Aberrant Motor Behavior Research Articles

Differentiating traits and states identifies the importance of chronic neuropsychiatric symptoms for cognitive prognosis in mild dementia.

IntroductionNeuropsychiatric symptoms (NPS) in dementia are associated with poor cognitive outcomes in longitudinal studies. Whether this is due to differences in symptom burden between persons (BP) or changes within persons (WP) is unknown.MethodsPatients with mild Alzheimer's disease (AD, n = 111) and Lewy‐body dementia (LBD, n = 85) were assessed annually for 8 years. We modelled the association between NPS assessed by the Neuropsychiatric Inventory (NPI) and Mini‐Mental State Examinations (MMSE) using Tobit mixed‐effects model with NPS as individual means over time (BP) and its deviance (WP).ResultsThe association between higher NPS and poorer cognitive outcomes was mostly due to BP differences for the NPI‐total score, and in particular for delusions, hallucinations, agitation, aberrant motor behavior, and apathy scores.DiscussionThe NPS trait (BP) effect on cognitive decline is considerably stronger than the state effect (WP). Clinically, long‐term rather than episodic NPS better identifies patients with poor cognitive outcomes.

Neuropsychiatric symptoms in early onset Alzheimer's disease and frontotemporal dementia

AbstractBackgroundHaving in mind a significant percentage of atypical presentations at disease onset (behavioral symptoms, depression, psychotic symptoms or non‐cognitive cognitive deficits), understanding clinical heterogeneity of early onset Alzheimer's disease (EOAD) and frontotemporal dementia (EOFTD) can improve early diagnosis and differentiation between these clinical entities.Our objective was to investigate the heterogeneity of neuropsychiatric symptoms (NPS) in EOAD and EOFTD spectrum.MethodTwo hundred and seven consecutive patients with EOAD and EOFTD spectrum, diagnosed according to the current clinical criteria, were recruited from the Neurology Clinic, Clinical Centre of Serbia. Sociodemographic and clinical characteristics were evaluated using a pre‐designed semi‐structured questionnaire while neuropsychiatric symptoms (NPS) were evaluated using Neuropsychiatric Inventory (NPI).ResultEOAD and EOFTD patients did not differ in age, age at disease onset, duration of the disease, gender and education. In comparison to EOAD, patients in the EOFTD spectrum expressed agitation, euphoria, apathy, disinhibition, irritability, aberrant motor behavior and dietary changes more frequently. EOFTD behavioral variant patients expressed apathy, aberrant motor behavior and disinhibition more often than patients with PPA, while in PPA anxiety was represented. In EOAD group total NPI score correlated with clinical dementia rating scale score. In the advanced stages of dementia, EOAD patients expressed agitation and irritability more frequently than at disease onset, while in advanced EOFTD agitation and aberrant motor behavior were more frequent than in the earlier stages of the disease. Amnestic and non‐amnestic presentation of EOAD did not differ in frequency on NPSConclusionNPS are a hallmark of behavioral variant of EOFTD and later stages of EOAD.

Neuropsychiatric symptoms in early stage autosomal dominant and sporadic Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms (NPS) in AD, though more prevalent and severe in advanced disease, can occur as early features, with case reports suggesting more robust NPS in autosomal dominant Alzheimer disease (ADAD). The characterization of NPS in person with ADAD and their comparison to late‐onset Alzheimer’s disease (LOAD) enhances our ability to anticipate such symptoms and provides insight into differences in the underlying pathology of the two forms of the disease.MethodInformants of 19 participants with mutations known to cause ADAD (mean age 45.58, 36.8% male) and 115 participants with LOAD (mean age 74.71, 42.6% male) were administered the full Neuropsychiatric Inventory (NPI) to assess the presence, frequency, and severity of 12 NPS, namely delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, aberrant motor behavior, sleep, and eating disorders. All participants had Clinical Dementia Rating (CDR) scores of 0.5. Chi‐square tests were used to compare the prevalence of NPS between ADAD and LOAD patients using both NPI screening and subquestions.ResultADAD and LOAD groups did not significantly differ in terms of MMSE score, CDR Sum of Boxes, gender, or years of education though ADAD subjects were more likely to be of Latinx origin (84% vs. 23%, p<0.001). ADAD and LOAD subjects did not differ on any qualifying questions, except for apathy, which was more common in ADAD mutation carriers (20.9% of LOAD subjects vs. 44.4% of ADAD subjects, p=0.039). Positive responses to subquestions regarding whether the participant was less affectionate and less interested in family were more commonly endorsed in ADAD.ConclusionAlthough apathy was more prevalent in ADAD subjects, the difference was not large and was not maintained when controlling for multiple comparisons. We therefore failed to identify robust differences in NPS between ADAD and LOAD. Our findings are limited by the small sample size of ADAD subjects but suggest that NPS are not markedly different in the early stages of ADAD and LOAD.

Prevalence of neuropsychiatric symptoms related to dementia in individuals with Down syndrome

AbstractBackgroundNeuropsychiatric symptoms (NPS) are significant manifestations of dementia, with important consequences for patients and caregivers. Despite the established genetic link between Down syndrome (DS) and Alzheimer’s disease (AD), studies investigating NPS in individuals with DS and dementia are scarce. The Neuropsychiatric Inventory (NPI) was developed to identify symptoms of dementia and while it is widely used for the assessment of individuals with dementia in the general population, we have found no studies using the NPI in those with DS. The aim of this study is to characterize NPS in a sample with DS with heterogeneous cognitive profiles using the NPIMethodParticipants (N=92) with DS, ≥30 years of age were assessed with the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS). They were classified by a psychiatrist into three categories: AD, prodromal dementia, and stable cognition. Another psychiatrist blinded to the CAMDEX‐DS dementia diagnosis, evaluated the participants using the NPI. Chi‐square tests were used to check for significant differences in frequency of symptoms.ResultThirteen participants (14.1%) had AD, 17 (18.4%) were classified as prodromal dementia and 62 (67.5%) were in the stable cognition group. Prevalence of delusion, depression, anxiety, disinhibition, irritability, appetite abnormalities and total NPI did not differ between groups. Anxiety and irritability were common across all groups (∼50% of the total), while euphoria was not present in any participant. Hallucination, agitation, apathy, aberrant motor behaviour and night‐time behaviour disturbance showed significant difference among the groups (p<0.05), with higher prevalence in the group with AD.ConclusionThe results indicate that individuals with DS and AD have some of the symptoms that are characteristically present among the general population with AD. Future studies are needed to understand if AD in DS is associated with a similar pattern of NPS observed among people with AD in the general population or may follow a specific NPS pattern. The high frequency of some NPS in individuals with DS and stable cognition should be considered in the diagnostic process in order to reduce the odds of generating a false positive.

The evolution of neuropsychiatric symptoms in atypical variants of Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms (NPS) constitute a pervasive component of Alzheimer’s disease (AD) for patients with a “typical” (i.e. amnestic‐predominant) phenotype. The prevalence and course of NPS is largely unknown in patients with atypical variants of AD and the few conducted studies are clouded by inclusion of Aβ‐negative individuals. Understanding the evolution of NPS in atypical AD is crucial for adequate patient care for individuals with these rare and early‐onset AD phenotypes.MethodsWe included 632 amyloid‐β‐positive subjects from the Amsterdam Dementia Cohort, including 26 behavioral variant AD (bvAD; showing ≥2/6 behavioral variant frontotemporal dementia (bvFTD) criteria), 30 logopenic variant primary progressive aphasia (lvPPA), 75 posterior cortical atrophy (PCA; Table 1). In addition, we included 47 AD patients with isolated predominant amnestic profiles (“amnestic AD”) and 454 amyloid‐β‐positive AD patients without predominant weaknesses on a single domain as “typical AD” reference groups. Linear mixed models were performed to compare baseline and longitudinal change in NPS as measured using Neuropsychiatric Inventory (NPI) scores across groups using general AD as the reference group (average follow‐up NPI assessment: 1.8 years).ResultAt baseline, apathy, appetite changes, disinhibition, aberrant motor behavior, and agitation were most frequent in bvAD patients, showing higher levels than typical AD (Figure 1). Apathy, irritability, anxiety, depression and appetite changes occured most frequently in PCA patients with similar levels as typical AD groups, whereas patients with lvPPA showed lower frequencies on 11/12 NPS compared to typical AD. Linear mixed models showed a significant decrease in total NPI score over time for the bvAD group (β(SE) = ‐0.0067 (0.003), p<.05). No significant changes were found in the other groups (all p>.05, Figure 2).ConclusionThis study assessing the baseline magnitude and longitudinal progression of NPS across amyloid‐positive clinical variants of AD suggests that patients with PCA do not show increased NPS, whereas patients with lvPPA show less NPS than typical AD patients. Despite high baseline levels of NPS in bvAD, NPS decrease over time, corresponding to observations in patients with bvFTD and suggestive of an inverted U‐shape trajectory of NPS in these patients.

Detection and Prediction of Incident Alzheimer Dementia over a 10-Year or Longer Medical History: A Population-Based Study in Primary Care

Background: Despite the crucial role played by general practitioners in the identification and care of people with cognitive impairment, few data are available on how they may improve the early recognition of patients with Alzheimer dementia (AD), especially those with long (i.e., 10 years and longer) medical history. Aims: To investigate the occurrence and the predictors of AD during a 10-year or longer period prior AD diagnosis in primary care patients aged 60 years or older. Materials and Methods: A cohort study with a nested case-control analysis has been conducted. Data were extracted from the Italian Health Search Database (HSD), an Italian database with primary care data. AD cases have been defined in accordance with the International Classification of Diseases, ninth edition (ICD-9-CM) codes and coupled with the use of anti-dementia drugs. Prevalence and incidence rates of AD have been calculated. To test the association between candidate predictors, being identified in a minimum period of 10 years, and incident cases of AD, we used a multivariate conditional logistic regression model. Results: As recorded in the primary care database, AD prevalence among patients aged 60 years or older was 0.8% during 2016, reaching 2.4% among nonagenarians. Overall, 1,889 incident cases of AD have been identified, with an incidence rate as high as 0.09% person-year. Compared with 18,890 matched controls, history of hallucinations, agitation, anxiety, aberrant motor behavior, and memory deficits were positively associated with higher odds of AD (p < 0.001 for all) diagnosis. A previous diagnosis of depression and diabetes and the use of low-dose aspirin and non-steroidal anti-inflammatory drugs were associated with higher odds of AD (p < 0.05 for all). Conclusion: Our findings show that, in accordance with primary care records, 1% of patients aged 60 years and older have a diagnosis of AD, with an incident AD diagnosis of 0.1% per year. AD is often under-reported in primary care settings; yet, several predictors identified in this study may support general practitioners to early identify patients at risk of AD.

Mental Health Status of Psychogeriatric Patients During the 2019 New Coronavirus Disease (COVID-19) Pandemic and Effects on Caregiver Burden.

Introduction: There is a growing awareness about the noxious effects of the 2019 Coronavirus Disease (COVID-19) pandemic on the mental health of the elderly. However, there is limited information from clinically driven research. The objectives of the present study were to examine the magnitude of psychiatric symptoms and to determine their association with caregiver distress, in a cross-section of community-dwelling older adults and a subsample of aging adults with Down syndrome (DS) attending a psychogeriatric service in São Paulo, Brazil.Method: Telephone-based interviews and electronically filled self-assessment questionnaires were used to collect information from patients and caregivers, addressing their impressions and concerns about the pandemic and related effects on the patient's emotional state and behavior. Clinical information was obtained from hospital charts, medical records, and psychometric tests administered through telephone interviews [Hospital Anxiety and Depression Scale (HADS) and Neuropsychiatric Inventory Questionnaire (NPI-Q)].Results: We included 100 consecutive participants, comprising 71 older adults with psychogeriatric/neurocognitive disorders and 29 aging adults with DS. Higher HADS and NPI-Q scores were significantly associated with caregiver distress (p < 0.05) in both groups. Correlation analyses indicated strong, positive associations between caregiver burden and scores in HADS anxiety (HADS-A) and HADS depression (HADS-D) scales in the subsamples of euploid and DS subjects. Higher NPI-Q scores in the former group were also correlated with caregiver distress, with stronger associations for neuropsychiatric symptoms. Similar findings were observed among DS subjects. ANOVA tests indicated significant associations between NPI-Q scores and caregiver distress among dementia patients, as well as with HADS scores. Similar results were found after multiple linear regressions; as such, among the elderly subsample, higher scores in HADS-A (p = 0.002) and HADS-D (p = 0.001) predict a significant impact on caregiver burden (p < 0.00001, R2 0.46); taking into consideration caregiver burden as a dependent variable and NPI-Q total score as an independent variable, we obtained significant strong prediction values for either DS (p < 0.00001, R2 0.95) or elderly adults (p < 0.00001, R2 0.88).Conclusion: During the COVID-19 pandemic, patients with neurocognitive disorders present with clinically relevant neuropsychiatric symptoms, with significant impact on caregiver distress. Apathy, aberrant motor behavior, sleep disorders, and psychoses were the main psychopathological domains, which had determined caregiver burden worsening.

Neuropsychiatric Presentations due to Traumatic Brain Injury in Cognitively Normal Older Adults.

Neuropsychiatric symptoms (NPS) are common sequelae of traumatic brain injuries (TBI) among adults. However, little is known about NPS associated with a history of TBI in adults relative to adults without a history of TBI and to what extent NPS may be modulated by sex and other factors. Using the National Alzheimer's Coordinating Center Uniform Data Set, we examined the association between Neuropsychiatric Inventory-Questionnaire (NPI-Q) scores in cognitively normal older adults with and without a history of TBI. A binomial logistic regression model was used to examine NPI-Q domains in adults with a history of TBI (n = 266) versus without a history of TBI (n = 1508). History of TBI, sex, age, and body mass index were used as covariates. Adults with a history of TBI had a greater probability of exhibiting agitation, anxiety, apathy, disinhibition and aberrant motor behavior relative to adults without a history of TBI. In terms of sex differences, males with and without a history of TBI had an increased likelihood of agitation, apathy, disinhibition, and apnea, whereas females had an increased likelihood of anxiety and insomnia relative to males. Our study confirms that history of TBI is associated with an increased prevalence of specific NPS, including agitation, anxiety, apathy, disinhibition, and aberrant motor behavior. Given that the aforementioned NPS are linked through different pathways, damage to any of them may cause an alteration in behavior. As well, NPS appear to be modulated by sex, with symptoms differing between males and females. Our research suggests future studies examining NPS sequelae of TBI should adjust for sex.

The Prevalence and Determinants of Neuropsychiatric Symptoms in People With Acquired Brain Injury in Nursing Homes

ObjectivesEstablishing the prevalence and determinants of neuropsychiatric symptoms (NPS) in patients with acquired brain injury (ABI) in nursing homes. DesignCross-sectional, observational study. Setting and ParticipantsPatients 18-65 years old with ABI in special care units in Dutch nursing homes. MethodsNursing homes were recruited through the national expertise network for patients with severe ABI, regional brain injury teams, and by searching the Internet. Patient characteristics were collected through digital questionnaires. NPS were assessed with the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI), cognition with the Mini-Mental State Examination, and activities of daily living with the Disability Rating Scale. Psychotropic drug use (PDU) was retrieved from the electronic prescription system. Individual NPS were clustered. Associations between determinants and NPS were examined using multilevel multivariate linear regression models. ResultsIn a population of 118 patients from 12 nursing homes, 73.7% had 1 or more clinically relevant NPS and 81.3% 1 or more agitated behaviors. The most common NPS were agitation, in particular aberrant motor behavior (24.6%), repetitious sentences/questions (35.5%), and constant requests for attention (34.6%), verbal (33.6%) and physical (50.5%) aggression, and irritability (28.0%). Male patients were more likely to display hyperactivity. Being married was associated with less verbally agitated behavior and pain was associated with a higher CMAI total score. PDU increased the likelihood of a higher NPI-NH total score. Conclusions and ImplicationsNPS are common in patients with ABI ≤65 years of age residing in nursing homes. This is a first step to fill in the knowledge gap concerning NPS in this population. An increasing number of patients with severe ABI may survive the acute phase and will reside many years in nursing homes. It is important to shed more light on these NPS, with regard to course, magnitude, and severity, to ultimately develop appropriate care for this vulnerable group of patients.

Gyroxin, a toxin from Crotalus durissus terrificus snake venom, induces a calcium dependent increase in glutamate release in mice brain cortical synaptosomes

Gyroxin is a thrombin-like toxin obtained from the venom of the South American rattlesnake, Crotalus durissus terrificus. Literature has reported “gyroxin syndrome” characterized, in mice, as series of aberrant motor behavior, known as barrel rotation, mainly after intraperitoneal administration. Despites several studies, a physiological mechanism of “gyroxin syndrome” are still not completely understood. In this context, alterations on the central nervous system (CNS), especially causing neurotoxic events, are pointed out as likely candidates. Then, we decided to investigate whether gyroxin induces alterations in glutamate release, one of the most important neurotransmitter involved in neurotoxicity. For that, we performed all experiments, in vitro, using a model of mice brain cortical synaptosomes. Notably, our results indicate that the administration of gyroxin on purified presynaptic brain cortical terminals resulted in an extracellular Ca2+- dependent raise in glutamate release. Indeed, our results also showed that gyroxin increases intrasynaptosomal calcium (Ca2+) levels through acting on voltage gated calcium channels (VGCC), specifically N and P/Q subtypes. Moreover, our data show that gyroxin increases exocytosis rate. Interestingly, these data suggest that gyroxin might induce neurotoxicity by increasing glutamate levels. However, future investigations are needed in order to elucidate the nature of the following events.

The Relationship between Neuropsychiatric Symptoms and Default-Mode Network Connectivity in Alzheimer's Disease.

ObjectiveNeuropsychiatric symptoms of dementia are prevalent and extremely burdening for the patient and caregivers, but the underlying mechanism of these symptoms has not been investigated. This study aimed to investigate the relationship between neuropsychiatric symptoms and default-mode functional connectivity in Alzheimer’s disease. MethodsNeuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. Functional magnetic resonance imaging was conducted on seventy patients with Alzheimer’s disease during rest. We conducted a seed-based functional connectivity analysis to identify anterior and posterior default-mode networks (DMN). Seeds were the medial prefrontal cortex (Montreal Neurological Institute 12, 51, 36; seed radius=3 mm) for the anterior DMN and the precuneus (Montreal Neurological Institute -6, -63, 27; seed radius=3 mm) for the posterior DMN We then correlated the scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective, and psychosis syndrome) with maps of connectivity in the default-mode network. ResultsThere was a significant correlation between decreased connectivity in the medial prefrontal cortex of the anterior defaultmode network and hyperactivity (agitation, irritability, aberrant motor behavior, euphoria, and disinhibition) syndrome (p<0.05, family wise error cluster-level corrected). ConclusionOur study demonstrated that hyperactivity syndrome is related to hypoconnected default-mode network in Alzheimer’s disease. This finding suggests that specific network alterations are associated with certain neuropsychiatric syndromes.

Neuropsychiatric symptoms and quality of life in Spanish patients with Alzheimer's disease during the COVID-19 lockdown.

Background and purposeThe COVID‐19 epidemic is affecting almost all individuals worldwide, and patients with Alzheimer’s disease (AD) and amnesic mild cognitive impairment (MCI) are particularly at risk due to their characteristics and age. We analysed the impact of the pandemic on these patients’ neuropsychiatric symptoms and their quality of life after 5 weeks of lockdown in Spain.MethodsA total of 40 patients with a diagnosis of MCI (n = 20) or mild AD (n = 20) from the Cognitive Stimulation Program of the Cognitive Disorders Unit were evaluated. All patients had undergone a previous evaluation during the month before the lockdown, and were re‐evaluated after 5 weeks of lockdown. The Neuropsychiatric Inventory (NPI) and EuroQol‐5D questionnaire (EQ‐5D) were used to assess neuropsychiatric symptoms in patients and the quality of life in patients as well in caregivers.ResultsThe mean (SD) total baseline NPI score was 33.75 (22.28), compared with 39.05 (27.96) after confinement (P = 0.028). The most frequently affected neuropsychiatric symptoms were apathy [4.15 (3.78) vs. 5.75 (4.02); P = 0.002] and anxiety [3.95 (3.73) vs. 5.30 (4.01); P = 0.006] in patients with MCI, and apathy [2.35 (2.70) vs. 3.75 (3.78); P = 0.036], agitation [0.45 (1.14) vs. 1.50 (2.66); P = 0.029] and aberrant motor behaviour [1.25 (2.86) vs. 2.00 (2.93); P = 0.044] in patients with AD. We did not observe differences in EQ‐5D scores during the re‐evaluation. The 30% of patients and 40% of caregivers reported a worsening of the patients' health status during confinement.ConclusionsThe results of this study show the worsening of neuropsychiatric symptoms in patients with AD and MCI during 5 weeks of lockdown, with agitation, apathy and aberrant motor activity being the most affected symptoms.

Neuropsychiatric symptoms as a distinguishing factor between memory diagnoses.

To determine whether neuropsychiatric symptoms (NPS) are able to differentiate those with mild cognitive impairment (MCI) and dementia from persons who are cognitively healthy. Multinomial and binary logistic regressions were used to assess secondary data of a sample (n = 613) of older adults with NPS. Analyses evaluated the ability to differentiate between diagnoses, as well as the influence of these symptoms for individuals with amnestic MCI (MCI-A), non-amnestic MCI (MCI-NA), and dementia compared with those who are cognitively healthy. Persons with MCI were more likely to have anxiety, apathy, and appetite changes compared with cognitively healthy individuals. Persons with dementia were more likely to have aberrant motor behaviors, anxiety, apathy, appetite changes, and delusions compared with those who were cognitively healthy. Individuals with any type of cognitive impairment were more likely to have anxiety, apathy, appetite changes, and delusions. Specifically, anxiety, apathy, appetite changes, and disinhibition were predictors of MCI-A; agitation and apathy were predictors of MCI-NA; and aberrant motor behaviors, anxiety, apathy, appetite changes, and delusions were predictors of dementia. Finally, nighttime behavior disorders were less likely in individuals with dementia. The present study's results demonstrate that specific NPS are differentially represented among types of cognitive impairment and establish the predictive value for one of these cognitive impairment diagnoses.

Behavioural changes in institutionalised older people: a gender perspective

There is a need to redefine and improve the treatment and care given in residences for the elderly from a non-pharmacological perspective that fosters person-centred care. In particular, the psychological and behavioural symptoms associated with dementia require a multidisciplinary evaluation to design appropriate interventions. The objective is to evaluate behavioural disorders in a group of residing elderly people and analyse whether the gender of the participants influences the presence of these behaviours. In the methodology, the group is consisted of 450 people, 73.6% women and 26.4% men with an average age of 86.82 (WD=8.22). The results show that women have a greater risk of presenting behavioural disorders. Men tend to present higher levels of anxiety, lack of inhibition, sleeping disorders, and loss of appetite; while women present more affective symptoms such as anxiety, euphoria, or apathy, or more psychotic symptoms such as delusions and hallucinations, and more aberrant motor behaviours. This influence is only significant for delusions and aberrant motor behaviour. The discussion and conclusions of the study show that gender influences behavioural disorders. This type of research work is very scarce because may be of great interest to develop and improve preventive strategies and non-pharmacological use of these symptoms in residence for the elderly settings.

Using a Rocking Chair in the Care of People with Dementia: A Single-Case Research Study

The people with dementia experience a progressive loss of cognition, while more than 90% of them develop behavioral and psychological symptoms of dementia (BPSD). BPSD may result in physical injuries and psychological distress among people with dementia and their family/caregivers. First-line care strategies in dementia care should not unthinkingly involve pharmacological interventions to avert or reduce the behavior, and should rather consider the person and their unique requirements. Therefore, a combination of pharmacological and non-pharmacological interventions is strongly recommended. Since the care staff in dementia care is required to be informed regarding the non-pharmacological approaches to address BPSD, the present study was aimed to evaluate the use of a rocking chair in the context of BPSD, quality of life, and medication usage among people with dementia at individual level. The secondary aim of the present study was to describe care staff’s experiences related to the feasibility and usability of rocking chair in providing care for PwD in a nursing home setting. The present research is a single-case study, performed using a mixed-methods approach, with six people having dementia and 11 care staff members in a nursing home setting. The people with dementia used the ErgoNova Rocking chair® for a mean number of five times/week, for eight weeks in total. Quantitative and qualitative data were collected prior to, during, and post-intervention (A-B-A design). The quantitative and qualitative data were consistent with each other. The mean, median, and relative change measures indicated a decrease in the BPSD symptoms, such as aberrant motor behavior, agitation, apathy, depression, irritability, and night-time behavior disturbances, and increased quality of life upon using the ErgoNova Rocking chair®. It was also considered to be feasible, usable, and non-labor-intensive intervention by the care staff. The obtained data suggested that the use of ErgoNova Rocking chair® provided short-term relief from aberrant motor behavior, agitation, apathy, depression, irritability, and night-time behavior disturbances, along with an increase in the quality of life of the person with dementia. The use of ErgoNova Rocking chair® may serve as a complementary tool to the non-pharmacological management techniques for people with dementia in nursing homes.

Correlation of Neural Oscillations during Stroop Testing with Hippocampal and Amygdala Volume differ between Cognitively Healthy Normal Aging and Pre‐symptomatic Alzheimer’s Disease

Background and ObjectivesStroop interference differences have been reported in the early stage of pre‐symptomatic Alzheimer’s disease (AD). The two most reported brain regions in AD (hippocampus and amygdala) haven’t been studied for interference processsing in the early AD stage. We aim to explore the relationship between brain interference processing and volumetric analysis on hippocampus and amygdala to understand the underlying neural events in pre‐symptomatic AD.MethodsWe employed a quantitative electroencephalography (qEEG) test to investigate brain activity during the Stroop interference test in a pre‐symptomatic AD study. Participants were instructed to name the color of the ink when the word and color match (congruent trials (CT)) or do not match (incongruent trials (IT)). Elderly study participants with normal cognition were recruited from the local community, consisting of two subgroups according to their cerebrospinal fluid proteins: cognitively healthy with normal amyloid/tau ratio (CH‐NAT, n=20) or pathological amyloid/tau ratio (CH‐PAT, n=21) between 60–95 years of age. A subgroup of the participants went through MRI scanning (9 CH‐NATs and 9 CH‐PATs) to obtain anatomical structures. They are age, gender, BMI, education balanced. We explored correlations between qEEG spectral power (2–30Hz) at six brain regions (frontal (F), central (C), parietal (P), left temporal (LT), right temporal (RT), and occipital (O)), and the magnetic resonance imaging (MRI) volumetric measures of two brain regions that most relate to Alzheimer’s disease: hippocampus and amygdala.Results &amp; DiscussionIn CH‐NATs but not CH‐PATs, hippocampal volume is negatively correlated with early beta power during incongruent trials (IT) (p=0.002~0.021, r=−0.87~ −0.75), and early alpha power (p=0.0004~0.020, r=−0.92~ −0.75) over F,C,P,LT,RT regions. However, in CH‐PATs but not CH‐NATs, hippocampal volume is positively correlated with both early and late delta power during incongruent trials (IT) (p=0.001~0.042, r=0.68~0.90) over C,LT,RT,O regions.In CH‐NATs but not CH‐PATs, amygdala volume is negatively correlated with early alpha power (p=0.0003~0.0496, r=−0.93~ −0.67) on both CT (over F,C,LT,RT,O) and IT (over F,C,P,LT). However, CH‐PATs but not CH‐NATs, amygdala volume is positively correlated with late delta power during incongruent trials (IT) (p=0.007~0.023, r=0.74~0.82) over C,P,RT,O regions.The different correlations of qEEG with MRI between CH subgroups indicate maladaptive neuroplasticity already occurs in pre‐symptomatic AD stage. Previous studies have shown that amygdala atrophy is a prominent indicator of AD severity in patients including a potential relationship with aberrant motor behavior, anxiety, and irritability. We propose that early intervention strategies for pre‐symptomatic AD individuals that correct maladaptive neuroplasticity may attenuate neurodegeneration.Support or Funding InformationAcknowledgmentFinancial support provided by the L.K. Whittier Foundation, NIH R56 Funding 1R56AG063857‐01. Betty Chung and David Buennagel assisted with patient recruitment. Roger Rochart assisted with final draft.

Effects of neuropsychiatric symptoms of dementia on reductions in activities of daily living in patients with Alzheimer's disease.

In patients with Alzheimer's disease (AD), cognitive impairments cause a progressive reduction in Activities of Daily Living (ADL). Neuropsychiatric symptoms (NPS) also appear in most patients; however, the association between NPS and reductions in ADL remains unclear. The present study evaluated whether NPS influence such reductions using two different ADL measures in patients with AD. Among 546 consecutive outpatients who visited the memory clinic at the Jikei University Kashiwa Hospital, we recruited 208 patients with AD and investigated the correlations between either the Physical Self-Maintenance Scale (PSMS) score or the Instrumental ADL (IADL) level, and each of the Behavioral Pathology in AD (Behave-AD) subscales. To clarify the causal relationships of these correlations, we then verified the associations between statistically significant demographic variables and the Behave-AD subscales as well as the two ADL scales (PSMS score and IADL percentage) using a general linear model. Neither the PSMS nor the IADL results were significantly influenced by the aberrant motor behaviors score. However, the IADL was significantly influenced by the Mini-Mental State Exam (MMSE) score. Furthermore, diurnal rhythm disturbances and the interaction between diurnal rhythm disturbances score and the MMSE score significantly influenced the PSMS results. Basic ADL reductions may be influenced by diurnal rhythm disturbances, in addition to cognitive impairments in patients with AD. Furthermore, the interaction between the diurnal rhythm disturbances score and cognitive function may also influence basic ADL. Geriatr Gerontol Int 2020; ••: ••-••.

THE EFFECTS OF STATINS ON NEUROPSYCHIATRIC SYMPTOMS IN A MEMORY CLINIC COHORT

Introduction Previous studies have reported either that statins are protective against dementia or that they increase the risk of cognitive decline. We focus on the effect of statins on dementia-associated neuropsychiatric symptoms (NPS), rather than cognition. Methods 164 patients referred for cognitive assessment from the St. Michael's Hospital memory clinic were allocated into 4 groups based on statin use: 1= atorvastatin 2= rosuvastatin; 3= nonspecific cholesterol medication; 4= not taking a statin. We then compared cross sectionally their Neuropsychiatric Inventory (NPI) severity scores (total and subdomains scores). All statistical analysis was done on SPSS 25. NPI total severity score, and NPI severity subdomain scores, were tested among the statin groups using Kruskal Wallis test. Chi-squared and Fisher exact tests were used to test the association between gender and education level of statin groups. Results There was no association between gender and statin use (p= 0.537). In addition, there was no association between education level and statin use (p= 0.330). For NPI scores, there was no difference between the groups H(3)= 3.725, p=0.293. Examining the 12 NPI subdomain scores, aberrant motor behavior was significantly different among the statin groups (p= 0.005). Further analysis revealed that taking nonspecific cholesterol medication had the most frequent occurrence of aberrant motor behavior. Conclusions While there was no difference in NPI severity total score between statin groups, the aberrant motor behavior subdomain score was significantly different among the four statin groups, with unspecified statin use associated with higher rates of aberrant motor behavior. This study suggests that statin use in general and type of statin selected may contribute differentially to NPS domains. Further studies in larger cohorts adjusting for dose and comorbities are required to clarify this finding. This research was funded by: N/A Previous studies have reported either that statins are protective against dementia or that they increase the risk of cognitive decline. We focus on the effect of statins on dementia-associated neuropsychiatric symptoms (NPS), rather than cognition. 164 patients referred for cognitive assessment from the St. Michael's Hospital memory clinic were allocated into 4 groups based on statin use: 1= atorvastatin 2= rosuvastatin; 3= nonspecific cholesterol medication; 4= not taking a statin. We then compared cross sectionally their Neuropsychiatric Inventory (NPI) severity scores (total and subdomains scores). All statistical analysis was done on SPSS 25. NPI total severity score, and NPI severity subdomain scores, were tested among the statin groups using Kruskal Wallis test. Chi-squared and Fisher exact tests were used to test the association between gender and education level of statin groups. There was no association between gender and statin use (p= 0.537). In addition, there was no association between education level and statin use (p= 0.330). For NPI scores, there was no difference between the groups H(3)= 3.725, p=0.293. Examining the 12 NPI subdomain scores, aberrant motor behavior was significantly different among the statin groups (p= 0.005). Further analysis revealed that taking nonspecific cholesterol medication had the most frequent occurrence of aberrant motor behavior. While there was no difference in NPI severity total score between statin groups, the aberrant motor behavior subdomain score was significantly different among the four statin groups, with unspecified statin use associated with higher rates of aberrant motor behavior. This study suggests that statin use in general and type of statin selected may contribute differentially to NPS domains. Further studies in larger cohorts adjusting for dose and comorbities are required to clarify this finding.

THE IMPACT OF SEX ON NEUROPSYCHIATRIC SYMPTOMS IN OLDER ADULTS POST TRAUMATIC BRAIN INJURY

Introduction Traumatic Brain injuries (TBIs) cause damage that manifest as a variety of neuropsychiatric sequelae. While it is understood that TBI may be associated with onset of neuropsychiatric symptoms (NPS), whether or not these symptoms differ by sex is not yet clear. Knowing this information is critical as it may lead to differential approaches to treatment and provide important insights into the role of sex in modulating TBI outcomes. The aim of this study was to determine the prevalence of NPS by examining the association between sex and NPI-Q scores in a TBI and without TBI older adult cohort. Methods Using data from the National Alzheimer's Coordinating Center (NACC) database, we identified a cognitively normal sample filtered for co-morbidities (N=1774). We included patients aged 50?years and above. The mean age was 68.7 in the TBI cohort, and 69.8 in the without-TBI cohort. We examined NPI-Q subdomain outcomes in a TBI (n=266) vs. without-TBI (n=1508) cohort using generalized linear models (GLM) that were estimated by generalized estimating equations (GEE). These models were run with age, sex and BMI as covariates. Results Subjects with TBI were more likely to exhibit agitation, anxiety, apathy, disinhibition and aberrant motor behaviour relative to those who did not have a TBI. Anxiety was more common among females while males were more likely to experience agitation, apathy and disinhibition. Sex did not play a role in aberrant motor behaviour. Conclusions TBIs affect the presentation of NPS because the areas of the brain that control these symptoms are closely intertwined. Our findings suggest that TBI is associated with predominantly frontal based NPS, consistent with mechanism of injury. Moreover, sex may modulate the expression of NPS. Thus, treatments should target frontal lobe behaviours and be individualized based on sex. This research was funded by: n/a

APOE ɛ4/ɛ4 Is Associated with Aberrant Motor Behavior Through Both Lewy Body and Cerebral Amyloid Angiopathy Pathology in High Alzheimer's Disease Pathological Load.

Aberrant motor behavior (AMB) is a neuropsychiatric symptom (NPS) prevalent in Alzheimer's disease (AD), known to cause great distress to both patients and caregivers. Apolipoprotein E4 (APOE4) is the most important genetic predictor of AD, and it has been associated with high NPS prevalence. To investigate the neuropathological substrates and risk factors associated with AMB in AD patients. Cases with Braak stage I-II and CERAD 0-1 were classified as Low AD (LAD), while Braak stage III-IV and CERAD 2 were grouped as Intermediate AD (IAD). Cases with Braak stage V-VI and CERAD 3 were classified as High AD (HAD) in accordance with NIA-Reagan criteria. All cases were stratified by APOE genotype, yielding No ɛ4 & ɛ4 and ɛ4/ɛ4 groups depending on ɛ4 copy number within APOE. Presence of AMB was assessed using NPI-Q. AMB increased in parallel with CERAD and Braak & Braak scores. Hypercholesterolemia, but no other cardiovascular risk factors, was associated with AMB in HAD. AMB prevalence in HAD was significantly increased in the presence of two APOEɛ4 alleles as compared to No ɛ4 & ɛ4. The relationship between homozygous APOE4 and AMB was strongly associated with the presence of both Lewy bodies and cerebral amyloid angiopathy pathologies in both sexes.