Anosognosia and Its Relation to Psychiatric Symptoms in Early-Onset Alzheimer Disease

Background: We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). Methods: We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. Results: The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. Conclusion: These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.

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Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers’ Depression on Caregiver Burden

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988719874123 ◽

2019 ◽

Vol 33 (5) ◽

pp. 243-249 ◽

Cited By ~ 1

Author(s):

Faik Ilik ◽

Hüseyin Büyükgöl ◽

Fatih Kayhan ◽

Devrimsel Harika Ertem ◽

Timur Ekiz

Keyword(s):

Alzheimer Disease ◽

Caregiver Burden ◽

Sexual Behaviors ◽

Rating Scale ◽

Neuropsychiatric Symptoms ◽

Clinical Dementia Rating ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Prevalence Of Depression ◽

State Examination

Objective: We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers’ depression, on the caregiver burden. Method: One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI). Results: Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD ( P = .009, χ2 = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs ( P = .000, χ2 = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores ( P < .05). Conclusions: The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.

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Neuropsychiatric Effects on Decision-Making in Early Alzheimer Disease

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988719888292 ◽

2020 ◽

Vol 33 (2) ◽

pp. 68-72

Author(s):

Oleg Yerstein ◽

Andrew R. Carr ◽

Elvira Jimenez ◽

Mario F. Mendez

Keyword(s):

Decision Making ◽

Alzheimer Disease ◽

Frontotemporal Dementia ◽

Ultimatum Game ◽

Neuropsychiatric Symptoms ◽

The Other ◽

Healthy Controls ◽

Neuropsychiatric Inventory ◽

Behavioral Variant Frontotemporal Dementia

Background: Neuropsychiatric symptoms can impact decision-making in patients with Alzheimer disease (AD). Methods: Using a simple decision-making task, a variant of the ultimatum game (UG) modified to control feelings of unfairness, this study investigated rejection responses among responders to unfair offers. The UG was administered to 11 patients with AD, 10 comparably demented patients with behavioral variant frontotemporal dementia (bvFTD), and 9 healthy controls (HC). The results were further compared with differences on the caregiver Neuropsychiatric Inventory (NPI). Results: Overall, patients with AD significantly rejected more total offers than did the patients with bvFTD and the HC ( P < .01). On the NPI, the only domain that was significantly worse among the patients with AD compared to the other groups was dysphoria/depression. Conclusions: These results suggest that early AD can be distinguished based on increased rejections of offers in decision-making, possibly consequent to a heightened sense of unfairness from dysphoria/depression.

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Depression and psychiatric symptoms preceding onset of dementia in a family with early-onset Alzheimer disease with a novel PSEN1 mutation

Journal of Neurology ◽

10.1007/s00415-009-5096-4 ◽

2009 ◽

Vol 256 (8) ◽

pp. 1351-1353 ◽

Cited By ~ 13

Author(s):

Kensaku Kasuga ◽

Tsukasa Ohno ◽

Tomohiko Ishihara ◽

Akinori Miyashita ◽

Ryozo Kuwano ◽

...

Keyword(s):

Alzheimer Disease ◽

Early Onset ◽

Psychiatric Symptoms ◽

Psen1 Mutation

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Neuropsychiatric Symptoms, Caregiver Burden and Distress in Behavioral-Variant Frontotemporal Dementia and Alzheimer's Disease

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000437351 ◽

2015 ◽

Vol 40 (5-6) ◽

pp. 268-275 ◽

Cited By ~ 32

Author(s):

Thais Bento Lima-Silva ◽

Valéria Santoro Bahia ◽

Viviane Amaral Carvalho ◽

Henrique Cerqueira Guimarães ◽

Paulo Caramelli ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Frontotemporal Dementia ◽

Sex Education ◽

Caregiver Burden ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Clinical Dementia Rating ◽

Behavioral Variant Frontotemporal Dementia ◽

Significant Difference

Background/Aims: We aimed to compare caregiver burden and distress in behavioral-variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) and to investigate which factors contribute to caregivers' burden and distress. Methods: Fifty patients and their caregivers were invited to participate. Among the patients, 20 had a diagnosis of bvFTD and 30 had AD. Caregivers and patients were statistically equivalent for age, sex, education and dementia severity according to Clinical Dementia Rating. The protocol included the Short Zarit Burden Inventory, the Neuropsychiatric Inventory (NPI), Disability Assessment for Dementia (DAD), the Cornell Scale for Depression in Dementia (CSDD), Addenbrooke's Cognitive Examination-Revised, the Executive Interview with 25 Items, Direct Assessment of Functional Status and the Geriatric Anxiety Inventory (GAI). Results: In the NPI, caregivers of bvFTD patients reported a higher presence and severity of neuropsychiatric symptoms and caregiver distress compared to caregivers of AD patients. There was no significant difference in the perceived burden. In bvFTD, DAD and GAI scores were significantly correlated with burden, whereas in AD, burden was correlated with CSDD and NPI scores. Psychiatric symptoms were associated with distress in both groups. Conclusions: Caregivers of bvFTD patients experienced higher levels of distress than caregivers of AD patients. Patients' functional limitations were associated with burden of caregivers of bvFTD patients, whereas neuropsychiatric symptoms were associated with caregiver strain in both groups.

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Sex Differences in Neuropsychiatric Symptoms of Alzheimer’s Disease: The Modifying Effect of Apolipoprotein Eε4 Status

Behavioural Neurology ◽

10.1155/2015/275256 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Yi Xing ◽

Yi Tang ◽

Jianping Jia

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Sex Differences ◽

Neuropsychiatric Symptoms ◽

Bonferroni Correction ◽

Neuropsychiatric Inventory ◽

Clinical Dementia Rating ◽

Severe Stage ◽

Modifying Effect ◽

Psychiatric Manifestations

Sex differences in neuropsychiatric symptoms of Alzheimer’s disease (AD) have been demonstrated in previous studies, and apolipoprotein E (ApoE)ε4 status influences psychiatric manifestations of AD. However, whether ApoEε4 status modifies the sex differences in neuropsychiatric symptoms of AD is still unclear. In this study, sex differences in neuropsychiatric abnormalities were stratified and analyzed by ApoEε4 status in mild AD and moderate to severe AD separately. The Clinical Dementia Rating (CDR) scale and the Neuropsychiatric Inventory (NPI) were used to assess dementia severity and neuropsychiatric symptoms. No sex differences were found in mild AD. In moderate to severe AD, amongε4 positive individuals, disinhibition was significantly more prevalent (8.0% in men versus 43.2% in women,p=0.003) and severerp=0.003in female patients. The frequency (16.0% in men versus 51.4% in women,p=0.005) and scorep=0.004of irritability were of borderline significance after strict Bonferroni correction. In conclusion, this study supported the modifying effect of ApoEε4 status on sex differences in neuropsychiatric symptoms of AD, and this modifying effect was pronounced in moderate to severe stage of AD. The interaction between gender and ApoEε4 status should be considered in studies on neuropsychiatric symptoms of AD.

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Are we comparing frontotemporal dementia and Alzheimer disease patients with the right measures?

International Psychogeriatrics ◽

10.1017/s1041610216000582 ◽

2016 ◽

Vol 28 (9) ◽

pp. 1481-1485 ◽

Cited By ~ 5

Author(s):

Mariel B. Deutsch ◽

Li-Jung Liang ◽

Elvira E. Jimenez ◽

Michelle J. Mather ◽

Mario F. Mendez

Keyword(s):

Cognitive Function ◽

Alzheimer Disease ◽

Frontotemporal Dementia ◽

Rating Scales ◽

Neuropsychiatric Symptoms ◽

Clinical Manifestations ◽

Clinical Dementia Rating ◽

Dementia Severity ◽

The Right ◽

And Behavior

ABSTRACTBackground:Clinical research studies of behavioral variant frontotemporal dementia (bvFTD) often use Alzheimer disease (AD) as a comparison group for control of dementia variables, using tests of cognitive function to match the groups. These two dementia syndromes, however, are very different in clinical manifestations, and the comparable severity of these dementias may not be reflected by commonly used cognitive scales such as the Mini-Mental State Examination (MMSE).Methods:We evaluated different measures of dementia severity and symptoms among 20 people with bvFTD compared to 24 with early-onset AD.Results:Despite similar ages, disease-duration, education, and cognitive performance on two tests of cognitive function, the MMSE and the Montreal Cognitive Assessment (MoCA), the bvFTD participants, compared to the AD participants, were significantly more impaired on other measures of disease severity, including function (Functional Assessment Questionnaire (FAQ)), neuropsychiatric symptoms (Neuropsychiatric Inventory (NPI)), and global dementia stage (Clinical Dementia Rating Scales (CDRs)). However, when we adjusted for the frontotemporal lobar degeneration-CDR (FTLD-CDR) in the analyses, the two dementia groups were comparable across all measures despite significant differences on the cognitive scales.Conclusion:We found tests of cognitive functions (MMSE and MoCA) to be insufficient measures for ensuring comparability between bvFTD and AD groups. In clinical studies, the FTLD-CDR, which includes additional language and behavior items, may be a better overall way to match bvFTD and AD groups on dementia severity.

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What are we trying to prevent in Alzheimer disease?

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2019.21.1/frjessen ◽

2019 ◽

Vol 21 (1) ◽

pp. 27-34

Keyword(s):

Alzheimer Disease ◽

Goal Attainment ◽

Neuropsychiatric Symptoms ◽

Treatment Options ◽

Cost Benefit ◽

Effective Prevention ◽

Preclinical Ad ◽

The Individual ◽

And Function ◽

Aging Societies

Within aging societies, the number of individuals suffering from Alzheimer disease (AD) is constistently increasing. This is paralleled by intense research aimed at improving treatment options and potentially even fostering effective prevention. The discussion on relevant outcomes of such interventions is ongoing. Here, different types of currently applied outcomes in the treatment of AD at the dementia stage, but also at the pre-dementia stages of mild cognitive impairment (MCI) and asymptomatic preclinical AD are discussed. Regulatory agencies require effects on the clinical measures of cognition and function. In novel disease-modifying therapy trials, biological markers are used as secondary and exploratory outcomes. Additional outcomes of great relevance for the individual patients are neuropsychiatric symptoms, quality of life, and goal attainment. In addition, costs and cost-benefit ratios are of interest for the reimbursement of interventions.

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Comparing the Neuropsychiatric Profile of Patients with Alzheimer Disease Who Present Spared versus Impaired Executive Functioning

Current Gerontology and Geriatrics Research ◽

10.1155/2011/514059 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Ezequiel Gleichgerrcht ◽

Anabel Chade ◽

Teresa Torralva ◽

María Roca ◽

Facundo Manes

Keyword(s):

Alzheimer Disease ◽

Executive Functioning ◽

Neuropsychological Tests ◽

Motor Behavior ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Significant Difference ◽

Repetitive Motor ◽

Shed Light

Background. A “dysexecutive” group of patients with Alzheimer disease (AD) has been previously identified, and these patients have been found to present higher frequency of psychiatric symptoms and more pronounced functional impact. This study aimed at evaluating the frequency of neuropsychiatric symptoms in patients with early AD who present with impaired executive functioning.Methods. Thirty patients with early AD diagnosis were divided into a spared (SEF) and an impaired (IEF) executive functioning group according to their performance scores on neuropsychological tests. Their closest relatives or caregivers completed the Cambridge behavioral inventory (CBI), which assesses behavioral symptoms grouped into 13 categories.Results. A significant difference was exclusively found between SEF and IEF in terms of the frequency of stereotypies and repetitive motor behavior (U=60.5,P=.024).Conclusions. The presence of stereotypies could be associated with a dysexecutive profile in AD patients. These results shed light on the role of frontal circuitry in the expression of motor symptoms in AD and prompt for further research that will contribute to the differential diagnosis both of different subtypes of AD and other types of dementia.

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The Differential Diagnosis of Adult Onset Metachromatic Leukodystrophy and Early Onset Familial Alzheimer Disease in an Alzheimer Clinic Population

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710004823x ◽

1993 ◽

Vol 20 (4) ◽

pp. 312-318 ◽

Cited By ~ 6

Author(s):

A.D. Sadovnick ◽

H. Tuokko ◽

D.A. Applegarth ◽

J.R. Toone ◽

T. Haijistavropoulos ◽

...

Keyword(s):

Family History ◽

Alzheimer Disease ◽

Behavioral Problems ◽

Early Onset ◽

Metachromatic Leukodystrophy ◽

Psychiatric Symptoms ◽

Age At Onset ◽

Positive Family History ◽

Personality Change ◽

Adult Onset

ABSTRACT:Clinical differentiation between forms of progressive dementia can prove difficult, particularly when relatively rare forms of dementia are involved. Factors such as family history of dementia, age at onset, presenting features such as personality change, cognitive deficits, psychiatric symptoms, and clinical course (progressive deterioration; retention of skills over time) may prove useful for directing investigations to identify underlying pathology and genetic implications. This is illustrated by two patient reports. Each patient had the onset of memory/behavioral problems at approximately age 40 years, was initially given a psychiatric, non-dementing diagnosis, and had a positive family history for early onset behavioral and memory problems. After longitudinal assessment, the diagnosis of Alzheimer disease was confirmed at autopsy in one patient and a diagnosis of familial, adult-onset metachromatic leukodystrophy in the other.

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