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"Dementia - psychology"
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Trial of Pimavanserin in Dementia-Related Psychosis
The serotonin-receptor modulator pimavanserin reduces psychosis in patients with Parkinson’s disease. In a randomized discontinuation trial involving patients with psychosis related to several types of dementia, the frequency of relapse over a period of 26 weeks was 13% with pimavanserin and 28% with placebo.
Journal Article
Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias
Behavioral and psychological symptoms of dementia (BPSDs) negatively impact the prognosis of dementia patients and increase caregiver distress. The aims of this study were to clarify the differences of trajectories of 12 kinds of BPSDs by disease severity in four major dementias and to develop charts showing the frequency, severity, and associated caregiver distress (ACD) of BPSDs using the data of a Japan multicenter study (J-BIRD).
We gathered Neuropsychiatric Inventory (NPI) data of patients with Alzheimer's disease (AD; n = 1091), dementia with Lewy bodies (DLB; n = 249), vascular dementia (VaD; n = 156), and frontotemporal lobar degeneration (FTLD; n = 102) collected during a 5-year period up to July 31, 2013 in seven centers for dementia in Japan. The NPI composite scores (frequency × severity) of 12 kinds of items were analyzed using a principal component analysis (PCA) in each dementia. The factor scores of the PCA were compared in each dementia by disease severity, which was determined with Clinical Dementia Rating (CDR).
Significant increases with higher CDR scores were observed in 1) two of the three factor scores which were loaded for all items except euphoria in AD, 2) two of the four factor scores for apathy, aberrant motor behavior (AMB), sleep disturbances, agitation, irritability, disinhibition, and euphoria in DLB, and 3) one of the four factor scores for apathy, depression, anxiety, and sleep disturbances in VaD. However, no increases were observed in any of the five factor scores in FTLD.
As dementia progresses, several BPSDs become more severe, including 1) apathy and sleep disturbances in AD, DLB, and VaD, 2) all of the BPSDs except euphoria in AD, 3) AMB, agitation, irritability, disinhibition, and euphoria in DLB, and 4) depression and anxiety in VaD. Trajectories of BPSDs in FTLD were unclear.
Journal Article
Addenbrooke’s Cognitive Examination III: Psychometric Characteristics and Relations to Functional Ability in Dementia
Objectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)
Journal Article
Clinical Manifestations
People caring of individuals with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries there is lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia; and to compare the effects of BPSD on caregiver burden across different types of dementia.
Cross-sectional study of 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB) and vascular dementia (VD), and their caregivers attended in a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory (ZBI). We used analysis of variance to compare the groups of AD, bvFTD, DLB and VD. Correlations between ZBI and NPI subscale scores were assessed with Spearman's correlation.
DLB caregivers had significantly higher levels of burden than the other patient groups (P < 0.05), and higher total NPI scores than caregivers for other patient groups (P < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (P < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively.
Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden.
Journal Article
The quality of the relationship perceived by spouses of people with young-onset dementia
ABSTRACTBackgroundYoung-onset dementia (YOD) has a profound impact on spouses. However, little is known on how the quality of the relationship changes over time in YOD. This study aims to determine how the quality of the relationship changes over time and identify predictors of this change. MethodsThis study used data from the NEEDs in Young onset Dementia (NeedYD) study. The primary outcome measure was the quality of the relationship perceived by spouses measured throughout 24 months. Baseline characteristics of persons with YOD and spouses were also measured to assess their predictive value. ResultsTotally, 178 dyads were included. The perceived quality of the relationship deteriorated over time. A longer symptom duration, a diagnosis of frontotemporal dementia, lower levels of awareness of deficits, lower levels of initiative toward daily living activities, and higher levels of apathy, hyperactivity, depression, and anxiety in the person with YOD were associated with a lower perceived quality of the relationship by spouses. A coping style characterized by palliative and passive reacting patterns and higher levels of neuroticism in spouses was also associated with a lower quality of the relationship. ConclusionThe quality of the relationship as perceived by spouses deteriorated over time and was influenced by characteristics of the person with YOD as well as their spouse. Helping spouses to come to terms with factors that threaten their sense of couplehood might help them to develop a more positive attitude toward their spousal relationship and improve the quality of the relationship and care.
Journal Article
Social cognition in mild cognitive impairment and dementia: A systematic review and meta‐analysis
Social cognition is impaired in people with dementia but the differences in social cognitive impairment between mild cognitive impairment (MCI) and dementia and its subtypes remain unclear. We therefore aimed to systematically review and meta‐analyze differences in emotion recognition, theory of mind (ToM), and empathy between individuals with MCI and dementia. Across 28 cross‐sectional studies (n = 2409), people with MCI had better emotion recognition (Cohen's d = 0.69) and ToM (d = 0.70) than individuals with Alzheimer's disease (AD) dementia, and larger effect sizes were observed for people with frontotemporal dementia (FTD) (emotion recognition (d = 2.09), ToM (d = 1.49), but emotional empathy was higher in AD than in MCI in included studies. Our findings suggest a progressive decline of aspects of social cognition across the MCI–dementia continuum. Longitudinal studies should investigate the diagnostic role of social cognition deficits in MCI progression to dementia, and interventions for social cognition in MCI should be developed and tested.
Highlights
First systematic review and meta‐analysis comparing social cognition between mild cognitive impairment (MCI) and dementia subtypes.
Findings from 28 studies with 2409 participants show people with MCI outperform those with Alzheimer's disease (AD) and frontotemporal dementia (FTD) in emotion recognition and theory of mind.
Empathy appears intact in AD dementia, suggesting that this cognitive domain is preserved throughout disease progression.
Evaluation of social cognition should be built into dementia assessment as it may hold diagnostic value.
Journal Article
Differentiating between right-lateralised semantic dementia and behavioural-variant frontotemporal dementia: an examination of clinical characteristics and emotion processing
Background and purposeRight-lateralised semantic dementia (right SD) and behavioural-variant frontotemporal dementia (bvFTD) appear clinically similar, despite different patterns of underlying brain changes. This study aimed to elucidate distinguishing clinical and cognitive features in right SD versus bvFTD, emphasising emotion processing and its associated neural correlates.Methods12 patients with right SD and 19 patients with bvFTD were recruited. Clinical features were documented. All patients were assessed on standardised neuropsychological tests and a facial emotion processing battery. Performance was compared to 20 age-matched and education-matched controls. Grey matter intensity was related to emotion processing performance using whole-brain voxel-based morphometry analysis.ResultsPatients with right SD exhibited disproportionate language dysfunction, prosopagnosia and a suggestion of increased obsessive personality/behavioural changes versus patients with bvFTD. In contrast, patients with bvFTD demonstrated pronounced deficits in attention/working memory, increased apathy and greater executive dysfunction, compared to patients with right SD. Decreased empathy, disinhibition and diet changes were common to both dementia subtypes. Emotion processing deficits were present in both FTD syndromes but were associated with divergent patterns of brain atrophy. In right SD, emotion processing dysfunction was associated with predominantly right medial and lateral temporal integrity, compared to mainly left temporal, inferior frontal and orbitofrontal and right frontal gyrus integrity in bvFTD.ConclusionsThis study demonstrates comparable deficits in facial emotion processing in right SD and bvFTD, in keeping with their similar clinical profiles. These deficits are attributable to divergent neural substrates in each patient group, namely, right lateralised regions in right SD, versus predominantly left lateralised regions in bvFTD.
Journal Article
Everyday functioning in young onset dementia: differences between diagnostic groups
BACKGROUND
The aim of this study was to examine differences in Instrumental Activities of Daily Living (IADL) among young‐onset dementia (YOD) diagnoses.
METHODS
Participants were included from Amsterdam Dementia and Longitudinal Early‐Onset Alzheimer's Disease (LEADS) cohorts, with diagnoses of typical Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), posterior cortical atrophy (PCA), or dementia with Lewy bodies (DLB) established in multidisciplinary meetings. We compared overall IADL scores and item level scores between groups using multiple regression analyses, adjusted for cohort, demographics, and disease severity.
RESULTS
We included 582 YOD patients (58.4 ± 4.2 years; 59%F), with overall moderate IADL problems (47.5 ± 8.57). DLB patients showed the most IADL difficulties (41.8 ± 7.8) compared to PCA, typical AD, bvFTD, and PPA (adjusted β range 4.62 to 14.14, all p < 0.01), whereas PPA patients showed the least IADL difficulties (55.8 ± 9.83), with item‐specific differences.
CONCLUSION
We found differences in everyday functioning between YOD types. Understanding IADL in YOD types will assist in care planning.
Highlights
Patients with DLB showed the most IADL difficulties compared to PCA, typical AD, bvFTD, and PPA
Patients with PPA showed the least IADL difficulties compared to DLB, PCA, typical AD, and bvFTD
We identified diagnostic group‐specific activity challenges. While ‘working’ was among the most commonly impaired activities across al groups, distinct functional challenges emerged per diagnosis: for example, DLB had high impairment in financial tasks, PCA patients in visual‐spatial tasks, and bvFTD with planning and organizational activities (e.g. making appointments).
Journal Article