scholarly journals Neuropsychiatric and cognitive symptoms across the Alzheimer’s disease clinical spectrum: Cross-sectional and longitudinal associations

2021 ◽  
Author(s):  
Willem S. Eikelboom ◽  
Esther van den Berg ◽  
Ellen Singleton ◽  
Sara J. Baart ◽  
Michiel Coesmans ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Functioning ◽  
Neuropsychiatric Symptoms ◽  
Clinical Stage ◽  
Clinical Spectrum ◽  
Subjective Cognitive Decline ◽  
Cognitive Symptoms ◽  
Cross Sectional ◽  
Over Time

ABSTRACTObjectiveTo investigate the prevalence and trajectories of neuropsychiatric symptoms (NPS) in relation to cognitive functioning in a cohort of amyloid-β positive individuals across the Alzheimer’s disease (AD) clinical spectrum.MethodsWe included 1,524 amyloid-β positive individuals from the Amsterdam Dementia Cohort with subjective cognitive decline (SCD, n=113), mild cognitive impairment (MCI, n=321), or dementia (n=1,090). We measured NPS with the neuropsychiatric inventory (NPI), examining total scores and the presence of specific NPI-items. Cognition was assessed across five cognitive domains and with the MMSE. We examined trajectories including model based trends for NPS and cognitive functioning over time. We used linear mixed models to relate baseline NPI scores to cognitive functioning at baseline (whole-sample) and longitudinal time-points (subsample n=520, Mean=1.8 [SD=0.7] years follow-up).ResultsNPS were prevalent across all clinical AD stages (NPI total score ≥1 81.4% in SCD, 81.2% in MCI, 88.7% in dementia). Cognitive functioning showed an uniform gradual decline; while in contrast, large intra-individual heterogeneity of NPS was observed over time across all groups. At baseline, we found associations between NPS and cognition in dementia that were most pronounced for NPI total scores and MMSE (range β:-0.18–0.11, FDR-adjusted p<0.05), while there were no cross-sectional relationships in SCD and MCI (β:-0.32– 0.36, FDR-adjusted p>0.05). There were no associations between baseline NPS and cognitive functioning over time in any clinical stage (β:-0.13–0.44, FDR-adjusted p>0.05).ConclusionNPS and cognitive symptoms are both prevalent across the AD continuum, but show a different evolution during the course of the disease.

scholarly journals Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012598
Author(s):  
Willem S. Eikelboom ◽  
Esther van den Berg ◽  
Ellen H. Singleton ◽  
Sara J. Baart ◽  
Michiel Coesmans ◽  
...  
Keyword(s):  
Cognitive Functioning ◽  
Neuropsychiatric Symptoms ◽  
Clinical Stage ◽  
Clinical Spectrum ◽  
Subjective Cognitive Decline ◽  
Cognitive Symptoms ◽  
Cross Sectional ◽  
Cognitive Domains ◽  
Over Time

Objective:To investigate the prevalence and trajectories of neuropsychiatric symptoms (NPS) in relation to cognitive functioning in a cohort of amyloid-β positive individuals across the Alzheimer’s disease (AD) clinical spectrum.Methods:In this single-center observational study, we included all individuals who visited the Alzheimer Center Amsterdam and had 1) a clinical diagnosis of subjective cognitive decline (SCD), mild cognitive impairment (MCI), or probable AD dementia, and 2) were amyloid-β positive (A+). We measured NPS with the Neuropsychiatric Inventory (NPI), examining total scores and the presence of specific NPI domains. Cognition was assessed across five cognitive domains and with the MMSE. We examined trajectories including model based trends for NPS and cognitive functioning over time. We used linear mixed models to relate baseline NPI scores to cognitive functioning at baseline (whole-sample) and longitudinal time-points (subsample n=520, Mean=1.8 [SD=0.7] years follow-up).Results:We included 1,524 amyloid-β positive individuals from the Amsterdam Dementia Cohort with A+ SCD (n=113), A+ MCI (n=321), or A+ AD dementia (n=1,090). NPS were prevalent across all clinical AD stages (≥1 NPS 81.4% in SCD, 81.2% in MCI, 88.7% in dementia; ≥1 clinically relevant NPS 54.0% in SCD, 50.5% in MCI, 66.0% in dementia). Cognitive functioning showed an uniform gradual decline; while in contrast, large intra-individual heterogeneity of NPS was observed over time across all AD groups. At baseline, we found associations between NPS and cognition in dementia that were most pronounced for NPI total scores and MMSE (range β=0.18 to 0.11, FDR-adjusted p<0.05), while there were no cross-sectional relationships in SCD and MCI (range β=-0.32 to 0.36, all FDR-adjusted p>0.05). There were no associations between baseline NPS and cognitive functioning over time in any clinical stage (range β=-0.13 to 0.44, all FDR-adjusted p>0.05).Conclusion:NPS and cognitive symptoms are both prevalent across the AD continuum, but show a different evolution during the course of the disease.

scholarly journals Perceived stress and depressive symptoms not neuropsychiatric symptoms predict caregiver burden in Alzheimer’s disease: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manee Pinyopornpanish ◽  
Kanokporn Pinyopornpanish ◽  
Atiwat Soontornpun ◽  
Surat Tanprawate ◽  
Angkana Nadsasarn ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Depressive Symptoms ◽  
Caregiver Burden ◽  
Perceived Stress ◽  
Neuropsychiatric Symptoms ◽  
Cross Sectional Study ◽  
Assessment Tools ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background Caregiver burden affects the caregiver’s health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer’s Disease (AD) and to investigate the predictors for caregiving burden. Methods A cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations. Results A higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001). Conclusion Caregiver burden is associated with patients’ neuropsychiatric symptoms indirectly through the caregiver’s depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.

scholarly journals Neuropsychiatric symptoms and severity of dementia

2013 ◽  
Vol 7 (2) ◽  
pp. 171-175
Author(s):  
Gustavo Henrique de Oliveira Caldas ◽  
Sueli Luciano Pires ◽  
Milton Luiz Gorzoni
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Motor Behavior ◽  
Neuropsychiatric Symptoms ◽  
Prevalence Ratio ◽  
Cross Sectional Study ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Specific Stage ◽  
Severity Of Dementia

ABSTRACT Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families Objective: To evaluate the prevalence of NPS as a specific stage of dementia status. Methods: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. Results: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001 while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). Conclusion: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

scholarly journals Neuroinflammation characterizes the earliest changes in Alzheimer’s disease pathology and associated subjective cognitive impairment in adult hydrocephalus biopsies

2020 ◽  
Author(s):  
Wenrui Huang ◽  
Anne Marie Bartosch ◽  
Harrison Xiao ◽  
Xena Flowers ◽  
Sandra Leskinen ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Status ◽  
Subjective Cognitive Decline ◽  
Cognitive Symptoms ◽  
Microglial Phenotype ◽  
Neuronal Genes ◽  
Early Alzheimer’S Disease ◽  
Disease Associated Genes ◽  
Microglial Response

AbstractIn an effort to better characterize the transcriptomic changes that accompany early Alzheimer’s disease (AD) pathology in living patients and correlate with contemporaneous cognitive data, we performed RNA-seq on 106 cortical biopsies that were taken during shunt placement for adult onset hydrocephalus with varying degrees of comorbid AD pathology. A restricted set of genes correlate with AD pathology in these biopsies, and co-expression network analysis demonstrates an evolution from microglial homeostasis to a disease-associated microglial phenotype in conjunction with increasing AD pathologic burden, along with a subset of additional astrocytic and neuronal genes that accompany these changes. Further analysis demonstrates that these correlations are driven by patients that report mild cognitive symptoms, despite similar levels of β-amyloid and tau pathology in comparison to patients who report no cognitive symptoms. Interestingly, downregulation of homeostatic genes and upregulation of disease-associated genes also correlate with microglial plaque invasion and an activated microglial morphology, and this change is not sensitive to cognitive status, suggesting that an initial microglial response to AD pathology is eventually maladaptive. Taken together, these findings highlight a restricted set of microglial and non-microglial genes and suggest that early AD pathology is largely characterized by a loss of homeostatic genes and an activated microglial phenotype that continues to evolve in conjunction with accumulating AD pathology in the setting of subjective cognitive decline.

scholarly journals AFFECTIVE THEORY OF MIND IN PEOPLE WITH ALZHEIMER’S DISEASE

2021 ◽  
Author(s):  
Aline De Lucena ◽  
Paulo Fernando Santos ◽  
Marcia Cristina Dourado
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Emotional State ◽  
Neuropsychiatric Symptoms ◽  
Cross Sectional Study ◽  
Social Situations ◽  
Cross Sectional ◽  
Emotional Reasoning ◽  
Significant Difference ◽  
Emotional Aspects

Background: In recent years, interest has been growing in cognitive and affective ToM functioning in individuals suffering from neurodegenerative disorders, such as Alzheimer’s disease (AD). However, the affective ToM has been less investigated. Objective: This study aims to compare affective ToM performance in persons with mild to moderate AD and healthy older controls (HOC), and its relationship with cognition. Methods: A cross-sectional study of 97 mild to moderate AD individuals and 40 HOC. To assess affective ToM, participants were administered a task that examines ability to comprehend the emotional situation nature along with the appropriate emotional state that one would experience in that situation. Assessments of cognition, dementia severity, functionality, awareness of disease and neuropsychiatric symptoms were completed for AD group. Results: Analyses of emotional reasoning indicated a group effect on performance. There was a significant difference between the AD and HOC groups in terms of their ability to understand situations of sadness, surprise, anger, and happiness, with the moderate AD showing the worst performance for all emotional situations. Ability to appropriately name the emotional state was significantly different for surprise, anger, and happiness, but not for sadness, with both AD groups showing lower performance for surprise and anger, and with the mild AD showing better performance for happiness. In both AD groups, ability to understand the emotional situation and to name the emotion was significantly correlated with cognitive impairment and awareness of disease. Neuropsychiatric symptoms were significantly correlated in moderate AD group. Conclusions: Impairment in understanding the emotional aspects of situations can lead moderate AD people to experience conflicts in family and social situations. Mild AD people can experience same conflicts when their preserved ability in understanding the emotional situation is underestimated.

scholarly journals Sundown syndrome in patients with Alzheimer’s disease dementia

2019 ◽  
Vol 13 (4) ◽  
pp. 469-474 ◽  
Author(s):  
Cristiani Sartorio Menegardo ◽  
Fernanda Alencar Friggi ◽  
Julia Baldon Scardini ◽  
Tais Souza Rossi ◽  
Thais dos Santos Vieira ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
High Frequency ◽  
Neuropsychiatric Symptoms ◽  
Time Of Day ◽  
Neuropsychiatric Inventory ◽  
Cross Sectional ◽  
Symptom Intensity ◽  
The Family ◽  
Alzheimer’S Disease Dementia

ABSTRACT The sundown syndrome is a complex neurobehavioral disorder in patients with dementia associated with high financial cost and significant caregiver burden. It is a multifactorial phenomenon with unclear pathophysiology, characterized by the presence of neuropsychiatric symptoms in the evening period. Objective: To analyze the main neuropsychiatric symptoms, their correlation with one another, with comorbidities, and with time of day of greatest symptom intensity in patients with Alzheimer’s disease dementia. Methods: This is a cross-sectional, observational and explanatory study in which caregivers/relatives of elderly patients with dementia were interviewed using a structured tool called the Neuropsychiatric Inventory (NPI). Results: The sample studied was composed of 38 patients, 60.5% female and 39.5% male, with mean age of 81±6 (67-94) years. A high frequency of neuropsychiatric symptoms in the evening period was observed, predominantly irritability (55.3%), nocturnal behavior (47.4%), and aggressiveness (42.1%). Only 36.8% of the family caregivers used non-pharmacological strategies. Conclusion: The frequency of neuropsychiatric symptoms was exacerbated in the evening among patients with Alzheimer’s disease, especially for those behavioral symptoms that had a positive correlation with one another.

scholarly journals Frequency and subgroups of neuropsychiatric symptoms in mild cognitive impairment and different stages of dementia in Alzheimer's disease

2017 ◽  
Vol 30 (1) ◽  
pp. 103-113 ◽  
Author(s):  
N. Siafarikas ◽  
G. Selbaek ◽  
T. Fladby ◽  
J. Šaltytė Benth ◽  
E. Auning ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Factor Analysis ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Neuropsychiatric Symptoms ◽  
Small Sample ◽  
Psychotic Symptoms ◽  
Cross Sectional

ABSTRACTBackground:Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD.Methods:This was a cross-sectional study using data from a Norwegian national registry of memory clinics. From a total sample of 4,571 patients, we included those with MCI or AD (MCI 817, mild AD 883, moderate–severe AD 441). To compare variables across groups ANOVA or χ2-test was applied. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items to identify subgroups of NPS.Results:The frequency of any NPS was 87.2% (AD 91.2%, MCI 79.5%; p < 0.001) and increased with increasing severity of cognitive decline. The most frequent NPS in MCI was depression. Apathy was the most frequent NPS in AD across different stages of severity. The factor analysis identified three subgroups in MCI and mild AD, and a fourth one in moderate–severe AD. We labelled the subgroups “depression,” “agitation,” “psychosis,” and “elation.”Conclusions:The frequency of NPS is high in MCI and AD and increases with the severity of cognitive decline. The subgroups of NPS were relatively consistent from MCI to moderate-severe AD. The subgroup elation appeared only in moderate-severe AD.

Patterns of neuropsychiatric sub-syndromes in Brazilian and Norwegian patients with dementia

2012 ◽  
Vol 25 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Annibal Truzzi ◽  
Ingun Ulstein ◽  
Letice Valente ◽  
Eliasz Engelhardt ◽  
Evandro Silva Freire Coutinho ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Factor Analysis ◽  
Motor Behavior ◽  
Neuropsychiatric Symptoms ◽  
Principal Component ◽  
Mixed Dementia ◽  
Cross Sectional ◽  
Brazilian Sample ◽  
Two Samples

ABSTRACTBackground: Neuropsychiatric symptoms (NPS) affect the majority of patients who have dementia. Neuropsychiatric sub-syndromes with symptoms that occur together and have common neurobiological correlates have been identified. There are scarce data regarding the comparison of the pattern of the neuropsychiatric sub-syndromes in distinct ethnical and cultural populations. We aim at comparing the pattern of the NPS, and the factor analysis of the Neuropsychiatric Inventory (NPI-10) in two samples of outpatients with dementia living in Brazil and Norway.Methods: This is a cross-sectional study. The sample consists of 168 Brazilian and 155 Norwegian demented patients from psychogeriatric facilities and community-based educational programs. Brazilian patients were diagnosed with Alzheimer's disease (63.7%), vascular dementia (15.5%), or mixed dementia (20.8%), whereas the diagnoses of Norwegian patients were Alzheimer's disease (97.4%) and mixed dementia (2.6%). Principal component analysis with the Varimax rotation was used for factor analysis of the NPI-10.Results: Apathy (80.4 %), agitation/aggression (45.8%), and aberrant motor behavior (45.8%) were the most common symptoms in the Brazilian sample. Apathy (72.3%), dysphoria (61.9%), and anxiety (52.3%) were the most frequent symptoms in the Norwegian sample. Factor analysis of the NPI-10 revealed three syndromes for the Brazilian (Psychosis, Mood, Psychomotor) and Norwegian (Psychosis, Mood, Frontal) groups.Conclusions: The frequency of individual NPS may differ among distinct populations. However, Psychosis and Depression are common sub-syndromes in diverse ethnical and cultural patients with dementia. Our findings support the syndromic approach for the clinical assessment of the patients with dementia.

scholarly journals SOCIAL COGNITION AND AWARENESS IN ALZHEIMER’S DISEASE

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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