Differences In Neuropsychiatric Symptoms Research Articles

Sex Differences in Neuropsychiatric Symptoms in Alpha-Synucleinopathies: A Systematic Review and Meta-Analysis.

Alpha-synucleinopathies, such as Parkinson's disease (PD), Parkinson's disease dementia (PDD), and dementia with Lewy bodies (DLB), demonstrate sex differences with regard to prevalence, age of onset, and motor manifestations. Neuropsychiatric symptoms (NPS) are common early and late manifestations of these disorders. We aimed to describe sex differences in NPS across alpha-synucleinopathies. We searched Web of Science Core collection databases to identify observational studies published between January 1, 2000, and June 1, 2022, reporting the prevalence or severity of NPS among individuals with a diagnosis of PD, PDD, or DLB. Prevalence and severity were pooled for each NPS according to sex using random-effects models. Two-hundred-and-forty studies, representing 796,026 participants (45% females), were included in the meta-analysis. Female sex was associated with a higher prevalence of anxiety (OR = 1.60 [95% CI: 1.40, 1.82]), depression (OR = 1.56 [1.45, 1.67]), fatigue (OR = 1.21 [1.02, 1.43]), and psychotic symptoms (OR = 1.26 [1.14, 1.40]) and more severe anxiety (g = 1.35 [95% CI: 0.58, 2.13]), depression (g = 1.57 [1.05, 2.08]), and fatigue (g = 0.86 [0.41, 1.32]), while male sex was associated with a higher prevalence of apathy (OR = 0.77 [0.63, 0.93]), impulse control disorders (OR = 0.67 [0.55, 0.82]), REM sleep behavior disorder (OR = 0.54 [0.42, 0.70]), hypersomnolence (OR = 0.67 [0.56, 0.80]), and suicide (OR = 0.30 [0.20, 0.44]). NPS have different prevalences and severities in alpha-synucleinopathies according to sex. These findings support consideration of sex in the elaboration of clinical tools.

Childhood Neighborhood Disadvantage and Cognitive Function among Veterans Recovering from Mild Traumatic Brain Injury

Abstract Objective Identifying risk factors and interventions for chronic symptoms following mild traumatic brain injury (TBI) is an important area of research for Veterans. Growing up in a disadvantaged neighborhood is associated with poorer health outcomes. We examined the relationship between childhood neighborhood disadvantage and cognitive outcomes among symptomatic Veterans with history of mild TBI. Method 58 Participants completed neuropsychological tests (CVLT-3, TMT A&B, COWA, Category Test), NSI, and PCL-5. The Neighborhood Atlas was used to derive disadvantage scores using childhood addresses. Global deficit scores were calculated as described by Heaton (2004). Results Neighborhood disadvantage was significantly correlated with CVLT-3 Total Learning (r = −0.26, p = 0.046), but not the overall global deficit or deficit performance across CVLT-3 Delayed Recall, TMT-A, TMT-B, COWA, and Category Test. There was a significant difference in neighborhood disadvantage between participants scoring in the deficit and normal ranges on CVLT-3 Total Learning (p = 0.046). There were no other differences in neighborhood disadvantage across other neuropsychological tests. There was a significant difference in PTSD symptoms between participants scoring within the deficit and normal ranges on the COWA (p = 0.002). There were no other significant group differences in neuropsychiatric symptoms or PTSD symptom severity. Conclusions Among Veterans in this sample, neighborhood disadvantage was not associated with cognitive function or cognitive deficits. Although neighborhood disadvantage is an important psychosocial risk factor for poor outcomes in the civilian literature, these results suggest that it may not be an important contributing factor in recovery from mild TBI for military Veterans.

Racial/ethnic differences in neuropsychiatric disturbances associated with incident dementia.

Neuropsychiatric symptoms(NPS) are nearly universal in dementia; some cross-sectional studies of NPS in dementia have found racial/ethnic differences, though it is unknown if NPS prevalence differs among racial/ethnic groups before and after dementia diagnosis. Participants were followed annually at Alzheimer's Disease Centers and were assessed on the Neuropsychiatric Inventory-Questionnaire (NPI-Q) with at least one follow-up visit at which they were diagnosed with dementia. Descriptive statistics were generated by race/ethnicity.NPS were modeled over time as a function of race/ethnicity and with diagnosis date as the baseline. NPS were present in 95% in at least one time point. After adjusting for covariates, there were no statistically significant differences in NPI-Q total scores among racial/ethnic groups at the time of and after dementia diagnosis. Findings from our prospective cohort study suggest that when individuals are matched at the time of conversion to dementia, there are no racial/ethnic differences in NPS. Neuropsychiatric symptoms of dementia are frequent and increase caregiver burden.Prior studies reported more neuropsychiatric symptoms (NPS) in Black compared to White individuals with dementia.National Alzheimer's Coordinating Center Black, White, and Hispanic participants did not differ in NPS at the time of dementia diagnosis.

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.

Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service

BackgroundNeuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs.MethodsThis was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively.ResultsOf the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen’s d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants.ConclusionThis study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.

Neuropsychiatric features in a multi-ethnic population with Alzheimer disease and mild cognitive impairment.

Alzheimer disease (AD) is more prevalent in African American (AA) and Hispanic White (HIW) compared to Non-Hispanic White (NHW) individuals. Similarly, neuropsychiatric symptoms (NPS) vary by population in AD. This is likely the result of both sociocultural and genetic ancestral differences. However, the impact of these NPS on AD in different groups is not well understood. Self-declared AA, HIW, and NHW individuals were ascertained as part of ongoing AD genetics studies. Participants who scored higher than 0.5 on the Clinical Dementia Rating (CDR) Scale (CDR) were included. Group similarities and differences on Neuropsychiatric Inventory Questionnaire (NPI-Q) outcomes (NPI-Q total score, NPI-Q items) were evaluated using univariate ANOVAs and post hoc comparisons after controlling for sex and CDR stage. Our sample consisted of 498 participants (26% AA; 30% HIW; 44% NHW). Overall, NPI-Q total scores differed significantly between our groups, with HIW having the highest NPI-Q total scores, and by AD stage as measured by CDR. We found no significant difference in NPI-Q total score by sex. There were six NPI-Q items with comparable prevalence in all groups and six items that significantly differed between the groups (Anxiety, Apathy, Depression, Disinhibition, Elation, and Irritability). Further, within the HIW group, differences were found between Puerto Rican and Cuban American Hispanics across several NPI-Q items. Finally, Six NPI-Q items were more prevalent in the later stages of AD including Agitation, Appetite, Hallucinations, Irritability, Motor Disturbance, and Nighttime Behavior. We identified differences in NPS among HIW, AA, and NHW individuals. Most striking was the high burden of NPS in HIW, particularly for mood and anxiety symptoms. We suggest that NPS differences may represent the impact of sociocultural influences on symptom presentation as well as potential genetic factors rooted in ancestral background. Given the complex relationship between AD and NPS it is crucial to discern the presence of NPS to ensure appropriate interventions.

Racial and ethnic differences in neuropsychiatric symptoms and progression to incident cognitive impairment among community-dwelling participants.

Neuropsychiatric symptoms (NPS) are a risk factor for dementia; however, their prevalence and severity among ethnoracial groups are poorly understood. We used data from the National Alzheimer's Coordinating Center (NACC) (n=6958; ≥50 years old). Cognitively normal participants at baseline, without any NPS or dementia diagnosis, had at least one follow-up. Survival analyses assessed the hazard ratio for 12 NPS models and progression to cognitive impairment. Propensity score weighting (PSW) matched participants on age, sex, education, and race/ethnicity. All 12 NPS were significantly associated with progression to cognitive impairment. In the PSW models, comparedtowhites,Black/African Americans were more likely to progress to cognitive impairment across all 12 NPS models, followed by Hispanic, and then Asian participants. PSW minimized selection bias to provide robust risk estimates. There is a higher risk of progressing to cognitive impairment for ethnoracial groups with NPS. Tailored screening of NPS and cognitive impairment should incorporate patient and caregiver reports.

DIFFERENCES IN NEUROPSYCHIATRIC SYMPTOMS AMONG RACIAL AND ETHNIC GROUPS LIVING WITH DEMENTIA IN HOME HEALTHCARE

Abstract The relationship between dementia and neuropsychiatric symptoms is well documented. Yet, little is known about the prevalence of neuropsychiatric symptoms among diverse homebound persons living with dementia. Guided by an intersectionality framework we asked: 1) Is there an association between the presence of individual neuropsychiatric symptoms and racial and ethnic groups? 2) If so, do these symptoms differ by dementia stage among groups? We conducted a cross-sectional study of n=190 receiving skilled home healthcare in Utah, New York, and New Jersey and enrolled in the DSM-H trial. We prospectively measured symptom prevalence with the Neuropsychiatric Inventory Questionnaire and dementia stage using the Quick Dementia Rating System. We performed Chi-square tests to determine the association of individual symptom prevalence with race and ethnicity and cross tabs to descriptively stratify individual symptom prevalence by dementia stage among groups. Participants were 11.9% Hispanic, 28% non-Hispanic Black, 56.1% non-Hispanic white (white). The prevalence of delusions was significantly higher in Hispanic and non-Hispanic Black groups than whites (41.7% &amp; 41.8% vs. 22.5%) and elation/euphoria in Hispanic and non-Hispanic Black groups than whites (20.8% &amp;12.7% vs. 5.4%). Delusions were most prevalent in non-Hispanic Black groups with mild dementia (53.8%) and Hispanics with moderate dementia (50.1%), while elation/euphoria was most prevalent for Hispanics with severe dementia (33.3%). Other neuropsychiatric symptoms showed no significant differences. These findings expand our knowledge of differences in neuropsychiatric symptoms among racial and ethnic persons living with dementia, which can inform future studies and targeted interventions that address disparities and improve care.

Neuropsychiatric symptoms influence differently cognitive decline in older women and men

ObjectiveThe potential impact of sex on cognitive performance in normal aging and participants with Alzheimer's disease (AD) has been outlined previously. Nevertheless, differences in neuropsychiatric symptoms (NPS) have been also outlined. We aimed to study a potential association between NPS and cognitive performances according to sex, in older individuals with and without cognitive impairment. MethodsDemographic, neuropsychiatric and neuropsychological data from the ADNI and NACC databases were merged into a dataset of 506 participants with healthy cognitive performance, 467 patients with mild cognitive impairment, and 238 patients with AD. Cognitive performance in each group was evaluated according to sex and the presence of NPS. ResultsBased on sex, cognitive performance differed according to clinical stage: in the healthy controls and AD groups, women had better fluency performance, while in the mild cognitive impairment group, women had better working memory and men better oral naming. Regardless of sex, depression showed a negative effect on processing speed in AD. Finally, there was an interaction between sex and NPS in mild cognitive impairment, where women with apathy had better working memory performance, and in AD, women with depression had better fluency performance. The opposite pattern being was observed in men, where men with depression have worse focused attention. ConclusionCognitive performance is influenced by sex, yet this influence has different manifestations at normal cognition, MCI or AD. Furthermore, apathy and depression seem to influence differently women and men at different types of cognitive decline.

Gender/Sex Differences in the Association of Mild Behavioral Impairment with Cognitive Aging.

While the gender/sex differences in neuropsychiatric symptoms in dementia population are well described, gender/sex differences in mild behavioral impairment (MBI) in dementia-free populations and the relationship to cognitive performance and to subsequent cognitive decline have not been studied. We aimed to explore gender/sex differences in the association of MBI with the level of cognitive performance and its rate of decline in a dementia-free cohort. We studied 8,181 older adults enrolled in the online PROTECT UK Study. MBI was assessed using the MBI Checklist and cognition was measured by digit span, paired associate learning, spatial working memory, and verbal reasoning. Statistical analysis was conducted using linear regression models and linear mixed-effects models. Out of 8,181 individuals (median age 63 years, 73% females), 11% of females and 14% of males had MBI syndrome. Females exhibited less often symptoms of decreased motivation (45% versus 36% in males), impulse dyscontrol (40% versus 44% in males; p = 0.001) and social inappropriateness (12% versus 15%; p < 0.001), while they showed more often symptoms of emotional dysregulation (45% versus 36%; p < 0.001). The associations of MBI domains with some measures of cognitive performance and decline were stronger in males than females, with the exception of the association of emotional dysregulation with the rate of cognitive decline in verbal reasoning, which was present exclusively in females. MBI may influence cognition to a greater extent in males than in females. We propose that predictors and biomarkers of dementia should consider gender/sex as an effect modifier.

Racial and Ethnic Differences in Neuropsychiatric Symptoms and Longitudinal Progression to Incident Cognitive Impairment Among Community-Dwelling Participants

Racial and Ethnic Differences in Neuropsychiatric Symptoms and Longitudinal Progression to Incident Cognitive Impairment Among Community-Dwelling Participants

Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: A meta‐analysis

AbstractBackgroundAlthough the majority of individuals with Alzheimer’s disease (AD) dementia exhibit neuropsychiatric symptoms (NPS), there is substantial heterogeneity in NPS manifestation. Sex is increasingly recognized as an important factor in explaining clinical variability within AD; yet, prior studies on sex differences in NPS have reported mixed findings. Therefore, we aimed to review the existing literature on sex differences in NPS in AD dementia using a meta‐analytic approach.MethodEffect sizes were extracted from 54 studies (N=19,730; N=12,092 females [61.3%], N=7,638 males [38.7%]). Random‐effects models were used to investigate sex differences in both NPS prevalence and severity for all studies combined, NPS total scores, and for specific NPS separately. Furthermore, meta‐regression analyses were conducted to examine the effects of study characteristics and demographic and clinical variables.ResultThe majority of the included studies were of fair quality and we found no indications of publication bias. When combining all studies, female sex was associated with overall greater NPS severity (k=17, g=0.07[0.01–0.14], p&lt;0.05), while no sex‐related differences were observed for NPS prevalence (k=41, OR =1.07[0.89–1.28], p=0.46). Meta‐regression analyses showed that younger age (QM =6.44, p&lt;0.05) and longer disease duration (QM =4.27, p&lt;0.05) were associated with more prevalent NPS for females with AD dementia. Regarding specific NPS, female sex was associated with more prevalent psychotic symptoms (k=4, OR=1.62[1.12–2.33], p&lt;0.01), aberrant motor behaviors (AMB; k=5, OR=1.61[1.15–2.25], p&lt;0.01), depressive symptoms (k=18, OR=1.56 [1.22–1.99], p&lt;0.001), and delusions (k=11, OR=1.56 1.27–1.92], p&lt;0.001). In addition, female sex was related to more severe depressive symptoms (k=10, g =0.20[0.08–0.29], p&lt;0.001), disinhibition (k=6, g=0.16[0.03–0.28], p&lt;0.05), and AMB (k=6, g=0.14[0.01–0.27], p&lt;0.05).ConclusionFemale sex was associated with more severe overall and specific NPS in AD dementia and a higher prevalence of specific NPS. These associations are generally not affected by study setting, measurement type, age, education, disease duration, MMSE score, and APOE status. These findings support the existing literature on sex differences in the clinical manifestation of AD, which could reflect sex‐related differences in neurobiological and psychosocial factors. Determining sex differences in NPS may guide personalized assessment and tailored treatment.

Diagnostic of psychoemotional and cognitive impairments in acute ischemic stroke

Background. Early rehabilitation of patients with stroke is an important aspect of modern healthcare. The leading factor in disability is polymorphism of movement disorders, which is associated with dysfunction of various parts of the movement regulation system. Disorders of higher mental functions are another group of functional disorders widely represented among stroke patient. Aims: To assess the severity of cognitive, psychoemotional, behavioral disorders, the level of self-control and prevalence of certain coping strategies in patients with lesions of the right and left cerebral hemispheres after acute ischemic stroke. Material and methods. The study included 60 patients with a diagnosis of ischemic stroke. Depending on the location of the stroke, patients were divided into two groups: Group 1 30 patients with lesions of the right hemisphere, Group 2 30 patients with lesions of the left hemisphere. The study was conducted on the 7th day of treatment and included: assessment of the cognitive status according to the Montreal scale (with additional scales for assessing the functions of the right hemisphere); assessment of the level of distress, depression, anxiety and somatization using the Four Dimensional Symptom Questionnaire; assessment of mental and physical asthenia according to the MFI-20 scale, level of self-control using the Rotter's Locus of Control Scale and coping strategies modality using E. Heim coping questionnaire. Results. The study established the prevalence of depression, a tendency towards non-adaptive coping strategies, ideational praxis related disorders understanding of metaphors and low level of self-control in relation to health in patients with lesions of the right hemisphere. Patients with ischemic stroke localized in the left hemisphere are characterized by a high level of mental asthenia, a choice of adaptive and relatively adaptive coping strategies, and a low level of self-control in respect to interpersonal relationships. Conclusions. The results of the study show that in the acute period of stroke there are qualitative and quantitative differences in neuropsychiatric symptoms of patients with lesions of the right and left cerebral hemispheres. The predominance of depression, cognitive impairments, and non-adaptive coping strategies in patients with lesions of the right hemisphere even with minimal or moderate motor deficits justifies early examination of the patient's behavioral, neuropsychiatric, and cognitive syndromes. The results of the study indicate the need to develop individual psychological rehabilitation programs for patients with lesions of the right and left cerebral hemispheres during the acute period of stroke.

Neuropsychiatric Symptoms in Mild Cognitive Impairment and Dementia Due to AD: Relation With Disease Stage and Cognitive Deficits.

Background: The interaction between neuropsychiatric symptoms, mild cognitive impairment (MCI), and dementia is complex and remains to be elucidated. An additive or multiplicative effect of neuropsychiatric symptoms such as apathy or depression on cognitive decline has been suggested. Unraveling these interactions may allow the development of better prevention and treatment strategies. In the absence of available treatments for neurodegeneration, a timely and adequate identification of neuropsychiatric symptom changes in cognitive decline is highly relevant and can help identify treatment targets.Methods: An existing memory clinic-based research database of 476 individuals with MCI and 978 individuals with dementia due to Alzheimer's disease (AD) was reanalyzed. Neuropsychiatric symptoms were assessed in a prospective fashion using a battery of neuropsychiatric assessment scales: Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD), Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia (CSDD), and Geriatric Depression Scale (30 items). We subtyped subjects suffering from dementia as mild, moderate, or severe according to their Mini-Mental State Examination (MMSE) score and compared neuropsychiatric scores across these groups. A group of 126 subjects suffering from AD with a significant cerebrovascular component was examined separately as well. We compared the prevalence, nature, and severity of neuropsychiatric symptoms between subgroups of patients with MCI and dementia due to AD in a cross-sectional analysis.Results: Affective and sleep-related symptoms are common in MCI and remain constant in prevalence and severity across dementia groups. Depressive symptoms as assessed by the CSDD further increase in severe dementia. Most other neuropsychiatric symptoms (such as agitation and activity disturbances) progress in parallel with severity of cognitive decline. There are no significant differences in neuropsychiatric symptoms when comparing “pure” AD to AD with a significant vascular component.Conclusion: Neuropsychiatric symptoms such as frontal lobe symptoms, psychosis, agitation, aggression, and activity disturbances increase as dementia progresses. Affective symptoms such as anxiety and depressive symptoms, however, are more frequent in MCI than mild dementia but otherwise remain stable throughout the cognitive spectrum, except for an increase in CSDD score in severe dementia. There is no difference in neuropsychiatric symptoms when comparing mixed dementia (defined here as AD + significant cerebrovascular disease) to pure AD.

Gender Differences in Neuropsychiatric Symptoms Among Community-Dwelling Mexican Americans Aged 80 and Older.

Background and ObjectivesTo assess gender differences in prevalence of neuropsychiatric symptoms (NPS) among community-dwelling Mexican Americans ≥80years. Research Design and Methods: Using data from Wave 7 (2010-2011) of the Hispanic Established Population for the Epidemiological Study of the Elderly, we analyzed the NPS of 914 participants as determined by the Neuropsychiatric Inventory (NPI) with assessments conducted by their caregivers. Multivariate logistic regression models were used to test the association of individual NPS with gender, adjusting for relevant characteristics. Results: The average age of our sample was 86.1years, and 65.3% were women. Over 60% of participants had at least one informant/caregiver reported NPS. After adjustment, women had lower odds than men of agitation/aggression but higher odds of dysphoria/depression and anxiety. Discussion: Recognizing gender differences in NPS phenotype could help guide development of culturally appropriate NPS screening and treatment programs.

Neuropsychologic changes in primary hyperparathyroidism after parathyroidectomy from a dual-institution prospective study

BackgroundThe impact of parathyroidectomy on neuropsychiatric symptoms in primary hyperparathyroidism remains poorly defined. The validated scales Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 can be used to assess depression and anxiety, respectively. Our aim was to prospectively characterize the changes in neuropsychiatric symptoms after parathyroidectomy. MethodsPatients undergoing parathyroidectomy and thyroidectomy (control) from two institutions between 2014 and 2019 were prospectively administered a questionnaire assessing neuropsychiatric symptoms before and after surgery. Paired t tests compared preoperative with postoperative neuropsychiatric symptoms and t tests compared differences in neuropsychiatric symptoms between parathyroidectomy and thyroidectomy. ResultsA total of 244 patients underwent parathyroidectomy and 161 underwent thyroidectomy. We observed improvement in neuropsychiatric symptoms after parathyroidectomy (6.2 [5.0–7.4], P < .01). Preoperatively, neuropsychiatric symptoms were more prevalent in patients undergoing parathyroidectomy when compared with thyroidectomy (11.2 ± 11.5 vs 7.5 ± 8.2, P < .01); however, after surgery there was no difference between the two groups (5.1 ± 7.1 vs 5.4 ± 7.2, P = .59). Preoperatively, 27.5% and 18.0% of patients endorsed moderate to severe depression and anxiety, which fell to 8.2% and 5.3%, respectively, (P < .01) after surgery. ConclusionPatients undergoing parathyroidectomy showed significant improvement in neuropsychiatric symptoms after surgery. Neuropsychiatric symptoms are more prevalent in patients with primary hyperparathyroidism. Neuropsychiatric symptoms should be assessed in all patients with primary hyperparathyroidism and should be considered a relative indication for parathyroidectomy.

Gender Differences in Neuropsychiatric Symptoms in Mild to Moderate Alzheimer's Disease Patients Undergoing Switch of Cholinesterase Inhibitors: A Post Hoc Analysis of the EVOLUTION Study.

Background: Alzheimer's disease (AD) is characterized by progressive cognitive decline, often associated with Behavioral and Psychological Symptoms of Dementia (BPSD). Acetylcholinesterase inhibitors (ChEi) may attenuate cognitive decline and mitigate BPSD. The EVOLUTION group found that the switch from oral ChEi to transdermal rivastigmine patch formulation resulted in improvement/stabilization in the frequency of clinically relevant BPSD, but gender-specific subgroup analyses were not reported.Methods: Participants underwent Neuropsychiatric Inventory to assess the frequency and severity of neuropsychiatric symptoms at baseline and 3 and 6 months after the switch from oral ChEi to transdermal rivastigmine patch. A descriptive post hoc analysis was conducted to assess whether there were gender-based differences in BPSD profile during the 6 months after the switch.Results: The entire sample consisted of 475 patients, 274 women and 201 men. Women were on average slightly older and with poorer cognitive performance (60.6% of the women had moderate-AD, defined as Mini-Mental State Examination [MMSE] score of 10–17, vs. 43.8% of men). In mild-AD patients (MMSE score 18–26), the frequency of BPSD did not change significantly over time and an association was found between gender and depression (odds ratio; OR [95% confidence interval; CI] female vs. male = 3.32 [1.44–7.67]), anxiety (2.42 [1.23–4.79]), apathy (2.25 [1.07–4.70]), nighttime behavior disturbances (3.97 [1.66–9.49]), and appetite/eating abnormalities (2.39 [1.10–5.18]). Moderate-AD female patients had euphoria more frequently than male patients (OR [95% CI] female vs. male = 3.67 [1.25–10.74]). The frequency of delusions, anxiety, and irritability decreased during the first 3 months after the switch, independently of gender.Conclusion: Mild-AD women tended to suffer more frequently from BPSD than men; in the 3 months after treatment switch, moderate-AD patients showed a decrease in delusions, anxiety, and irritability, with no significant differences between genders. Ad hoc studies to investigate this potential gender effect in AD could be well worthwhile.

Sex Differences in the Neuropsychiatric Symptoms of Patients With Alzheimer's Disease.

The aim of this study was to describe sex differences in neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease (AD). Baseline scores on the Cohen-Mansfield Agitation Inventory, Neurobehavioral Rating Scale-Agitation subscale, and the Neuropsychiatric Inventory from patients with AD enrolled in a multicenter trial of citalopram for the treatment of agitation were analyzed. We found not only that patients with AD having agitation were likely to exhibit many other NPSs but also that the women in this study were more likely to exhibit a broader range of NPS than were the men. These results suggest greater heterogeneity in the clinical presentation of women compared to men, and thus in the potential targets for treatment in these patients. Further characterization of sex differences in NPS can inform future efforts aimed at establishing subtypes of patients for whom various treatment approaches will be most appropriate.

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

ABSTRACTObjective: The aims of the current study are (1) to explore the differences in neuropsychiatric symptoms (NPS) between young-onset dementia (YOD) and late-onset dementia (LOD), and (2) to investigate whether the possible differences can be attributed to differences in dementia subtype, gender, psychotropic drug use (PDU), or dementia severity.Method: Three hundred and eighty-six nursing home (NH) residents with YOD and 350 with LOD were included. Multilevel modeling was used to compare NPS between the groups . Furthermore, dementia subtype, gender, PDU, and dementia severity were added to the crude multilevel models to investigate whether the possible differences in NPS could be attributed to these characteristics.Results: Higher levels of apathy were found in NH residents with YOD. After the characteristics were added to the models, also lower levels of verbally agitated behaviors were found in YOD .Conclusion: We recommend that special attention be paid to interventions targeting apathy in YOD. Although no differences in other NPS were found, the PDU rates were higher in YOD, suggesting that the threshold for the use of PDU in the management of NPS is lower. This underscores the need for appropriate attention to non-pharmacological interventions for the management of NPS in YOD.

Sleep Patterns and Neuropsychiatric Symptoms in Hospitalized Patients With Dementia.

The authors examined 28 dementia inpatients receiving treatment as usual. Beginning-to-end differences in neuropsychiatric symptoms and actigraphic sleep patterns were measured. Using a mixed-model, the authors regressed neuropsychiatric symptoms on average sleep minutes (between-subjects effect) and each night's deviation from average (within-subject effect). Sleep did not significantly differ from beginning to end of participation, whereas neuropsychiatric symptoms did. Average sleep minutes predicted average neuropsychiatric symptoms (p=0.002), but each night's deviation from the average did not predict next day's symptoms (p=0.90). These findings raise questions about the immediate benefits of treating sleep-wake disturbances on neuropsychiatric symptoms in hospitalized inpatients with dementias.