Neuropsychiatric Assessment Research Articles

Neurotheology: Insights on the relationship between the brain and religion through the Life and Ministry of St. Paul the Apostle

Can we see God? No, we can't. But can we see His presence in the brain? The answer is perplexing. It is said that generally, anything that affects, must be there to cause this effect, and this is the main purpose of Neurotheology: finding God within the brain cells and understanding how religiosity and spirituality affect the brain. As well as understanding what is the kind of relationship between both of them on the neurobiological and neuropsychiatric scale aided by the modern advances in neurobiological investigations and neuropsychiatric assessments.

The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy.

ObjectiveCurrent nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL). MethodsCommunity survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL. ResultsIn the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5–2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9–24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00. ConclusionOne out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.

Long-term neurobehavioral correlates of brain cortical microinfarcts in a memory clinic cohort in Singapore.

Cortical cerebral microinfarcts are a small vessel disease biomarker underlying cognitive impairment and dementia. However, it is unknown whether cortical cerebral microinfarcts are associated with neuropsychiatric disturbances, and whether its effects are independent of conventional small vessel disease markers. We investigated the associations of cortical cerebral microinfarcts burden with incidence and progression of neuropsychiatric subsyndromes in a memory clinic cohort of elderly in Singapore. In this prospective cohort, 496 subjects underwent detailed neuropsychological and clinical assessments, 3T brain MRI, and Neuropsychiatric Inventory assessment at baseline and two years later. Cortical cerebral microinfarcts and other small vessel disease markers, including white matter hyperintensities, lacunes, and microbleeds, were graded according to established criteria. Neuropsychiatric symptoms (NPS) were clustered into subsyndromes of hyperactivity, psychosis, affective, and apathy following prior findings. Functional decline was determined using the clinical dementia rating (CDR) scale. The presence of multiple cortical cerebral microinfarcts (≥2) was associated with higher total NPS scores (β = 4.19, 95% CI = 2.81-5.58, p < 0.001), particularly hyperactivity (β = 2.01, 95% CI = 1.30-2.71, p < 0.01) and apathy (β = 1.42, 95% CI = 0.65-2.18, p < 0.01) at baseline. Between baseline and year-2, multiple cortical cerebral microinfarcts were associated with accelerated progression in total NPS scores (β = 0.29, 95% CI = 0.06-0.53, p = 0.015), driven by hyperactivity (β = 0.45, 95% CI = 0.17-0.72, p < 0.01). Subjects with multiple cortical cerebral microinfarcts also had a faster functional decline, as measured with the CDR-sum-of-boxes scores, when accompanied with progression (β = 0.31, 95% CI = 0.11-0.51, p < 0.01) or hyperactivity in total NPS (β = 0.34, 95% CI = 0.13-0.56, p < 0.01). Cortical cerebral microinfarcts are associated with incidence and progression of geriatric neurobehavioral disturbances, independent of conventional small vessel disease markers. The impact of incident cortical cerebral microinfarcts on neurocognitive and neuropsychiatric trajectories warrants further investigations.

Maintaining therapeutic continuity in adolescent psychiatric day hospital programs during the COVID-19 lockdown

IntroductionThe COVID-19 social lockdown imposed important limitation to non-emergency health care services in Italy, between March and May 2020, with many difficulties in the mental health assistance of those chronic conditions needing a continuative therapeutic support.ObjectivesOur study aimed to describe how therapeutic activities have been carried on by remote services in two Adolescent Psychiatric Day Hospital Units (Rome and Turin) and the outcome of these assistance interventions in youths with subacute psychopathology.MethodsThe patient cohort includes 162 adolescents (12-19 years old; QI&gt;70) DH outpatients presenting a complete clinical and neuropsychiatric assessment before the lockdown. During the several phases of COVID-19 quarantine all patients were monitored and supported by telemedicine interventions. All data were recorded and standardized every 15 days: symptom severity was rated by global severity (CGI-S) and stress level by self-reported measures of stress (IES-R).ResultsAmong patients, CGI score remained stable, IES-R score declined over time: higher IES-R score was significantly associated with female gender and but no differences was observed related with the primary diagnosis. 5 patients presented a clinical acute state needing a hospitalization. The rate of hospitalization was not significantly different compared with the rate observed in the same period of 2019.ConclusionsIn youth with psychopathological conditions, remote assistance for psychiatric cares resulted effective and it was associated with a clinical stability with decreasing stress levels.DisclosureNo significant relationships.

How to reduce the number of children awaiting the diagnosis of intellectual disability in Brazil?

IntroductionIn Brazil there is high number of children with Intellectual Disability (ID) who begin basic education but did not receive a diagnosis. The basic education teachers can be important agents in identifying signs of ID in the student so that they can be referred to health services.ObjectivesTo develop and implement a decision-making model for basic education teachers to identify students with predictive signs of ID.MethodsThe sample was composed by 51 teachers from 20 public schools and their 1758 students eligible for the study enrolled in a educational network in São Paulo state, Brazil. A standardized model was developed for the evaluation process using an open-source software named BONITA. For the screening of students with ID signs the teachers answered a checklist based on the diagnostic criteria of the DSM-5 and the students were evaluated with neuropsychological test WASI (Wechsler Abbreviated Scale of Intelligence) and neuropsychiatric assessment. A Classification Based on Association Rules (CBA) generated the predictive models of sensitivity for confirming ID from the items in the checklists.Results35 children had suspected ID. The CBA showed an accuracy of 82%, identifying only 1 false-negative case and 3 false-positive cases for ID. According to the teachers, the most accurate signs were deficits in abstract thinking skills, deficits in communication and conversation and difficulties in emotional regulation in social interactions.ConclusionsThe decision-making model by elementary school teachers to identify students with ID showed high levels of sensitivity and can help the waiting for diagnosis.DisclosureNo significant relationships.

Prevalence and 1-year incidence of HIV-associated neurocognitive disorder (HAND) in adults aged ≥50 years attending standard HIV clinical care in Kilimanjaro, Tanzania.

HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities. Longitudinal study. A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March-May 2016 and followed up March-May 2017. HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records. In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9-53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0-28.6 n = 16) was observed. HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.

Neural Effects of Hearing Loss and Hearing Aids in Late-Life Depression

<h3>Introduction</h3> Age-related hearing loss (ARHL) has been associated with the development of late-life depression (LLD). However, no prospective, randomized controlled trial of hearing treatment for individuals with ARHL/LLD incorporating comprehensive neuropsychiatric assessments and multimodal neuroimaging has been performed previously. <h3>Methods</h3> Double-blind randomized controlled trial of hearing aids for individuals aged ≥60 years with a depressive disorder and at least moderate hearing loss (as defined by Pure Tone Average > 50dB). Participants are randomized to full-amplitude hearing aids or low-amplitude (i.e., sham) hearing aids for 12-weeks as an augmentation to antidepressant medications. Primary outcomes include depressive symptoms (Hamilton Rating Scale for Depression [HRSD]), hearing status (Hearing Handicap Inventory for the Elderly [HHIE]), cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]), and social functioning (Social Adjustment Scale - Self Report [SAS-SR]), as well as connectivity/activation within the cognitive control network on a response inhibition/interference (Simon) task. <h3>Results</h3> As the study is ongoing, data is reported for the combined sample (full- and low-amplitude groups) to preserve blinding. However, the between group analyses will be available for presentation at the AAGP Annual Meeting. Over the 12 weeks, significant improvements have been observed on HHIE and HRSD scores (-6.9, ES=0.7, p=0.01 and -7.0, ES=1.4, p=0.002; respectively), SAS-SR (+0.27, ES=0.7, p=0.003), immediate (+9.2, ES=0.6, p=0.005) and delayed memory (+4.4, ES=0.3, p=0.006). Behavioral data for N=13 participants completing the Simon task show significantly slower reaction times (RT, 772.3 vs. 701.6ms, p<0.001) and lower accuracy (92.7 vs. 95.8%, p=0.015) on incongruent vs. congruent trials. Significant task-related activations on this contrast are present in the basal ganglia, dorsolateral prefrontal cortex, and supramarginal gyrus (voxelwise p<0.01, cluster size > 100). <h3>Conclusions</h3> Combination therapy of hearing aids and antidepressant medications may result in improvement in depressive symptoms, cognition, and social functioning among individuals with ARHL and LLD. Further studies are needed to evaluate if hearing remediation can reverse the neuroplastic changes associated with chronic ARHL. <h3>Funding</h3> 5T32MH020004-22: Research Training in Late-Life Neuropsychiatric Disorders

Behavioral and Clinical Characteristics and Outcomes of Treatment Among Older Patients Receiving Medical Care for HIV Infection in Iran

Background: Although the number of new HIV infections continues to decline in Iran, the number of HIV-infected patients aged ≥50 years continues to rise due to the introduction of new treatment and longer survival. The higher prevalence of medical comorbidities and treatment failure in this population is a critical challenge in HIV treatment. In the present study, prevalence of comorbidities, rate of response to treatment, and results of HIV drug resistance tests were explored in older patients. Methods: A cross-sectional study was conducted at a tertiary referral HIV center in Tehran, Iran. The data for all the HIV-positive patients older than 50 years old were collected by reviewing their medical records within the last 15 years. Data included demographic and behavioral characteristics, immunologic and virologic response, rate of treatment failure, and HIV resistance. Results: The records for 100 patients with a mean age of 62.5 (range 50-79) years were reviewed and analyzed. Medical comorbidities were observed in 20% of the patients, with HCV co-infection, diabetes mellitus, and neuropsychiatric impairments being the most common. Complete immunologic and virologic responses were respectively observed in 88 and 97% of patients. The treatment regimen was modified in 66 patients, with drug side effects being the reason in 63 patients (95.4%). HIV drug resistance tests showed a low rate of resistance (&lt;10%) to all drugs used in this population. Conclusion: Our findings highlight the high prevalence of comorbidities in older HIV-positive individuals in Iran. A thorough endocrine and neuropsychiatric assessment at each visit is recommended for these patients. Access to an appropriate psychosocial support system will ensure earlier detection of HIV infection and comorbidities in the older population, and will undoubtedly improve the treatment outcome and quality of life among them.

Psychiatric symptoms are the strongest predictors of quality of life in patients with drug-resistant epilepsy or psychogenic nonepileptic seizures

ObjectiveThis cross-sectional study aimed to determine the effect of psychiatric comorbidity and neurocognitive deficits on the quality of life in a cohort of patients admitted for Video-EEG Monitoring (VEM) for investigation into a presumed seizure disorder. MethodsPatients were recruited from an inpatient VEM unit between January 2009 and December 2016. All patients had formal neuropsychiatric assessment. All patients completed questionnaires assessing psychiatric symptomatology (SCL-90-R), Anxiety and Depression (HADS), quality of life (QOLIE-89), and cognition (NUCOG). ResultsA total of 451 patients were enrolled. Upon discharge, 204 patients were diagnosed to have epilepsy, 118 psychogenic nonepileptic seizures (PNES), and 29 both epilepsy and PNES, while the diagnosis was uncertain diagnosis in 100. Diagnosis (p = .002), HADS Depression score (p < .001), SCL-90-R positive symptoms total (p < .001), and NUCOG total score (p < .001) were found to be significant predictors of QOLIE-89 total scores, together explaining 65.4% of variance in quality of life. Seizure frequency was not a significant predictor of quality of life (p = .082). Patients with PNES had significantly worse quality of life, and scored higher on measures of psychiatricsymptomatology, compared to patients with epilepsy alone. The prevalence of psychiatric comorbidity was significantly higher in patients with PNES (70.3%) or both PNES and epilepsy (62.1%) compared to patients with epilepsy alone (41.2%) (p < .001). SignificancePsychiatric symptomatology, depression, and cognition were stronger determinants of quality of life than seizure frequency in this study population of patients with drug-resistant epilepsy and PNES. Patients with PNES with or without comorbid epilepsy had similar neuropsychiatric profiles.

Neural links between facial emotion recognition and cognitive impairment in presbycusis.

Facial emotion recognition (FER) is impaired in people with dementia and with severe to profound hearing loss, probably reflecting common neural changes. Here, we aim to study the association between brain structures and FER impairment in mild to moderate age-related hearing loss participants. We evaluated FER in a cross-sectional cohort of 111 Chilean nondemented elderly participants. They were assessed for FER in seven different categories using 35 facial stimuli. We collected pure-tone average (PTA) audiometric thresholds, cognitive and neuropsychiatric assessments, and morphometric brain imaging using a 3-Tesla MRI. According to PTA threshold levels, participants were classified as controls (≤25dB, n=56) or presbycusis (>25dB, n=55), with an average PTA of 17.08±4.8dB HL and 36.27±9.5dB HL respectively. Poorer total FER score was correlated with worse hearing thresholds (r=-0.23, p<0.05) in participants with presbycusis. Multiple regression models explained 57 % of the variability of FER in presbycusis and 10% in controls. In both groups, the main determinant of FER was cognitive performance. In the brain structure of presbycusis participants, FER was correlated with the atrophy of the right insula, right hippocampus, bilateral cingulate cortex and multiple areas of the temporal cortex. In controls, FER was only associated with bilateral middle temporal cortex volume. FER impairment in presbycusis is distinctively associated with atrophy of neural structures engaged in the perceptual and conceptual level of face emotion processing.

Total Plasma Homocysteine and Depressive Symptoms in Older Hispanics.

Very few studies have investigated the association between total plasma homocysteine (tHcy) and depressive symptoms in older Hispanics. To test the hypothesis that high tHcy associates with depressive symptoms in older Hispanics. A total of 1,418 participants .55 years old from the Maracaibo Aging Study (MAS) underwent standardized neurological, neuropsychiatric, and cardiovascular assessments. The Neuropsychiatric Inventory Depression Subscale (NPId) was used to assess the burden of depressive symptoms. The tHcy levels and other biochemical parameters in blood samples were measured. Univariate and multivariate logistic regression models were applied. Participants with depressive symptoms had higher levels of tHcy than those without (15.1 versus 13.9 µmol/L; p = 0.009). Elevated tHcy levels were associated with depressive symptoms after adjusting for age, sex, education, smoking, diabetes, hypertension, alcohol intake, stroke, and dementia (OR = 1.58; 95% CI, 1.18-2.12). Elevated levels of tHcy were associated with depressive symptoms in older Hispanics living under the nutritional and environmental conditions of a developing country.

Neuropsychiatric Symptoms Assessment: Cross-cultural Adaptation and Validation of the Portuguese Abe’s BPSD Score (ABS)

ABSTRACT Objectives This study aims to report on the development and psychometric properties of the Portuguese-language Abe’s BPSD score (ABS) to screen for neuropsychiatric symptoms (NPS). Methods ISPOR and COSMIN recommendations were followed to translate and culturally adapt the ABS. A validation study was conducted to assess the psychometric properties of the newly-translated instrument. Outpatients attending a psychogeriatric consultation were included by consecutive referrals and were assessed with the ABS, the Neuropsychiatric Inventory (NPI) and NPI Caregiver Distress scale (NPI-D), and the Mini-Mental State Examination (MMSE). The ABS reliability (internal consistency, item-total correlations, inter-rater and test-retest reliability), validity (concurrent and convergent), feasibility and diagnostic accuracy were examined. Results Overall, 107 participants were included. The ABS Cronbach alpha was 0.672, and item-total correlations ranged from −0.056 to 0.546. Strong inter-rater (ICC 0.997; 95%CI: 0.995–0.999) and test-retest reliability (ICC 0.976; 95%CI: 0.958–0.986) were found. Concurrent validity with NPI was high (rs = 0.847, p < .001), and correlations with MMSE and NPI-D were also significant. An exploratory threshold score ≥2 is proposed to identify clinically relevant NPS. Conclusions Data provide satisfactory proof of ABS psychometric characteristics. Nevertheless, some items exhibited less optimal properties. Clinical Implications The newly-translated instrument proved to be relevant, valid and easy to use in a real geriatric clinical setting.

The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews

BackgroundGeneralized anxiety disorder (GAD) is one of the most reported diagnoses in psychiatry, but there is some discrepancy between the cases identified in community studies and those identified in tertiary care. This study set out to evaluate whether the use of clinicians as interviewers may provide estimates in a community survey close to those observed in primary or specialized care.MethodsThis is a community survey on a randomly selected sample of 2338 adult subjects. The Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) was administered by clinicians, providing lifetime diagnosis based on the DSM-IV-TR. Health-related quality of life (HR-QoL) was measured with the Short-Form Health Survey (SF-12).ResultsOverall, 55 (2.3%) subjects met the criteria for GAD, with greater prevalence in women (3.6%) than in men (0.9%): OR = 4.02; 95%CI: 1.96–8.26. Up to 40% of those with GAD had at least another diagnosis of mood, anxiety, or eating disorders. The mean score of SF-12 in people with GAD was 32.33 ± 6.8, with a higher attributable burden than in other conditions except for major depressive disorder.ConclusionsWe found a relatively lower lifetime prevalence of GAD than in community surveys based on lay interviewers and a structured interview. The identified cases of GAD showed a strong impact on the quality of life regardless of co-morbidity and high risk in women, suggesting a profile similar to the one identified from studies in primary and specialized care.

The Role of Cilostazol and Inflammation in Cognitive Impairment After Ischemic Stroke.

The aim of this study is to examine the potential effect of cilostazol and inflammation on cognitive impairment after stroke in an Asian population. Forty-five patients with cognitive impairment after ischemic stroke using cilostazol were enrolled as the study group and 45 patients using aspirin or clopidogrel were enrolled as the control group. Neuropsychiatric assessments were administered at the start of the study and after 6 months. Multiple logistic regression analysis was used to estimate the association between the cognitive change and cilostazol use. Macrophage polarization were assessed using flow cytometry in 7 patients. There were a significantly higher number of patients with peripheral arterial occlusive disease in the cilostazol group. No significant differences were observed in the cognitive change between the cilostazol and control groups. M1 macrophage subset increment were observed in the patient having a declined cognitive change. Cilostazol did not make a significant difference in cognitive change after ischemic stroke. M1 macrophage subset increment may indicate post stroke cognitive decline. Due to limited number of subjects, these findings should be examined further in large-scale randomized clinical trials.

Associations between APOE-, COMT Val108/158Met- and BDNF Val66Met polymorphisms and variations in depressive and anxiety symptoms, sense of coherence and vital exhaustion in the real-life setting of mandatory basic military training.

Apolipoprotein E (APOE) ε, catechol-O-methytranferase (COMT) Val108/158Met and brain-derived neurotrophic factor (BDNF) Val66Met single nucleotide polymorphisms (SNPs) were shown to affect stress perception and response. The present study explored possible associations between these SNPs and changes in subclinical anxiety- and depressive symptoms, sense of coherence (SOC) and vital exhaustion (VE) during compulsory basic military training. The study encompassed 179 conscripts of a training base in Greece. The neuropsychiatric assessment was based on the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Antonovsky SOC scale and the Maastricht Questionnaire. It was conducted at three time points of the 19-day basic military training: on day one (baseline), day six (follow-up I) and day 13 (follow-up II). Statistical analyses included Mann-Whitney test, Chi-square test and cross-sectional time series regression models based on the Skillings-Mack statistic. APOE ε4 non-carriers encountered significant changes in anxiety- and depressive symptoms and SOC (in all cases P < 0.001) over the observation period, whilst ε4 carriers did not. The changes in anxiety, depressive symptoms and SOC attained statistical significance in both BDNF Met66 carriers (in all cases P < 0.001) and non-carriers (P = 0.036; < 0.001; < 0.001, respectively) as well as in COMT Met108/158 carriers (P = 0.004; < 0.001; < 0.001, respectively) and non-carriers (P = 0.02; 0.01; 0.021, respectively. Changes over time in VE were not significant (P > 0.05). The observed resistance of APOE ε4 carriers vs non-carriers to changes in anxiety- and depressive symptoms and SOC when exposed to a stressful environment may point to superior coping capacities of healthy young men carrying the ε4 allele.

Electroencephalogram abnormalities in children have rotated error on block design performance: An university hospital child and adolescent psychiatry clinic sample.

Neuropsychiatric assessment is essential part of child and adolescent psychiatry clinic practice, also provides important information about central nervous system dysfunctions. In studies conducted to date, it has been known that both the high frequency of psychiatric comorbidity in epileptic patients and that epilepsy comorbidity is quite common in neurodevelopmental disorders. In fact, considering the high comorbidity of epileptic abnormalities and psychiatric disorders, it has been very important to determine predictors for epileptic abnormalities in a clinical sample of child and adolescent psychiatry. In this retrospective study, we aim to determine possible predictive factors for epileptic abnormalities in a clinical sample of child and adolescent psychiatry according to Weschler Intelligence Scale for Children (WISC-R) results. We identified patients who had two or more rotation errors in the block design subtest of WISC-R by retrospectively scanning the system records of 2609 cases who were applied WISC-R with different prediagnoses at Gazi University Child and Adolescent Psychiatry Outpatient Clinic between January 2013 and December 2020 (n=71). After the first step identification, we selected the ones who had a previous electroencephalography (EEG) recording available for our own re-review (n=60). We found 15% EEG abnormalities and ADHD is the most common diagnosis in both normal and abnormal EEG groups. Due to correlation analysis, there was a positive-mild correlation between presence of EEG abnormality and WISC-R performance (r=0.56) in intellectual disability (ID) group and a positive-strong correlation between presence of EEG abnormality and WISC-R performance-verbal scores (r=0.74) in ID group. This study has shown that many different abnormal EEG patterns can be found in patients who have rotation errors in the block design test of WISC-R, suggesting diagnoses of ID, and having notable performance-verbal subtests scores difference and rotation errors in the block design subtest of WISC-R should be predicitive factors for epileptic abnormalities.

Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study.

Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.

Neuropsychiatric adverse drug reactions induced by montelukast impair the quality of life in children with asthma

Introduction Montelukast-induced neuropsychiatric adverse drug reactions (ADRs) have been reported in retrospective studies. This study aimed to reveal the neuropsychiatric ADRs triggered in patients taking montelukast due to asthma in real time, and to evaluate the effect of these ADRs on quality of life (QoL). Methods Patients, ages 3–18 years, taking montelukast for the first time and their parents were included. Ages 3–7 years were defined as the preschool and ages 8–18 years as the school-age group. At the beginning of the study and at the end of the second week of treatment, the neuropsychiatric complaint assessment questionnaire and the KINDL QoL scale were administered to patients and their parents. The effect of ADRs on the decrease in QoL was evaluated by multivariable logistic regression. Results Neuropsychiatric ADRs were reported in 78 (62.4%) of 125 patients, who recovered when the drug was discontinued. Temperamental behavior, nightmares and sleep disorders occurred significantly more often in both groups compared with pretreatment (p < 0.001 for each). In both groups, except in the child-reported family relationships subscale in the school-age group, significant decreases were found in both child and parent proxy-reported QoL total/sub-scores compared with pretreatment (p˂0.001 for each). It was found in the evaluation that the overall QoL of those experiencing ADRs in both age groups was more affected. (Child-reported QoL ORpreschool age=2.66, p = 0.048; ORschool-age=5.95, p = 0.027; parent-proxy QoL ORpreschool age =3.52, p = 0.010, ORschool-age=6.43, p = 0.027) Conclusions Montelukast-induced neuropsychiatric ADRs are more frequent than reported in the literature and negatively impact children’s QoL.

Hyperbaric oxygen ameliorates cognitive impairment in patients with Alzheimer’s disease and amnestic mild cognitive impairment

AbstractBackgroundIt is reported that environmental factors such as hypoxia could contribute to the pathogenesis of Alzheimer’s disease (AD). Therapeutics like hyperbaric oxygen treatment which improves tissue oxygen supply and ameliorates hypoxic conditions in the brain may be a strategy for AD and amnestic mild cognitive impairment (aMCI) treatment. The present work aims to investigate the potential therapeutic effect of hyperbaric oxygen treatment in patients with AD and aMCI.MethodWe included 42 AD and 11 aMCI patients in this study. All participants were continuously treated with hyperbaric oxygen treatment once daily for 20 days and assessed by neuropsychiatric assessments before and at 1, 3, and 6 months after the hyperbaric oxygen treatment. We also applied fluorodeoxyglucose positron emission tomography (FDG‐PET) in some of the patients.ResultHyperbaric oxygen treatment could improve the global cognitive functions, especially visuospatial and executive functions, language and abstract thinking abilities at 1 month after treatment in AD patients and improved the memory of aMCI patients in 1, 3, and 6 months after treatment. The ADL scores were improved in 1, 3, and 6 months after treatment in AD patients. Hyperbaric oxygen treatment also ameliorated the reduced brain glucose metabolism in AD and aMCI patients.ConclusionBased on the previous studies and our recent findings, hyperbaric oxygen treatment may be a potential therapeutic and preventive strategy for AD and aMCI.

A panel of blood lipids associated with cognitive performance, brain atrophy and diagnosis: A longitudinal study of elders without dementia

AbstractBackgroundBlood metabolites have been suggested as promising biomarkers of Alzheimer’s disease. Identifying diagnostic and predictive lipids can provide new spots in worse cognitive decline fields.MethodTotal 579 plasma lipid signatures were sampled in 374 participants without dementia at baseline enrolled in the Alzheimer’s Disease Neuroimaging Initiative cohort over 10 years. Ten‐fold cross‐validated least absolute shrinkage and selection operator‐logistic regression selected a subset of lipids that best classified individuals with worse slopes of cognitive decline determined by linear mixed models. Multivariable adjusted model examined associations between lipids and neuropsychiatric assessments, CSF biomarkers, brain structural measures and diagnostic categories.ResultIn a training and a validation set, a panel of seventeen lipids classified cognitively declined individuals with favorable prediction (training set: area under curve [AUC]=0.768, 95% confidence interval [CI]=0.715‐0.821; validation set: AUC =0.747, 95%CI= 0.627‐0.867) and calibration efficacy (Hosmer‐Lemeshow test: p&gt;0.05). Adding risk score to the predictive model yielded a better AUC of 0.779 (95%CI=0.712‐0.845) than the one with clinical variables alone (p=0.014). The model combining polygenic hazard score, lipid signature and clinical variables yielded the best improvement in prediction. Baseline lipid signatures consisting of all selected lipids independently predicted declined cognition and positively associated with baseline cognitive performance (p=0.007) and cerebrospinal tau protein changes (p‐tau, p=0.025; t‐tau, p=0.010). Longitudinal analyses showed lipid signatures had adverse impacts on cognitive performance and brain atrophy over 10 years, and predicted diverse diagnostic categories (case vs. control, stable mild cognitive impairment [MCI] vs. cognitively normal [CN], progressive MCI vs.CN, A+[positive β‐amyloid deposition] vs. A‐[negative β‐amyloid deposition] , A+T+ [positive tau pathology] vs. A‐T‐[negative tau pathology]) and a trend for progressive outcomes.ConclusionA comprehensive panel of peripheral lipids instead of individual lipid molecule could better diagnose and predict cognitive decline. Further, integrating genetic variations, proteins and other biological information in future may expand the fit of exited detect models.