RESTING HEART RATE MODERATES THE RELATIONSHIP BETWEEN NEUROPSYCHIATRIC SYMPTOMS, MCI, AND ALZHEIMER’S DISEASE

Abstract Little is known about how resting heart rate moderates the relationship between neuropsychiatric symptoms and cognitive status. This study examined the relative risk of NPS on increasingly severe cognitive statuses and examined the extent to which resting heart rate moderates this relationship. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, using observations from participants with normal cognition at baseline (13,470). The relative risk of diagnosis with a more severe cognitive status at a future visit was examined using log-binomial regression for each neuropsychiatric symptom. The moderating effect of resting heart rate among those who are later diagnosed with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assessed. Delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, motor disturbance, nighttime behaviors, and appetite disturbance were all significantly associated (p<.001) with an increased risk of AD, and a reduced risk of MCI. Resting heart rate increased the risk of AD but reduced the relative risk of MCI. Depression significantly interacted with resting heart rate to increase the relative risk of MCI (RR: 1.07 (95% CI: 1.00-1.01), p<.001), but not AD. Neuropsychiatric symptoms increase the relative risk of AD but not MCI, which may mean that the deleterious effect of NPS is delayed until later and more severe stages of the disease course. Resting heart rate increases the relative risk of MCI among those with depression. Practitioners considering early intervention in neuropsychiatric symptomology may consider the downstream benefits of treatment considering the long-term effects of NPS.

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The Relationship Between Neuropsychiatric Symptoms, Nighttime Behaviors, and Alzheimer’s Disease CSF Biomarkers

Innovation in Aging ◽

10.1093/geroni/igab046.2463 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 655-656

Author(s):

Meina Zhang ◽

Young-Eun Cho ◽

Chooza Moon

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Sleep Disturbances ◽

Linear Models ◽

Neuropsychiatric Symptoms ◽

Cognitive Status ◽

Csf Biomarkers ◽

T Tau ◽

The Relationship

Abstract Alzheimer's disease (AD) commonly involves neuropsychiatric symptoms (NPS), such as nighttime behaviors (or sleep disturbance), hallucination, delusion, or mood changes. However, it is unclear how NPS and sleep disturbances are correlated with AD biomarkers. The purpose of this analysis was to examine how NPS and nighttime behaviors are associated with AD CSF biomarkers by cognitive status. A total of 1,667 subjects’ (mean age = 69.4 SD=9.3, 48 % (808) were male) data from the National Alzheimer’s Disease Coordinating Center (NACC) were used, including subjects with dementia (n = 577), mild cognitive impairment (MCI, n = 363), cognitive impairment but not MCI (n = 47), cognitive impairment due to Alzheimer’s etiology (n= 608), and normal cognition (n = 680). The nighttime symptoms, number, and severity of NPS were assessed using the Neuropsychiatric Inventory Questionnaire Quick Version (NPI-Q). Cerebrospinal fluid (CSF) samples were analyzed for Aβ42,dft5 t-tau, p-tau. We used generalized linear models to explore the associations accounting for age, sex, APOE4 alleles, and BMI. We found the number of NPS were associated with Aβ42 (p = 0.042) in individuals with MCI, impaired, or dementia due to Alzheimer’s etiology. Yet, the number of NPS were not associated with t-tau or p-tau in individuals with and without dementia. The severity of NPS including nighttime symptoms were not associated with biomarkers. Our results could suggest that the number of NPS can be reflected by higher CSF Aβ42 levels in the individuals with Alzheimer’s etiology. Future longitudinal analyses are warranted to understand the causal relationships.

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Cognitive anosognosia and behavioral changes in probable Alzheimer's disease patients

Dementia & Neuropsychologia ◽

10.1590/s1980-57642013dn70200010 ◽

2013 ◽

Vol 7 (2) ◽

pp. 197-205 ◽

Cited By ~ 2

Author(s):

Corina Satler ◽

Carlos Tomaz

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Neuropsychiatric Symptoms ◽

Cognitive Status ◽

Behavioral Changes ◽

Self Awareness ◽

Functional Abilities ◽

Neuropsychological Battery ◽

Subjective Memory ◽

Study Objective

ABSTRACT Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. Objective: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). Methods: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. Results: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic- DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. Conclusion: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

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Treatment of Sleep Disturbance May Reduce the Risk of Future Probable Alzheimer’s Disease

Journal of Aging and Health ◽

10.1177/0898264318795567 ◽

2018 ◽

Vol 31 (2) ◽

pp. 322-342 ◽

Cited By ~ 3

Author(s):

Shanna L. Burke ◽

Tianyan Hu ◽

Christine E. Spadola ◽

Aaron Burgess ◽

Tan Li ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Sleep Disturbance ◽

Proportional Hazards ◽

Secondary Analysis ◽

Cox Proportional Hazards ◽

Data Set ◽

Proportional Hazards Regression ◽

Increased Risk ◽

Research Questions

Objective: This study explored two research questions: (a) Does sleep medication neutralize or provide a protective effect against the hazard of Alzheimer’s disease (AD)? (b) Do apolipoprotein (APOE) e4 carriers reporting a sleep disturbance experience an increased risk of AD? Method: This study is a secondary analysis of the National Alzheimer’s Coordinating Center’s Uniform Data Set ( n = 6,782) using Cox proportional hazards regression. Results: Sleep disturbance was significantly associated with eventual AD development. Among the subset of participants taking general sleep medications, no relationship between sleep disturbance and eventual AD was observed. Among individuals not taking sleep medications, the increased hazard between the two variables remained. Among APOE e4 carriers, sleep disturbance and AD were significant, except among those taking zolpidem. Discussion: Our findings support the emerging link between sleep disturbance and AD. Our findings also suggest a continued need to elucidate the mechanisms that offer protective factors against AD development.

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Coffee Consumption and Risk of Dementia and Alzheimer’s Disease: A Dose-Response Meta-Analysis of Prospective Studies

Nutrients ◽

10.3390/nu10101501 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1501 ◽

Cited By ~ 17

Author(s):

Susanna Larsson ◽

Nicola Orsini

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Relative Risk ◽

Confidence Interval ◽

Dose Response ◽

Prospective Studies ◽

Linear Trend ◽

Meta Analysis ◽

Coffee Consumption ◽

Increased Risk

Coffee consumption is associated with a reduced risk of several diseases but uncertainty remains about the influence of coffee consumption on the risk of dementia. We performed a dose-response meta-analysis to summarize the prospective data on coffee consumption and associated risk of dementia and Alzheimer’s disease. We identified studies by searching PubMed (from January 1966) and Web of Science (from January 1945) through 4 October 2018 and by scrutinizing the reference lists of pertinent publications. Two researchers independently reviewed the literature. Results were combined using a restricted cubic spline random-effects dose-response meta-analysis based on a one-stage approach. Eight relevant prospective studies were identified. These studies included 7486 dementia cases diagnosed among 328,885 individuals during an average follow-up of 4.9–25 years. Meta-analysis of all eight studies indicated no statistically significant association between coffee consumption and the risk of dementia and no deviations from a linear trend (p = 0.08). The relative risk of dementia per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval (CI) 0.98–1.05; p = 0.37). Meta-analysis of five studies that focused on Alzheimer’s disease revealed no association between coffee consumption and Alzheimer’s disease and no deviations from a linear trend (p = 0.79). The relative risk of Alzheimer’s disease per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval 0.95–1.07; p = 0.80). These results do not support an association between coffee consumption and an increased risk of overall dementia or Alzheimer’s disease specifically, but further research on the association of coffee consumption with dementia risk is needed.

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Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.3252.2418 ◽

2014 ◽

Vol 22 (2) ◽

pp. 317-324 ◽

Cited By ~ 10

Author(s):

Vanessa Fernanda Goes ◽

Pâmela Billig Mello-Carpes ◽

Lilian Oliveira de Oliveira ◽

Jaqueline Hack ◽

Marcela Magro ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nutritional Status ◽

Elderly Patients ◽

Elderly People ◽

Energy Intake ◽

Caloric Intake ◽

Micronutrient Intake ◽

Increased Risk ◽

The Relationship

OBJECTIVE: to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease.METHODS: the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed.RESULTS: it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients.CONCLUSION: an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease.

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Apathy in Alzheimer's disease: Contribution to a clinical view on progression of dementia

Dementia & Neuropsychologia ◽

10.1590/s1980-57642010dn40300007 ◽

2010 ◽

Vol 4 (3) ◽

pp. 188-193 ◽

Cited By ~ 3

Author(s):

Florindo Stella ◽

Larissa Pires de Andrade ◽

Thays Martins Vital ◽

Flávia Gomes de Melo Coelho ◽

Carla Manuela Crispim Nascimento ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Mini Mental State Examination ◽

Cognitive Status ◽

Clinical Dementia Rating ◽

Global Deterioration Scale ◽

Severe Dementia ◽

Coefficient Corrélation ◽

The Relationship ◽

State Examination

Abstract In addition to cognitive impairment, apathy is increasingly recognized as an important neuropsychiatric syndrome in Alzheimer's disease (AD). Aims: To identify the relationship between dementia severity and apathy levels, and to discuss the association of this condition with other psychopathological manifestations in AD patients. Methods: This study involved 15 AD patients (mean age: 77 years; schooling: 4.9 years), with mild, moderate and severe dementia, living in Rio Claro SP, Brazil. Procedures included evaluation of cognitive status by the Mini-Mental State Examination, Clinical Dementia Rating, and Global Deterioration Scale. Apathy syndrome was assessed by the Apathy Evaluation Scale and Neuropsychiatric Inventory (NPI-apathy domain). Other psychopathological manifestations such as depression were also considered. Results: Patients with more severe dementia presented higher levels of apathy, reinforcing the hypothesis that apathy severity aggravates as the disease progresses. Using the Spearman coefficient correlation an association was identified between the MMSE and Apathy Evaluation Scale (r=0.63; p=0.01), and also between the MMSE and NPI-apathy domain (r=0.81; p=0.01). Associations were also found between the Global Deterioration Scale and Apathy Evaluation Scale (r=0.58; p=0.02), and between the Global Deterioration Scale and NPI-apathy domain (r=0.81; p=0.01). Conclusions: Apathy is a distinct syndrome among patients with AD and increases with global deterioration.

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The Relationship Between Dementia Severity & Caregiver Preferences for Decision Making Role Regarding Mammography

Innovation in Aging ◽

10.1093/geroni/igab046.3532 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 992-992

Author(s):

Molly Frank ◽

Seho Park ◽

Kathleen Lane ◽

Alexia Torke ◽

Mara Schonberg ◽

...

Keyword(s):

Breast Cancer ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Decision Making ◽

Rating Scale ◽

Medical Decision ◽

Diagnose Breast Cancer ◽

Dementia Severity ◽

Increased Risk ◽

The Relationship

Abstract The incidence of Alzheimer’s disease and related dementias (ADRD) and breast cancer increases with age. Despite being one of the most effective ways to diagnose breast cancer early, mammography in ADRD patients comes with an increased risk of treatment complications and false-positive results. Family caregivers are often involved in the decision-making process, and this study evaluates the relationship between dementia severity and caregiver preferences when making decisions about mammography with the patient alone, and with the patient and doctor. We included 181 caregivers from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) to assess dementia severity and a modified Control Preferences Scale (CPS) to assess each caregiver’s preferred decision-making approach. Multinomial logistic regression models evaluated the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, sex, race, education, and relationship to patient. Model 1 examined the caregivers’ preferred role with the patient, and it found a significant association between increased dementia severity and preference for a collaborative approach (p<0.001) or passive approach (p<0.05) compared to an active approach. Model 2 did not find a significant association between dementia severity and the caregivers’ preferred role when making decisions with the patient and doctor; however, those with increased age and education were more likely to prefer an active role. The association between dementia severity, caregiver characteristics, and decision-making preferences supports the need for approaches to support ADRD caregivers with medical decision making.

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SOCIAL COGNITION AND AWARENESS IN ALZHEIMER’S DISEASE

Innovation in Aging ◽

10.1093/geroni/igz038.441 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S120-S120

Author(s):

Marcia Dourado ◽

Tatiana Belfort ◽

José Simões Neto

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Social Cognition ◽

Social Functioning ◽

Neuropsychiatric Symptoms ◽

Consecutive Series ◽

Cross Sectional ◽

Significant Difference ◽

Impaired Awareness ◽

The Relationship

Abstract Social cognition is the capacity to interpret and predict another’s behavior according to beliefs, intentions, and emotions, and the ability to decode environmental stimuli in order to be better able to adapt to new situations. A key question is the relationship between social cognition and awareness in dementia. This study aimed to investigate the relation between social and emotional functioning (SEF) and awareness in Alzheimer's disease (AD). In a cross-sectional design, a consecutive series of 50 people with mild to moderate AD and their 50 family caregivers were assessed. The study variables were awareness, SEF, neuropsychiatric symptoms, cognition, working memory, quality of life, functional activities, presence of depressive symptoms, and caregivers’ burden and cognition. We found a significant difference between self-rated SEF and informant-rated SEF. In 56% of the cases, self-rated SEF was lower than the informant-rated SEF. People with AD mostly (56%) had mildly impaired awareness of disease, 20% had moderate impaired awareness of disease, and 6% were unaware of the disease. A multivariate linear regression examined the association between informant-rated SEF score and the variables. The social functioning and relationship domain of awareness and informant-rated QoL of people with AD were significantly associated with informant-rated SEF. Conclusion: The relationship between informant-rated SEF and awareness of social functioning and relationship supports the multidimensional nature of awareness. SEF and awareness of social functioning shows that they are comprised of judgments related to perceptions about oneself and values qualitatively different from awareness of memory or functionality, which can be directly observed.

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Caring for a Loved One With Alzheimer’s Disease

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317512459795 ◽

2012 ◽

Vol 27 (8) ◽

pp. 579-583 ◽

Cited By ~ 1

Author(s):

Charles Van Liew ◽

Terry A. Cronan

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Health Status ◽

Cognitive Status ◽

Negative Effects ◽

Loved One ◽

Social Burden ◽

Independent Variable ◽

The Impact ◽

The Relationship

Objective: Alzheimer’s disease (AD) is associated with considerable caregiver and social burden. It is important to examine ways to minimize the negative effects of AD. Health care advocates (HCAs) may be one means of limiting the aversive effects of AD. Method: Participants completed a short survey that assessed their perceptions of the impact of comorbid AD on health status and their likelihood of hiring an HCA to assist in managing it. A mediational model was proposed: cognitive status (AD vs cognitively healthy) was the independent variable, perception of severity was the mediator, and the probability of hiring an HCA was the dependent variable. Results: The results indicated that the relationship between cognitive status and probability of hiring an HCA was fully mediated by perceptions of severity. Conclusion: This study demonstrated that participants appreciated the impact of AD on health status, and this translated into a greater probability of hiring an HCA.

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