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INTRODUCTION: Knowledge is limited about behavioral and psychological symptoms of mild cognitive impairment (MCI) and dementia in racial and ethnic minorities. METHODS: As part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), we interviewed knowledgeable informants of 2319 older Brazilian decedents (67% white, 11% black, 22% mixed) using the informant portion of the Clinical Dementia Rating Scale to classify MCI and dementia and the Neuropsychiatric Inventory to assess behavioral and psychological symptoms. RESULTS: We identified four clusters of neuropsychiatric symptoms: agitation, affect/apathy, psychosis, and behavioral problems. On the Clinical Dementia Rating Scale, 1407 had no cognitive impairment, 180 had MCI, and 732 had dementia. Both MCI and dementia were associated with symptoms in each behavioral/psychological cluster (all P's < .001). There was little evidence of racial differences in the association of MCI and dementia with these neuropsychiatric symptoms. CONCLUSION: MCI and dementia are associated with elevated behavioral and psychological symptoms in older black and white Brazilians.
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Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from Wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.
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BACKGROUND: Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. OBJECTIVE: We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. METHODS: We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). RESULTS: The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (pâ<â0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (pâ<â0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. CONCLUSION: Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.
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Envelhecimento/psicologia , Hispânico ou Latino/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Escalas de Graduação Psiquiátrica , Adulto , Idoso , Envelhecimento/patologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Demência/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Estudos Prospectivos , Venezuela/epidemiologiaRESUMO
BACKGROUND: Behavioral and psychological symptoms (BPSD) can be a prodrome of dementia, and the Neuropsychiatric Inventory (NPI) is widely used for BPSD evaluation. OBJECTIVE: To compare the prevalence of BPSD according to cognitive status, and to determine NPI cutoffs that best discern individuals with mild cognitive impairment (MCI) and dementia from those without dementia. METHODS: We included 1,565 participants (mean ageâ=â72.7±12.2 years, 48% male). BPSD and cognitive status were assessed with the NPI and the Clinical Dementia Rating (CDR). We used multivariable logistic regression models to investigate the association of BPSD with cognitive status. The area under the curve (AUC) was used to assess model discrimination, and to determine the best NPI cutoff for MCI and dementia. RESULTS: Participants were cognitively normal (CDRâ=â0; nâ=â1,062), MCI (CDRâ=â0.5; nâ=â145), or dementia (CDR≥1.0, nâ=â358). NPI symptoms were more frequent in dementia and MCI when compared to cognitively normal. Higher odds for delusions, hallucinations, disinhibition, and psychomotor alterations were found among participants with dementia and MCI than in those who were cognitively normal. The best NPI cutoff to discern participants with dementia from those cognitively normal was 11 (AUCâ=â0.755). Poor discrimination (AUCâ=â0.563) was found for the comparison of MCI and those cognitively normal. CONCLUSIONS: We found an increase in BPSD frequencies across the continuum of cognitive impairment. BPSD severity and frequency in MCI was more similar to individuals cognitively normal than with dementia. NPI scores≥to 11 in individuals with no diagnosis of dementia can support the decision for further investigation of dementia.
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Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/patologia , Cognição , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/patologia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Vida Independente , Masculino , Testes Neuropsicológicos , Prevalência , Escalas de Graduação PsiquiátricaRESUMO
SPG11 mutations are the major cause of autosomal recessive Hereditary Spastic Paraplegia. The disease has a wide phenotypic variability indicating many regions of the nervous system besides the corticospinal tract are affected. Despite this, anatomical and phenotypic characterization is restricted. In the present study, we investigate the anatomical abnormalities related to SPG11 mutations and how they relate to clinical and cognitive measures. Moreover, we aim to depict how the disease course influences the regions affected, unraveling different susceptibility of specific neuronal populations. We performed clinical and paraclinical studies encompassing neuropsychological, neuroimaging, and neurophysiological tools in a cohort of twenty-five patients and age matched controls. We assessed cortical thickness (FreeSurfer software), deep grey matter volumes (T1-MultiAtlas tool), white matter microstructural damage (DTI-MultiAtlas) and spinal cord morphometry (Spineseg software) on a 3â¯T MRI scan. Mean age and disease duration were 29 and 13.2â¯years respectively. Sixty-four percent of the patients were wheelchair bound while 84% were demented. We were able to unfold a diffuse pattern of white matter integrity loss as well as basal ganglia and spinal cord atrophy. Such findings contrasted with a restricted pattern of cortical thinning (motor, limbic and parietal cortices). Electromyography revealed motor neuronopathy affecting 96% of the probands. Correlations with disease duration pointed towards a progressive degeneration of multiple grey matter structures and spinal cord, but not of the white matter. SPG11-related hereditary spastic paraplegia is characterized by selective neuronal vulnerability, in which a precocious and widespread white matter involvement is later followed by a restricted but clearly progressive grey matter degeneration.
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Gânglios da Base/diagnóstico por imagem , Mutação , Proteínas/genética , Paraplegia Espástica Hereditária/genética , Substância Branca/diagnóstico por imagem , Adolescente , Adulto , Imagem de Tensor de Difusão , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Testes Neuropsicológicos , Paraplegia Espástica Hereditária/diagnóstico por imagem , Adulto JovemRESUMO
The Neuropsychiatric Inventory Questionnaire (NPI-Q) is an informant-based instrument that measures the presence and severity of 12 Neuropsychiatric Symptoms (NPS) in patients with dementia, as well as informant distress. OBJECTIVE: To measure the psychometric properties of the NPI-Q and the prevalence of NPS in patients with Alzheimer's disease (AD) in Chile. METHODS: 53 patients with AD were assessed. Subjects were divided into two different groups: mild AD (n=26) and moderate AD (n=27). Convergent validity was estimated by correlating the outcomes of the NPI-Q with Neuropsychiatric Inventory (NPI) scores and with a global cognitive efficiency test (Addenbrooke's Cognitive Examination - Revised - ACE-R). Reliability of the NPI-Q was analysed by calculating its internal consistency. Prevalence of NPS was estimated with both the NPI and NPI-Q. RESULTS: Positive and significant correlations were observed between the NPI-Q, the NPI, and the ACE-R (r=0.730; p<0.01 and 0.315; p<0.05 respectively). The instrument displayed an adequate level of reliability (Cronbach's alpha=0.783). The most prevalent NPS were apathy/indifference (62.3%) and dysphoria/depression (58.5%). CONCLUSION: The NPI-Q exhibited acceptable validity and reliability indicators for patients with AD in Chile, indicating that it is a suitable instrument for the routine assessment of NPS in clinical practice.
O Questionário de Inventário Neuropsiquiátrico (NPI-Q) é um instrumento baseado em informantes que mede a presença e a gravidade de 12 Sintomas Neuropsiquiátricos (NPS) em pacientes com demência, bem como o sofrimento do informante. OBJETIVO: Avaliar as propriedades psicométricas do NPI-Q e a prevalência de NPS em pacientes com doença de Alzheimer (DA). MÉTODOS: Foram avaliados 53 pacientes com DA. Eles foram divididos em dois grupos diferentes: AD leve (n=26) e AD moderado (n=27). A validade convergente foi estimada correlacionando os resultados do NPI-Q com os escores do Inventário Neuropsiquiátrico (NPI) e um teste de eficiência cognitiva global (Addenbrooke's Cognitive Examination - Revised - ACE-R). A confiabilidade do NPI-Q foi analisada pelo cálculo da sua consistência interna. A prevalência de NPS foi estimada com NPI e NPI-Q. RESULTADOS: Foram observadas correlações positivas e significativas entre NPI-Q, NPI e ACE-R (r=0,730; p<0,01 e 0>315; p<0>05). O instrumento apresentou um nível adequado de confiabilidade (alfa de Cronbach=0J83). Os NPS mais prevalentes foram apatia/indiferença (62,3%) e disforia/depressão (58,5%). CONCLUSÃO: O NPI-Q apresenta indicadores de validade e confiabilidade aceitáveis em pacientes com DA, o que indica que é um instrumento adequado para a avaliação rotineira de NPS na prática clínica.
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ABSTRACT. The Neuropsychiatric Inventory Questionnaire (NPI-Q) is an informant-based instrument that measures the presence and severity of 12 Neuropsychiatric Symptoms (NPS) in patients with dementia, as well as informant distress. Objective: To measure the psychometric properties of the NPI-Q and the prevalence of NPS in patients with Alzheimer's disease (AD) in Chile. Methods: 53 patients with AD were assessed. Subjects were divided into two different groups: mild AD (n=26) and moderate AD (n=27). Convergent validity was estimated by correlating the outcomes of the NPI-Q with Neuropsychiatric Inventory (NPI) scores and with a global cognitive efficiency test (Addenbrooke's Cognitive Examination - Revised - ACE-R). Reliability of the NPI-Q was analysed by calculating its internal consistency. Prevalence of NPS was estimated with both the NPI and NPI-Q. Results: Positive and significant correlations were observed between the NPI-Q, the NPI, and the ACE-R (r=0.730; p<0.01 and 0.315; p<0.05 respectively). The instrument displayed an adequate level of reliability (Cronbach's alpha=0.783). The most prevalent NPS were apathy/indifference (62.3%) and dysphoria/depression (58.5%). Conclusion: The NPI-Q exhibited acceptable validity and reliability indicators for patients with AD in Chile, indicating that it is a suitable instrument for the routine assessment of NPS in clinical practice.
RESUMO. O Questionário de Inventário Neuropsiquiátrico (NPI-Q) é um instrumento baseado em informantes que mede a presença e a gravidade de 12 Sintomas Neuropsiquiátricos (NPS) em pacientes com demência, bem como o sofrimento do informante. Objetivo: Avaliar as propriedades psicométricas do NPI-Q e a prevalência de NPS em pacientes com doença de Alzheimer (DA). Métodos: Foram avaliados 53 pacientes com DA. Eles foram divididos em dois grupos diferentes: AD leve (n=26) e AD moderado (n=27). A validade convergente foi estimada correlacionando os resultados do NPI-Q com os escores do Inventário Neuropsiquiátrico (NPI) e um teste de eficiência cognitiva global (Addenbrooke's Cognitive Examination - Revised - ACE-R). A confiabilidade do NPI-Q foi analisada pelo cálculo da sua consistência interna. A prevalência de NPS foi estimada com NPI e NPI-Q. Resultados: Foram observadas correlações positivas e significativas entre NPI-Q, NPI e ACE-R (r=0,730; p<0,01 e 0>315; p<0>05). O instrumento apresentou um nível adequado de confiabilidade (alfa de Cronbach=0J83). Os NPS mais prevalentes foram apatia/indiferença (62,3%) e disforia/depressão (58,5%). Conclusão: O NPI-Q apresenta indicadores de validade e confiabilidade aceitáveis em pacientes com DA, o que indica que é um instrumento adequado para a avaliação rotineira de NPS na prática clínica.
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Humanos , Prevalência , Manifestações Neurocomportamentais , Demência , Doença de Alzheimer , Testes de Estado Mental e DemênciaRESUMO
OBJECTIVE: The Neuropsychiatric Inventory (NPI) is a well-established measure of psychopathology and frequently used in dementia studies. Little is known about its psychometric characteristics at a population level, particularly among Hispanics. We report the frequency of NPI symptoms in a community-dwelling older Mexican-American (MA) population cohort and the degree of symptom-related distress experienced by participant informants. METHODS: Participants were 1079 MA age 80 years and over residing in five southwestern states who were administered the NPI as part of wave-7 of the Hispanic Established Population for Epidemiological Study of the Elderly (HEPESE) conducted from 2010 to 2011. RESULTS: Nine hundred twenty-five informants rated NPI domains. Prevalence of neuropsychiatric symptoms (NPS) varied by symptom domain and ranged from agitation/aggression (32%) to euphoria/elation (5%). The overall rate of behavioral disturbances was 62.7%. On the other hand, 37.3% of informants reported no NPS. A significant fraction of the informants reported distress from the mood disorder cluster of the scale. CONCLUSIONS: A large percentage (>60%) of community-dwelling older MA have one or more informant-reported NPS. These symptoms have diagnostic, prognostic, and therapeutic implications. Although neuropsychiatric disorders may be the initial clinical manifestation of dementia and often appear before cognitive alterations, the high frequency of these symptoms in the HEPESE cohort may reflect a high prevalence of these disorders among community-dwelling MA. The pattern we observed also suggests relatively advanced stages of dementia.
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Transtornos Mentais/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Idoso de 80 Anos ou mais , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Americanos Mexicanos/psicologia , Prevalência , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To validate and translate the English version of the Neurologic Depression Disorders Inventory in Epilepsy (NDDI-E) into Spanish as a screening instrument for major depressive episodes (MDE) for patients with epilepsy from Argentina and Uruguay. METHODS: One hundred fifty-five consecutive outpatients with epilepsy participated in this study. The module of MDE of the MINI International Neuropsychiatric Instrument (MINI Plus version) was used as the gold standard against which the translated version of the NDDI-E was validated. RESULTS: Among the 155 patients, 25 (16%) met Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for MDE according to the MINI. With a total score of >15, The NDDI-E identified MDE with an 80% sensitivity, 90% specificity, 60% positive predictive value, and 95.5% negative predictive value. SIGNIFICANCE: These data indicate that the Spanish version of the NDDI-E can reliably identify MDE in patients with epilepsy from Argentina and Uruguay.
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Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Epilepsia/diagnóstico , Epilepsia/psicologia , Programas de Rastreamento/normas , Multilinguismo , Adolescente , Adulto , Argentina/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Uruguai/epidemiologia , Adulto JovemRESUMO
Cholinesterase inhibitors (ChE-Is) are among the main drugs approved for the treatment of Alzheimer's disease (AD). Rivastigmine in the form of a transdermal patch is an alternative delivery method, and can give greater treatment compliance. Objectives: To conduct a preliminary assessment of the neurocognitive and biological effects of oral and transdermal Rivastigmine in patients with AD and to identify a potential biological marker and demonstrate a possible relationship between esterase levels and behavioral scores of AD patients. Methods: Forty patients with AD were treated with cholinesterase inhibitors (ChE-Is), evaluated using the MMSE and NPI, and simultaneously sampled to determine their serum levels of AChE and BuChE for 180 days. Results: The differences obtained between oral and transdermal forms, as assessed by the MMSE and NPI scores of the AD patients, were not significant at the three time points examined (0, 90, and 180 days). However, serum BuChE levels of the transdermal group differed significantly (p<0.0004) compared with those of the oral group at 90 days. Conclusion: Use of a transdermal ChE-I, rivastigmine tartrate significantly reduced BuChE levels in the AD patients studied.
Os inibidores das colinesterases estão entre as principais drogas aprovadas para tratamento da doença de Alzheimer (DA). Rivastigmina na forma de adesivo transdérmico é um método alternativo de liberação e pode fornecer uma maior aderância ao tratamento. Objetivos: Conduzir uma abordagem preliminar dos efeitos neurocognitivos e biológicos da rivastigmina oral e transdérmica em pacientes com DA e identificar um potencial marcador biológico e demonstrar uma possível relação entre níveis de esterases e escores de comportamento de pacientes com DA. Métodos: Quarenta pacientes com DA com inibidores de colinesterases foram avaliados usando o MEEM e o INP e colhidas amostras para determinar seus níveis séricos de AChE e BuChE por 180 dias. Resultados: As diferenças obtidas entre as formas oral e transdérmica, avaliadas pelo MEEM e INP não diferiram em três ocasiões (0, 90 e 180 dias). Todavia, os níveis de BuChE no grupo transdérmico diferiu significativamente (p<0.0004) comparados ao grupo de administração oral em 90 dias. Conclusão: O uso do tartarato de rivastigmina, forma transdérmica reduziu significativamente os níveis de BuChE nos pacientes estudados com DA.
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Humanos , Acetilcolina , Esterases , Doença de Alzheimer , Rivastigmina , Testes de Estado Mental e DemênciaRESUMO
Cholinesterase inhibitors (ChE-Is) are among the main drugs approved for the treatment of Alzheimer's disease (AD). Rivastigmine in the form of a transdermal patch is an alternative delivery method, and can give greater treatment compliance. OBJECTIVES: To conduct a preliminary assessment of the neurocognitive and biological effects of oral and transdermal Rivastigmine in patients with AD and to identify a potential biological marker and demonstrate a possible relationship between esterase levels and behavioral scores of AD patients. METHODS: Forty patients with AD were treated with cholinesterase inhibitors (ChE-Is), evaluated using the MMSE and NPI, and simultaneously sampled to determine their serum levels of AChE and BuChE for 180 days. RESULTS: The differences obtained between oral and transdermal forms, as assessed by the MMSE and NPI scores of the AD patients, were not significant at the three time points examined (0, 90, and 180 days). However, serum BuChE levels of the transdermal group differed significantly (p<0.0004) compared with those of the oral group at 90 days. CONCLUSION: Use of a transdermal ChE-I, rivastigmine tartrate significantly reduced BuChE levels in the AD patients studied.
Os inibidores das colinesterases estão entre as principais drogas aprovadas para tratamento da doença de Alzheimer (DA). Rivastigmina na forma de adesivo transdérmico é um método alternativo de liberação e pode fornecer uma maior aderância ao tratamento. OBJETIVOS: Conduzir uma abordagem preliminar dos efeitos neurocognitivos e biológicos da rivastigmina oral e transdérmica em pacientes com DA e identificar um potencial marcador biológico e demonstrar uma possível relação entre níveis de esterases e escores de comportamento de pacientes com DA. MÉTODOS: Quarenta pacientes com DA com inibidores de colinesterases foram avaliados usando o MEEM e o INP e colhidas amostras para determinar seus níveis séricos de AChE e BuChE por 180 dias. RESULTADOS: As diferenças obtidas entre as formas oral e transdérmica, avaliadas pelo MEEM e INP não diferiram em três ocasiões (0, 90 e 180 dias). Todavia, os níveis de BuChE no grupo transdérmico diferiu significativamente (p<0.0004) comparados ao grupo de administração oral em 90 dias. CONCLUSÃO: O uso do tartarato de rivastigmina, forma transdérmica reduziu significativamente os níveis de BuChE nos pacientes estudados com DA.
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Introducción: el deterioro cognitivo leve (DCL) se caracteriza por la alteración de uno o varios procesos cognitivos sin afectación significativa en las actividades de la vida diaria del paciente y que puede presentarse acompañado de síntomas neuropsiquiátricos, lo que incrementa el riesgo a evolucionar a demencia. Objetivo: identificar la frecuencia y severidad de las alteraciones comportamentales en una población con deterioro cognitivo leve de tipo amnésico. (DCL-A)Procedimiento: estudio no experimental, transversal de alcance descriptivo, que contó con 70 personas, con diagnostico de DCL-A. Seleccionada la muestra los cuidadores respondieron el inventario neuropsiquiátrico. Resultados: el 65.7 por ciento de los participantes presentaron síntomas comportamentales, donde la irritabilidad fue la mas frecuente (32.9 por ciento), seguido por depresión (30 por ciento) y agitación (25.7 por ciento). La apatía fue el síntoma que se presenta con mayor severidad sin ser el más frecuente. Discusión: dentro del cuadro clínico propio del DCL-A se reportan síntomas neuropsiquiátricos que acompañan el déficit cognitivo. En la población estudiada el 65.7 por ciento presentaba dichos síntomas, dato que se aproxima a lo encontrado en la literatura; sin embargo el síntoma más frecuente fue la irritabilidad, no la depresión como se ha reportado en otros estudios; los síntomas menos frecuentes fueron conductas eufóricas y conductas motoras aberrantes.
Introduction: Mild Cognitive Impairment (MCI) is characterized by the alteration of one or more cognitive processes without significant impairment in the activities of patients daily life and may be accompanied by neuropsychiatric symptoms, which increase the risk to develop dementia. Objective: To identify the frequency and severity of behavioral alterations in a population with mild cognitive impairment amnesiac type (MCI-A) Procedure: non experimental study, with a cross-sectional descriptive scope, attended by 70 people with diagnosis of MCI-A.Selected sample of caregivers responded neuropsychiatric inventory. Results: 65.7 percent of participants had behavioral symptoms, where irritability was the most frequent (32.9 percent), followed by depression (30 percent) and agitation (25.7 percent). Apathy was the symptom presented with most severity but not the most frequent. Discussion: Neuropsychiatric symptoms that accompany cognitive deficits are reported in clinical features of MCI-A. In the population studied, 65.7 percent had such symptoms, data that approximates those found in literature. Nonetheless, the most common symptom was irritability and not depression, as has been reported in other studies; euphoric and aberrant motor behaviors were theless frequent symptoms.