scholarly journals Study of Prevalence of Neuropsychiatric Symptoms in Elderly Dementia Patients

2021 ◽  
Author(s):  
Mohan Mahale ◽  
Pradeep Behal ◽  
Nitul M Bewal ◽  
Vivek Aggarwal ◽  
Anuj Singhal ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Tertiary Care ◽  
Primary Caregiver ◽  
Ageing Population ◽  
Night Time ◽  
Neuropsychiatric Manifestations ◽  
B12 Deficiency

Introduction: Prevalence of dementia is increasing with rapidly ageing population. Neuropsychiatric Symptoms (NPS) are common in certain types of dementia and increases with duration of dementia in Alzheimer’s disease and are causes significant psychosocial and management issues. Aim: To study the prevalence and type of NPS in patients of dementia presenting to a Tertiary Care Hospital and to find out the association between NPS and the type of dementia and to assess the association of the caregiver stress in this setting. Materials and Methods: The present cross-sectional observational study was conducted at Tertiary Care Government Hospital of Western Maharashtra. All patients with suspected dementia were initially screened by a Mini-Cog questionnaire and patients with a score of three or less were assessed with Hindi Mental Status Examination (HMSE). The inclusion criteria were patients with HMSE of less than or equal to 23. All the diagnosed patients with dementia were screened for common psychiatric symptoms using Neuropsychiatric Inventory (NPI). The presence of NPS was noted based on either presenting complaint of the patient or as per the history given by the primary caregiver for these symptoms in last one month. These questions were administered in focused group discussion form to the primary caregiver by the physician. The data was collected and analysed using descriptive statistics and Chi-square test with SSPS 20. Results: The most common neuropsychiatric manifestation was sleep and night-time behavioural disorder (51.5%). It was followed by depression (44%). Neuropsychiatric manifestations were much more common in demented patients of probable Dementia with Lewy Bodies (DLB) and dementia with B12 deficiency. More than 50% of the patients had two or more psychiatric symptoms. The most common psychiatric symptom in patients with probable Alzheimer’s disease was sleep and night-time disturbance in 54.9%. Common neuropsychiatric manifestations seen in DLB were visual hallucinations (100%), followed by irritability (88%). More than 90% of the caregivers were not aware of the psychiatric manifestations of dementia and did not know how to cope up with these symptoms. Conclusion: NPS were more common in patients with DLB dementia and dementia with B12 deficiency, with depression been more common symptom in patients with Parkinson’s related dementia. It is therefore, very important to look for NPS in all elderly patients which can help us to diagnose dementia earlier.

The Ups and Downs of BACE1: Walking a Fine Line between Neurocognitive and Other Psychiatric Symptoms of Alzheimer’s Disease

2020 ◽  
pp. 107385842094094
Author(s):  
Saak V. Ovsepian ◽  
Jiri Horacek ◽  
Valerie B. O’Leary ◽  
Cyril Hoschl
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Treatment Strategies ◽  
Neurocognitive Deficit ◽  
Key Characteristics ◽  
Noncognitive Symptoms ◽  
Therapeutic Leads ◽  
Rate Limiting

Although neurocognitive deficit is the best-recognized indicator of Alzheimer’s disease (AD), psychotic and other noncognitive symptoms are the prime cause of institutionalization. BACE1 is the rate-limiting enzyme in the production of Aβ of AD, and one of the promising therapeutic targets in countering cognitive decline and amyloid pathology. Changes in BACE1 activity have also emerged to cause significant noncognitive neuropsychiatric symptoms and impairments of circadian rhythms, as evident from clinical trials and reports in transgenic models. In this study, we consider key characteristics of BACE1 with its contribution to neurocognitive deficit and other psychiatric symptoms of AD. We argue that a growing list of noncognitive mental impairments related to pharmacological modulation of BACE1 might present a major obstacle in clinical translation of emerging therapeutic leads targeting this protease. The adverse effects of BACE1 inhibition on mental health call for a revision of treatment strategies that assume indiscriminate inhibition of this key protease, and stress the need for further mechanistic and translational studies.

scholarly journals Frontal Behavior Syndromes in Idiopathic Normal Pressure Hydrocephalus as a Function of Alzheimer’s Disease Biomarker Status

2020 ◽  
Vol 26 (9) ◽  
pp. 883-893
Author(s):  
Madison Niermeyer ◽  
Chad Gaudet ◽  
Paul Malloy ◽  
Irene Piryatinsky ◽  
Stephen Salloway ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Normal Pressure Hydrocephalus ◽  
Neuropsychiatric Symptoms ◽  
Executive Dysfunction ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Future Research ◽  
Positron Emission ◽  
Neuropsychiatric Manifestations

AbstractObjectives:Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer’s disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH.Methods:Fifty patients from Butler Hospital’s Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio.Results:Results revealed clinically significant elevations on the FrSBe’s apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales.Conclusions:These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.

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

2015 ◽  
Vol 40 (5-6) ◽  
pp. 268-275 ◽  
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.

Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer's disease and mild cognitive impairment subtypes

2010 ◽  
Vol 22 (4) ◽  
pp. 629-640 ◽  
Author(s):  
Fulvia Di Iulio ◽  
Katie Palmer ◽  
Carlo Blundo ◽  
Anna Rosa Casini ◽  
Walter Gianni ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Psychiatric Disorders ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Disorders ◽  
Structured Interviews ◽  
Night Time ◽  
Amnestic Mci

ABSTRACTBackground: Neuropsychiatric disorders are common in cognitively impaired older persons, and associated with institutionalization and caregiver stress in Alzheimer's disease (AD). Few studies have compared the occurrence of both psychiatric disorders and neuropsychiatric symptoms in patients with AD and mild cognitive impairment (MCI) subtypes. We aimed to investigate the frequency of psychiatric disorders and neuropsychiatric symptoms in AD and MCI patients, compared to controls.Methods: We included 245 outpatients of a memory clinic in Rome, Italy (119 AD; 68 multidomain-MCI; 58 amnestic-MCI) and 107 controls. Categorical disorders of depression and apathy were diagnosed with structured interviews. Symptoms were evaluated with the Neuropsychiatric Inventory (NPI). The odds ratios (OR) of patients having neuropsychiatric symptoms compared to controls were calculated with logistic regression, adjusted for sociodemographic and clinical variables.Results: A large proportion of AD (49.6%) and multidomain-MCI (44.1%) patients had depression disorder. Apathy disorder was common in AD (51.3%) but less frequent in amnestic-MCI (6.9%) and multidomain-MCI (14.7%). AD patients were three times more likely to have depression disorders (OR = 3.0, CI = 1.1–7.6) or apathy (OR = 16.9, CI = 4.6–61.8) compared to amnestic-MCI, and seven times more likely to have apathy disorder than multidomain-MCI (OR = 7.5, CI = 3.0–19.2). After apathy and depression, the most prevalent neuropsychiatric symptoms in AD and MCI were anxiety, agitation, irritability, night-time behaviors, and appetite disturbances. There was an increasing prevalence of many neuropsychiatric symptoms with increasing severity of cognitive syndromes.Conclusions: Clinicians should consider the relevance of neuropsychiatric disorders and symptoms in patients with cognitive disturbances, and incorporate a thorough psychiatric examination in the evaluation of patients.

scholarly journals Neuropsychiatric Manifestations of Cognitively Advanced Idiopathic Normal Pressure Hydrocephalus

2018 ◽  
Vol 8 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Robert Mathew ◽  
Sauda Pavithran ◽  
P. Byju
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Normal Pressure Hydrocephalus ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Examination Score ◽  
Neuropsychiatric Manifestations ◽  
The Mean

Background: Neuropsychiatric manifestations of patients with idiopathic normal pressure hydrocephalus (iNPH) have not been studied in a systematic way. Aim: To study the spectrum of neuropsychiatric abnormalities in patients with iNPH. Patient Selection and Evaluation: Patients attending 3 different tertiary care centers during three consecutive time periods spanning from 2010 to 2015 were analyzed for neuropsychiatric manifestations. Patients diagnosed as having probable or possible iNPH as per the consensus criteria were included in the study. Neuropsychiatric manifestations were captured by a comprehensive inventory (Cambridge Behavioral Inventory, CBI). Results: The CBI score was available for 41 patients. The mean Mini-Mental State Examination score was 15.37 (SD 7.2) and the Addenbrooke’s Cognitive Examination score was 34.95 (SD 19.67), thereby indicating cognitively advanced iNPH. All patients had impairment in one or more items on the CBI. The mean score was 55.46 (SD 27) out of 180, thereby indicating a mild degree of impairment. Among the subscores, impairment with motivation was the most observed abnormality followed by memory impairment. When the CBI total score and subscores were compared, all of them (except motivation) were higher for Alzheimer’s disease; however, none was statistically significant. Even though the motivation score was higher for iNPH, the difference did not reach statistical significance. Conclusions: It can be concluded that neurobehavioral abnormalities are common in patients with cognitively advanced normal pressure hydrocephalus. However, the intensity of involvement appeared less when compared to Alzheimer’s disease. Apathy appears to be the most common impairment.

scholarly journals Association of brain amyloidosis with the incidence and frequency of neuropsychiatric symptoms in ADNI: a multisite observational cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031947 ◽  
Author(s):  
Naira Goukasian ◽  
Kristy S. Hwang ◽  
Tamineh Romero ◽  
Jonathan Grotts ◽  
Triet M. Do ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Motor Behavior ◽  
Neuropsychiatric Symptoms ◽  
Amyloid Pet ◽  
Neuropsychiatric Inventory ◽  
Night Time ◽  
Survival Analyses ◽  
Exact Test ◽  
Amyloid Pathology

ObjectiveTo investigate the relationship between amyloid burden and frequency of existing and incidence of new neuropsychiatric symptoms (NPS) in elderly with and without cognitive decline.Methods275 cognitively normal controls (NC), 100 subjective memory complaint (SMC), 559 mild cognitive impairment (MCI) and 143 Alzheimer’s disease dementia subjects from the Alzheimer’s Disease Neuroimaging Initiative received (18F)-florbetapir positron emission tomography (PET) scans. Yearly neuropsychiatric inventory (Neuropsychiatric Inventory (NPI)/NPI-Questionnaire) data were collected from the study partners at each visit. Mean standard uptake volume ratios (SUVR) normalised to whole cerebellum were obtained. Positive amyloid PET scan was defined as mean SUVR ≥1.17. Fisher’s exact test was used to compare frequency and incidence between amyloid positive and amyloid negative subjects. Survival analyses were used to estimate of neuropsychiatric symptoms (NPS) between amyloid positive and amyloid negative subjects. Survival analyses were used to estimate hazard ratios for developing the most common NPS by amyloid status.ResultsNo differences in NPS frequency were seen between amyloid positive and amyloid negative NC, SMC, MCI or dementia groups. MCI subjects with amyloid pathology however tended to have greater frequency x severity (FxS) of anxiety, hallucinations, delusions, apathy, disinhibition, irritability, aberrant motor behavior, and appetite, but not agitation, depression, night-time disturbances, or elation. MCI subjects with amyloid pathology were at greater risk for developing apathy, anxiety and agitation over time. Baseline presence of agitation and apathy and new onset agitation, irritability and apathy predicted faster conversion to dementia among MCI subjects.ConclusionsAmyloid pathology is associated with greater rate of development of new NPS in MCI. Anxiety and delusions are significant predictors of amyloid pathology. Agitation, irritability and apathy are significant predictors for conversion from MCI to dementia.

scholarly journals Behavioral and Psychological Symptoms in Alzheimer’s Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Xiao-Ling Li ◽  
Nan Hu ◽  
Meng-Shan Tan ◽  
Jin-Tai Yu ◽  
Lan Tan
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Psychiatric Symptoms ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Treatment Success ◽  
Future Research ◽  
Brain Changes ◽  
Specific Symptoms

Neuropsychiatric symptoms (NPS) such as depression, apathy, aggression, and psychosis are now recognized as core features of Alzheimer’s disease (AD), and there is a general consensus that greater symptom severity is predictive of faster cognitive decline, loss of independence, and even shorter survival. Whether these symptoms result from the same pathogenic processes responsible for cognitive decline or have unique etiologies independent of AD-associated neurodegeneration is unclear. Many structural and metabolic features of the AD brain are associated with individual neuropsychiatric symptoms or symptom clusters. In addition, many genes have been identified and confirmed that are associated with symptom risk in a few cases. However, there are no single genes strongly predictive of individual neuropsychiatric syndromes, while functional and structural brain changes unique to specific symptoms may reflect variability in progression of the same pathological processes. Unfortunately, treatment success for these psychiatric symptoms may be lower when comorbid with AD, underscoring the importance of future research on their pathobiology and treatment. This review summarizes some of the most salient aspects of NPS pathogenesis.

scholarly journals The neuro-inflammasome in Alzheimer’s disease and cerebral stroke

2020 ◽  
Author(s):  
Jong-hoon Lee
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Side Effects ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Clinical Staging ◽  
Cerebral Stroke ◽  
Study Results ◽  
Before And After ◽  
Neuro Inflammation

Aim/Background: This study investigated patients with Alzheimer’s disease (AD) who were treated with 4,4’-diaminodiphenyl sulfone (DDS) as a neuro-inflammasome competitor according to the 2018 'NIA-AA Research Framework' to differentiate neuro-psychiatric symptoms from drug side effects. Methods: According to the diagnostic criteria of AD, the Seoul study analysed AD and anti-AD drugs (AADs) in the EDI database of the Sorokdo National Hospital archived from January 2005 to June 2020 and searched using the ICD-9 and 10 codes. Numeric clinical staging (NCS) was determined by managing the AD symptoms and neuropsychiatric symptoms caused by AADs with a new biomarker, (D). We report related cases of cerebral infarction and the function of DDS as a neuro-inflammasome competitor in the Seoul study. Results: DDS acts as a neuro-inflammasome competitor; this effect can be inferred by comparing the prevalence of AD in patients who have been prescribed DDS and those who have not. By the introduction of (D), the progression of AD was monitored through NCS staging; AAD side effects and neuropsychiatric symptoms were distinguished and treated with DDS. AD can occasionally be exacerbated by AADs, and mild cognitive impairment can be alleviated by DDS. We clinically confirmed the role of DDS as a neuro-inflammasome competitor before and after cerebral infarcts in the Seoul study. Conclusions: DDS acts as a blocker of canonical/non-canonical ubiquitylation; NLRP3 inflammasome formation; Higgins’ cascade; and iron-rich, strongly magnetic nanoparticles released by the splitting of red blood cells. (D) can be used to guide the prevention and treatment of AD with DDS. This study demonstrates the use of NCS and neuro-inflammation treatment as a preventive and therapeutic method for AD.

The Involvement of Post-Translational Modifications in Alzheimer's Disease

2018 ◽  
Vol 15 (4) ◽  
pp. 313-335 ◽  
Author(s):  
Serena Marcelli ◽  
Massimo Corbo ◽  
Filomena Iannuzzi ◽  
Lucia Negri ◽  
Fabio Blandini ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Protein Modification ◽  
Neurodegenerative Disorder ◽  
Amyloid Β ◽  
Normal Function ◽  
Ageing Population ◽  
Covalent Bonds ◽  
Post Translational Modifications ◽  
Related Proteins

Background: Alzheimer's disease (AD) is a neurodegenerative disorder recognized as the most common cause of chronic dementia among the ageing population. AD is histopathologically characterized by progressive loss of neurons and deposits of insoluble proteins, primarily composed of amyloid-β pelaques and neurofibrillary tangles (NFTs). Methods: Several molecular processes contribute to the formation of AD cellular hallmarks. Among them, post-translational modifications (PTMs) represent an attractive mechanism underlying the formation of covalent bonds between chemical groups/peptides to target proteins, which ultimately result modified in their function. Most of the proteins related to AD undergo PTMs. Several recent studies show that AD-related proteins like APP, Aβ, tau, BACE1 undergo post-translational modifications. The effect of PTMs contributes to the normal function of cells, although aberrant protein modification, which may depend on many factors, can drive the onset or support the development of AD. Results: Here we will discuss the effect of several PTMs on the functionality of AD-related proteins potentially contributing to the development of AD pathology. Conclusion: We will consider the role of Ubiquitination, Phosphorylation, SUMOylation, Acetylation and Nitrosylation on specific AD-related proteins and, more interestingly, the possible interactions that may occur between such different PTMs.

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