Assessment Of Neuropsychiatric Symptoms Research Articles

Obrasci neuropsihijatrijskih simptoma u primarnim i sekundarnim tauopatijama iz ugla negovatelja i pacijenata

Introduction/Aims: Understanding the differences in neuropsychiatric symptoms (NPSs) across tauopathies, particularly in the early stages of the disease, may aid in differential diagnosis. The aims of the research are as follows: a) to examine the patterns of NPSs in primary (frontotemporal dementia - FTD and progressive supranuclear palsy - PSP) and secondary (Alzheimer's disease - AD) tauopathies; b) to examine the differences in NPSs reported by patients and caregivers. Methods: The study included 312 patients, 176 of whom had a disease duration of ≤3 years. The presence of NPSs based on caregiver's report was assessed by neuropsychiatric questionnaire (NPI). Patient's assessment of NPSs was examined by Hamilton's Depression and Anxiety Scales and the Apathy Scale. Results: In AD, the most common and severe neuropsychiatric symptoms are mood disorders and apathy. In contrast, agitation-related symptoms are also prominent in FTD and PSP. The profile of NPSs in FTD and PSP is similar, but irritability and aberrant motor behavior are more pronounced in FTD, while sleep disturbances are dominant in PSP. The prevalence of NPSs reported by caregivers on NPI was higher than that reported by patients. Conclusions: FTD and PSP are characterized by more frequent and more severe NPSs and have distinct psychiatric patterns compared to AD, even in the early disease course. Caregiver's observations of the patient's behavior could be of key importance in distinguishing these tauopathies, particularly in the absence of hard motor and cognitive symptoms in early disease course. Assessments of depression, anxiety, and apathy by patients themselves and their caregivers differ significantly, and data from these two sources cannot be considered interchangeable and comparable.

ApoE ε4 status in pre‐dementia risk states, mild behavioural impairment and subjective cognitive decline, and the risk of incident cognitive decline

AbstractBackgroundDementia has an increasing global burden with over 40 million affected individuals. With sub‐optimal advances in drug development, there is an increasing shift to determine risk of dementia in the non‐demented population. Assessment of neuropsychiatric symptoms (NPS) may offer an opportunity to capture the at‐risk group earlier. Mild Behavioural Impairment (MBI) is a validated neurobehavioural syndrome, characterized by the emergence of sustained NPS in older adults as an at‐risk state for dementia. Cognitively, subjective cognitive decline (SCD) is a dementia at‐risk group in which cognitive symptoms are reported in the absence of objective findings. The apolipoprotein epsilon 4 (ApoE ε4) gene is a well‐known risk marker for dementia. We aim to determine the frequency of ApoE homozygosity in SCD, stratified by MBI status cross‐sectionally, and calculate the hazard of incident cognitive decline in this group longitudinally.MethodData from 5005 participants in the National Alzheimer’s Coordinating Center (NACC) were used to capture older adults who were cognitively normal, but had subjective cognitive complaints (SCD). We determined MBI status (+/‐) using a previously published transformation algorithm of NPI‐Q scores. We tabulated ApoE genotype in both groups. We compared proportion of ApoE homozygousity (APOE ε4+/+)in the MBI+ versus the MBI‐ group. Additionally, a Cox proportional hazards regression will be done to capture hazard of incident mild cognitive impairment in MBI+ versus MBI‐.ResultA two‐sample test of proportions of MBI+/‐ status stratified by ApoE ε4+/+resulted in significant differences between groups with homozygosity more frequent in MBI+ versus MBI‐ (p<0.001). We will also present the results of the Cox proportional hazards regression analysis.ConclusionIn older adults with subjective cognitive decline, ApoE ε4 allele homozygosity was more frequently seen in the MBI+ group. These findings provide additional evidence for the utility in determining MBI status in SCD.

Assessment of neuropsychiatric symptoms in dementia: validity and reliability of the Lebanese version of the neuropsychiatric inventory questionnaire

This study aims to examine the psychometric properties of an Arabic version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) that evaluates neuropsychiatric symptoms in patients with dementia. A cross-sectional study was carried out with a sample of 136 Lebanese demented patients aged 63–98 years. NPI-Q was completed by the patients’ primary caregiver and standard NPI was administered through personal interview by an experienced research assistant to the same caregiver. The internal consistencies of the Arabic NPI-Q total and distress scale were 0.680 and 0.684 respectively. One week test-retest reliability of the total NPI-Q and distress scores were 0.991 and 0.988 respectively (p-value <0.0001 for both). The NPI-Q correlated significantly with the standard NPI in individual and total symptom scores as well as caregiver distress scores. Exploratory factor analysis extracted five factors that explained 64.7% of variances. The prevalence of analogous symptoms reported on the NPI and NPI-Q differed on average by 3% while moderate or severe symptom ratings differed on average by 1%. The Arabic version of the NPI-Q showed evidence of good psychometric properties indicating that it is a suitable tool for the routine assessment of neuropsychiatric symptoms for Lebanese patients with dementia in clinical settings.

Adopting a Diary to Support an Ecological Assessment of Neuropsychiatric Symptoms of Dementia.

Neuropsychiatric symptoms (NPS) are one of the most challenging issues in the management and care of people with dementia. Their accurate assessment is thus crucial for properly approaching subjects with cognitive disorders in the clinical setting. In parallel, the correct evaluation of NPS is also particularly relevant in the research field where they serve as critical indicators for measuring the efficacy of interventions against cognitive disorders. However, the study of NPS is extremely challenging given their extreme inter- and intra-individual variability. Moreover, the available assessment tools are often inadequate to fully capture their complexity and phenotypic expression. Based on these considerations, novel modalities for the assessment and measurement of NPS may be important to identify and develop. In this regard, a promising alternative (or, at least, a complementary aid) to traditional scales and questionnaires might be constituted by diaries. In the present article, we discuss the potential advantages and implications that may result from the adoption of this kind of instruments for the ecological assessment of NPS in subjects with dementia.

Potentially modifiable factors associated with agitation and aggression in Alzheimer's disease: results of the ICTUS study.

To study potentially modifiable factors associated with the severity of agitation or aggression (A/A) symptoms among Alzheimer's disease (AD) patients. Data from the Impact of Cholinergic Treatment Use (ICTUS) study, European longitudinal prospective observational study. Community dwelling outpatients included in 29 European memory clinics. 1375 participants with probable AD (Mini-Mental State Examination score of 10-26) with an informal caregiver. At baseline and twice yearly over the two-year follow-up, patients underwent comprehensive clinical and neuropsychological assessments: sociodemographic data, cognitive status, functional impairment, and assessment of neuropsychiatric symptoms based on Neuro-Psychiatric Inventory (NPI). The ZARIT scale assessed the caregiver's burden. The variable of interest was the severity of the item of A/A of the NPI. To study factors associated to the severity of A/A symptoms six months later, a multivariate mixed regression model was used. Frequency of A/A symptom varied from 30% to 34% at each visit. Two factors were found to be independently associated with the severity of A/A: (1) the presence of affective disorder (anxiety, depression, and/or irritability) that increased the severity of the A/A by 0.89 point (coefficient:0.89; 95% Confidence Interval (CI) = [0.48,1.30], p < 0.001), and (2) a severe caregiver burden that increased the severity of the A/A by 1.08 point (coefficient:1.08; 95% CI = [0.69,1.47], p < 0.001). Research should evaluate whether the identification and treatment of an affective disorder along with the evaluation and optimal management of the caregiver would have a positive impact on the course of A/A in mild to moderate AD patients.

How Well Do Caregivers Detect Depression and Anxiety in Patients With Parkinson Disease?

Depression and anxiety are prevalent in Parkinson disease (PD) yet underrecognized in clinical practice. Caregiver reports are frequently utilized to aid in the assessment of neuropsychiatric symptoms but little is known about caregivers' ability to recognize them in patients with PD. This study sought to examine the accuracy of caregiver reports. Eighty patient-caregiver dyads were involved. Accuracy of caregiver recognition was assessed by examining the level of agreement between caregiver ratings on the Neuropsychiatric Inventory and patients' diagnosis of depression and anxiety on the Mini-International Neuropsychiatric Interview (MINI)-Plus. The agreement between caregiver report and MINI-Plus diagnosis was low for both depression (6.3%) and anxiety (17.5%). The presence of depression was overreported, while anxiety was largely underestimated by caregivers. Caregiver distress significantly predicted inaccurate caregiver identification of depression ( R2 = .51, P < .001) and anxiety ( R2 = .08, P < .05). Results indicate that caregivers may be poor at recognizing depression and anxiety in patients with PD. Utilization of caregiver report should take into account potential biases that affect caregiver judgment.

Epilepsia, psicose e religiosidade – Caso clínico

Os autores apresentam o caso de uma paciente de 61 anos, com antecedentes depressivos e história de síncopes, que desenvolve, no espaço de meio ano, alterações de comportamento pautadas por hiper-religiosidade, ideias delirantes de grandiosidade e fenômenos compatíveis com déjà vu. Nesse contexto, foi referenciada pelo médico de família para a urgência de psiquiatria, tendo sido realizada investigação orgânica e identificada epilepsia do lobo temporal após realização de eletroencefalograma. Foi medicada com valproato de sódio, na dose de 750 mg/dia, com esbatimento progressivo da sintomatologia psicótica. Com este trabalho, os autores pretendem sublinhar a importância da exploração orgânica dos sintomas neuropsiquiátricos, antes de atribuir um diagnóstico psiquiátrico ao paciente.

Validity and reliability of the neuropsychiatric inventory-clinician rating scale (NPI-C)© in a Brazilian multicenter study: Assessment of neuropsychiatric symptoms in dementia

Validity and reliability of the neuropsychiatric inventory-clinician rating scale (NPI-C)© in a Brazilian multicenter study: Assessment of neuropsychiatric symptoms in dementia

Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study

We studied the suitability of The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimer's disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD. In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters. Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline. The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.

The Neuropsychiatric Inventory Scores Change Across the Mini Mental State Examination Ranges in Patients With Alzheimer's Disease: A Multicenter Study in Turkey

To investigate neuropsychiatric manifestations in patients at various stages of Alzheimer's disease (AD). Several earlier studies reported high prevalence of neuropsychiatric symptoms in patients with AD; to date, no such study has been conducted in Turkey. We evaluated 217 patients with AD from 18 referral centers across Turkey using a web-based dementia data registry. The Mini Mental State Examination and the Neuropsychiatric Inventory (NPI) were used to evaluate the global cognitive function, and assessment of neuropsychiatric symptoms, respectively. We classified the patients into mild, moderate, and severe stages on the basis of their Mini Mental State Examination scores. We assessed group differences and correlations between the degree of AD severity and NPI values. The highest NPI scores were seen in patients with severe AD. The mean composite scores for apathy, anxiety, and depression were the highest. The prevalence of any behavioral symptom was 86%. There was no difference in the behavioral domain between the groups or between the referral centers. Moderate correlation was found between the severity of AD and the total NPI score. The caregivers' NPI distress scores varied among referral centers. The prevalence of behavioral disturbance in AD is high and similar to earlier studies, yet regional differences are seen in caregivers' reactions to behavioral symptoms.

The Neuropsychiatric Inventory—NPI. Validation of the Danish version

Assessment of neuropsychiatric symptoms in dementia has great clinical importance. The aim of the study was validation of the Danish version of the NPI, using assessments of 72 demented and 29 non-demented of age 65+ years and their caregivers at three visits. The NPI was administered by the same psychiatric nurse interviewing the same caregiver. At visits 1 and 3, a psychogeriatrician assessed the participant using the ICD-10, the Geriatric Deterioration Scale (GDS) and the Clinical Global Impression (CGI) as well as the NPI in a visual analogue scale (VAS) version. These scores were blindly converted into scores equalling the frequency and severity of the NPI by one of the investigators. Data analysis comprised inter-rater reliabilities (intra-class coefficients, ICC); NPI scores and corresponding VAS scores were compared using Spearman's correlation coefficients. NPI scores at visits 1 and 2 were used to assess the test–retest reliabilities. The scalability of the NPI was assessed with Mokken and Loevinger coefficients. The ICC for all the NPI domains and the GDS (>0.80) were perfect, the ICC for the NPI-VAS (0.68–0.95) and the CGI (0.69) was satisfactory to perfect. Correlations between NPI and NPI-VAS were high; only two domains had coefficients below 0.60: depression and agitation/aggression. NPI-total scores increase with increasing severity of dementia. The NPI did not fulfil the scalability assessed by the Mokken and Loevinger coefficients. The NPI Danish version is valid and reliable in assessing neuropsychiatric symptoms in dementia but not fully scalable. The use of single item scores and not total sum score is recommended.

Neuropsychiatric aspects of Parkinson's disease.

Previous studies of the neuropsychiatric aspects of Parkinson"s disease were frequently methodologically inadequate. Small sample sizes, selection bias, lack of diagnostic criteria of Parkinson"s disease, different definitions and assessment of neuropsychiatric symptoms, and lack of control groups seriously questioned the validity of and ability to generalize the results from many studies. During the past decade, however, several of these methodological issues have been addressed. Recent studies have found that mild cognitive impairment is very common, and dementia, depression, and psychotic symptoms develop in a large proportion of patients. Neuropsychiatric symptoms are important determinants of mortality and disease progression, as well as of the patients quality of life and course of disease, caregiver distress, and nursing home admission. Few adequately designed treatment trials have been published, but available evidence suggests that depression and hallucinations may be effectively treated using new antidepressants and atypical antipsychotic agents without worsening of parkinsonism.