y. [P‐012]: Early markers of Alzheimer's disease in patients with minimal to mild cognitive impairment. Alzheimers Dement 2005. [DOI: 10.1016/j.jalz.2005.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Pelton GH, Devanand D, Padilla M, Juszczak N, Chen CS, Marder K, Roose SP, Sackeim HA, Stern Y. P1-409 The risk of dementia in sertraline treated elderly patients with depression and cognitive impairment. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)80721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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40
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Devanand D, Pratap G, Khandji A, Tabert MH, Pelton GH, de Santi S, Segal S, Goodkind M, Rusinek H, de Leon M. P3-058 MRI-defined hippocampus volume predicts conversion to AD in cognitively impaired patients without dementia. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)81210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Albert SM, Jacobs DM, Sano M, Marder K, Bell K, Devanand D, Brandt J, Albert M, Stern Y. Longitudinal study of quality of life in people with advanced Alzheimer's disease. Am J Geriatr Psychiatry 2001; 9:160-8. [PMID: 11316620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The authors examined three indicators of health-related quality of life in people with advanced Alzheimer's disease ([AD]; N=150): confinement to home, null activity, and null positive affect, as reported by patient proxies. Dementia severity predicted time-to-onset for all three disease milestones in models that controlled for sociodemographic indicators, nursing home status, and death in the follow-up period. Patients whose dementia worsened over follow-up were more likely to reach each milestone. These outcomes represent key milestones in the care of patients; they are sensitive to disease progression, and they are likely to be useful for studying treatment in advanced AD.
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Affiliation(s)
- S M Albert
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University, New York, NY, USA.
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Roose SP, Devanand D, Suthers K. Depression: treating the patient with comorbid cardiac disease. Geriatrics (Basel) 1999; 54:20-1, 25-6, 29-31 passim. [PMID: 10024871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Depressed patients develop symptomatic and fatal ischemic heart disease at a higher rate than nondepressed patients, even after studies are controlled for known cardiovascular risk factors. Changes in sympathetic and parasympathetic tone appear to make depressed patients more vulnerable to ventricular fibrillation. Tricyclic antidepressants share the electrophysiologic profile of type 1A antiarrhythmic compounds and therefore may carry a risk of increased mortality when given to patients with ischemic heart disease. Serotonin reuptake inhibitors have shown no antiarrhythmic effect in depressed patients with serious cardiovascular disease, but studies to date have been small and short-term.
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Affiliation(s)
- S P Roose
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Stern Y, Tang MX, Albert MS, Brandt J, Jacobs DM, Bell K, Marder K, Sano M, Devanand D, Albert SM, Bylsma F, Tsai WY. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA 1997; 277:806-12. [PMID: 9052710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To develop and validate an approach that uses clinical features that can be determined in a standard patient visit to estimate the length of time before an individual patient with Alzheimer disease (AD) requires care equivalent to nursing home placement or dies. DESIGN Prospective cohort study of 236 patients, followed up semiannually for up to 7 years. A second validation cohort of 105 patients was also followed. SETTING Three AD research centers. PATIENTS All patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable AD and had mild dementia at the initial visit. INTERVENTION Predictive features, ascertained at the initial visit, were sex, duration of illness, age at onset, modified Mini-Mental State Examination (mMMS) score, and the presence or absence of extrapyramidal signs or psychotic features. MAIN OUTCOME MEASURES (1) Requiring the equivalent of nursing home placement and (2) death. RESULTS Prediction algorithms were constructed for the 2 outcomes based on Cox proportional hazard models. For each algorithm, a predictor index is calculated based on the status of each predictive feature at the initial visit. A table that specifies the number of months in which 25%, 50%, and 75% of patients with any specific predictor index value are likely to reach the end point is then consulted. Survival curves for time to need for care equivalent to nursing home placement and for time to death derived from the algorithms for selected predictor indexes fell within the 95% confidence bands of actual survival curves for patients. When the predictor variables from the initial visit for the validation cohort patients were entered into the algorithm, the predicted survival curves for time to death fell within the 95% confidence bands of actual survival curves for the patients. CONCLUSIONS The prediction algorithms are a first but promising step toward providing specific prognoses to patients, families, and practitioners. This approach also has clear implications for the design and interpretation of clinical trials in patients with AD.
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Affiliation(s)
- Y Stern
- Department of Neurology, Gertrude H. Sergievsky Center, New York, NY 10032, USA
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Richards M, Folstein M, Albert M, Miller L, Bylsma F, Lafleche G, Marder K, Bell K, Sano M, Devanand D. Multicenter study of predictors of disease course in Alzheimer disease (the "predictors study"). II. Neurological, psychiatric, and demographic influences on baseline measures of disease severity. Alzheimer Dis Assoc Disord 1993; 7:22-32. [PMID: 8481223 DOI: 10.1097/00002093-199307010-00003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The "Predictors Study" is a prospective cohort study of the natural history of Alzheimer disease (AD), the aim of which is to identify milestones in disease progression and to develop a model to predict disease course in individual patients. The empirical background to this study is based on previous reports that the presence of extrapyramidal signs (EPS), myoclonus, and psychosis in AD may signify greater disease severity at any given stage and a more rapid course of the disease over time. The present analyses were conducted to determine whether these independent "predictor" variables were associated with greater disease severity at baseline within a new cohort of 224 mild AD patients recruited from three different medical centers (in New York, Baltimore, and Boston). Measures of disease severity were provided by the modified Mini-Mental State Examination (mMMSE) and the Blessed Dementia Rating Scale (BDRS), which measures functional capacity. Independent variables were EPS, delusions, and slowing of the posterior dominant EEG rhythm. The frequency of myoclonus and hallucinations was too low to permit adequate statistical assessment of their effects at this time. EPS and EEG slowing were associated with low mMMSE scores, whereas delusions were primarily associated with impaired functional capacity. These effects were independent of the influence of age and disease duration. These results indicate that the effects of these independent variables can be detected at mild stages of AD and that these effects can be generalized across different geographical regions.
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Affiliation(s)
- M Richards
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York
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