International Journal of Geriatric Psychiatry, 2021.
Neuropsychiatric symptoms and comorbidity: Associations with dementia progression rate in a memory clinic cohort
Objectives: Neuropsychiatric symptoms (NPS) are associated with dementia severity and progression rate. NPS clusters have different neurobiological underpinnings; therefore, their effect on dementia progression may differ. Further, little is known about whether individual comorbidities affect progression rate. We investigated the effect of NPS clusters and individual comorbidities on dementia progression.
Methods: A memory clinic cohort with all-cause dementia (N = 442), was followed for up to three years from diagnosis. Previously, we found trajectory groups of dementia progression in this cohort: one with slow progression and two with rapid progression. In the present study, using principal component analysis, three symptom clusters of NPS were on the Neuropsychiatric Inventory Questionnaire (NPI-Q): agitation, affective, and psychosis symptom clusters. Data regarding comorbidity were collected by linkage to the Norwegian patient registry. Multinomial logistic regression was applied to explore the association between NPS clusters and comorbidity with trajectory-group membership.
Results: Adjusted for demographics, dementia aetiology, comorbidity, and cognition, we found that, at the time of dementia diagnosis, for every point within the psychosis symptom cluster of the NPI-Q, the risk of rapid progression increased by 53%; for every point within the affective symptom cluster, the risk of rapid progression increased by 29%. A previous diagnosis of mental and behavioural disorders (excluding dementia) decreased the risk of rapid dementia progression by 65%.
Conclusions: Psychosis and affective symptom clusters at the time of diagnosis were associated with rapid progression of dementia. Previous diagnoses of mental and behavioural disorders (excluding dementia) were associated with slow progression. This article is protected by copyright. All rights reserved.
Frontiers in Neurology, 2021.
The Human Brain Representation of Odor Identification in Amnestic Mild Cognitive Impairment and Alzheimer’s Dementia of Mild Degree.
Background: Odor identification (OI) ability is a suggested early biomarker of Alzheimer’s disease. In this study, we investigated brain activity within the brain’s olfactory network associated with OI in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer’s dementia (mAD) to uncover the neuronal basis of this impairment.
Materials and Methods: Patients with aMCI (n = 11) or mAD (n = 6) and 28 healthy older adults underwent OI functional MRI (fMRI) at 3T, OI, odor discrimination, and cognitive tests and apolipoprotein-e4 (APOE4) genotyping. Eleven patients had cerebrospinal fluid (CSF) analyzed. Those with aMCI were followed for 2 years to examine conversion to dementia.
Results: The aMCI/mAD group performed significantly worse on all OI tests and the odor discrimination test compared to controls. The aMCI/mAD group had reduced activation in the right anterior piriform cortex compared to the controls during OI fMRI [Gaussian random field (GRF) corrected cluster threshold, p < 0.05]. This group difference remained after correcting for age, sex education, and brain parenchymal fraction. This difference in piriform activity was driven primarily by differences in odor discrimination ability and to a lesser extent by OI ability. There was no group by odor discrimination/identification score interaction on brain activity. Across both groups, only odor discrimination score was significantly associated with brain activity located to the right piriform cortex. Brain activity during OI was not associated with Mini Mental Status Examination scores. At the group level, the aMCI/mAD group activated only the anterior insula, while the control group had significant activation within all regions of the olfactory network during OI fMRI. There was no association between brain activity during OI fMRI and total beta-amyloid levels in the CSF in the aMCI/mAD group.
Conclusion: The OI impairment in aMCI/mAD patients is associated with significantly reduced activity in the piriform cortex compared to controls. Activation of downstream regions within the olfactory network is also significantly affected in the aMCI/mAD group, except the anterior insula, which is impinged late in the course of Alzheimer’s disease. OI tests thus reflect Alzheimer’s disease pathology in olfactory brain structures.
Archives of Gerontology and Geriatrics, 2020.
Cornell’s Depression for Dementia Scale: A psychometric study among Norwegian nursing home residents
Background: Depression is common among residents in long term-care facilities. Therefore, access to a valid and reliable measure of depressive symptoms among nursing home (NH) residents is highly warranted. Aim: The aim of this study was to test the psychometrical properties of the Norwegian version of the Cornell Scale for Depression in Dementia (CSDD). Methods: A sample of 309 NH residents were assessed for depressive symptoms using the CSDD in 2015-2016. Data on CSDD were missing for 64 residents, giving an effective sample of 245 (79.3%). Principal component and confirmatory factor analysis were used. Results: A five-dimensional solution yielded the best fit with the data (χ2=174.927, df=94, χ2/df=1.86, p=0.0001, RMSEA=0.058, p-value for test of close fit=0.152, CFI=0.94, TLI=0.92 and SRMR=0.056). As expected, higher depressive symptoms correlated positively with higher scores on the Minimum Data Set Depression Rating Scale (MDSDRS) and correlated negatively with Quality of life assessed with the Quality of Life in Late Stage-Dementia Scale. Limitations: The excluded residents (n=64, 20.7%) had lower cognitive function, which may limit the generalizability of the study results. Conclusion: This study suggests a five-dimensional solution of the CSDD scale. Sixteen of the 19 original items showed highly significant loadings, explaining a notable amount of the variation in the CSDD-construct. Further development and testing of a well-adapted scale assessing depression in the nursing home population with and without dementia is required.
Nordisk tidsskrift for helseforskning, 2020.
Lydhør identitetsstøtte i samtaler med personer med demens. En studie av intervjuer i en femårig narrativ forløpsstudie.
Responsive identity support in conversations with people with dementia: A study of interviews in a five-years narrative longitudinal study A narrative longitudinal study depends on trust and a positive relationship between the interviewer and the participant to encourage the participant’s continued participation. In reported studies, the methodological part is usually too short to present the complexities in dialogues over time. We therefore have analyzed the interview processes with younger people with dementia, relating the interactions to central concepts associated with identity.
The aim was to explore the methodological interview approach used in a longitudinal study, focusing on supporting identity and self-esteem. We used the concept of responsive identity to illuminate our findings. In addition, we demonstrate how the interview dialogues can support identity and self-esteem of the participants. The core of this approach is that the interviewee, living with dementia, should be seen, confirmed and supported to preserve the person`s self and dignity. Dialogue with responsive identity support is a fruitful research method in dementia research. This approach can be generalized to person-centred communication in health and caring relationships.
Human Brain Mapping, 2020.
Multimodal imaging improves brain age prediction and reveals distinct abnormalities in patients with psychiatric and neurological disorders.
Abstract: The deviation between chronological age and age predicted using brain MRI is a putative marker of overall brain health. Age prediction based on structural MRI data shows high accuracy in common brain disorders. However, brain aging is complex and heterogenous, both in terms of individual differences and the underlying biological processes. Here, we implemented a multimodal model to estimate brain age using different combinations of cortical area, thickness and sub-cortical volumes, cortical and subcortical T1/T2-weighted ratios, and cerebral blood flow (CBF) based on arterial spin labeling. For each of the 11 models we assessed the age prediction accuracy in healthy controls (HC, n = 750) and compared the obtained brain age gaps (BAGs) between age-matched subsets of HC and patients with Alzheimer’s disease (AD, n = 54), mild (MCI, n = 90) and subjective (SCI, n = 56) cognitive impairment, schizophrenia spectrum (SZ, n = 159) and bipolar disorder (BD, n = 135). We found highest age prediction accuracy in HC when integrating all modalities. Furthermore, two-group case-control classifications revealed highest accuracy for AD using global T1-weighted BAG, while MCI, SCI, BD and SZ showed strongest effects in CBF-based BAGs. Combining multiple MRI modalities improves brain age prediction and reveals distinct deviations in patients with psychiatric and neurological disorders. The multimodal BAG was most accurate in predicting age in HC, while group differences between patients and HC were often larger for BAGs based on single modalities. These findings indicate that multidimensional neuroimaging of patients may provide a brain-based mapping of overlapping and distinct pathophysiology in common disorders.
Dementia and Geriatric Cognitive Disorders Extra, 2020
Associations between Cognition and Hand Function in Older People Diagnosed with Mild Cognitive Impairment or Dementia.
Background/Aims: The aim of this study was to examine the associations between different cognitive domains and hand function in older people diagnosed with mild cognitive impairment (MCI) or dementia.
Methods: This study is cross-sectional, including 98 communityliving older people aged ≥65 years with MCI or dementia. Assessments of hand function included grip strength, the Finger Tapping Test, and the Grooved Pegboard. Cognitive assessments were the Mini-Mental State Examination, the Clock Drawing Test, and Trail Making Tests A and B, as well as a 10-word List Learning Test. Statistical analyses were based on descriptive statistics and univariable and multivariable analyses.
Results: Sixty participants were diagnosed with MCI and 38 were diagnosed with dementia. The mean age was 78.8 years (SD 7.4). Analyses of hand function, cognitive tests, and demographic factors showed an association between cognitive tests, in particular executive function (EF), and hand function.
Conclusions: The findings indicated an association between physical and cognitive function. Among the cognitive domains, declines in EF were most related to a reduced physical function.
J Appl Res Intellect Disabil, 2020
Participation in employment and day care for adults with intellectual disabilities: Equal access for all?
Background: The employment rate for people with intellectual disabilities is low. This study aims to increase the knowledge about the association between age, gender, diagnosis, functional level, educational level, and daily activities for adults with intellectual disabilities.
Method: A multinomial logistic analysis was applied to registry data on 12,735 adults
with intellectual disabilities from the Norwegian Information System for the Nursing and Care Sector (IPLOS) and Statistics Norway (SSB).
Results: Higher likelihood of employment and day care participation were associated with younger age but differed between genders and diagnoses. High functional level and lack of a registered functional level decreased the likelihood for employment. Educational level was not associated with employment.
Conclusions: The systematic differences in employment and day care participation among people with intellectual disabilities indicate that actions are needed to prevent inequalities. Improved individual assessment of personal resources and wishes might promote participation in employment and day care.
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2020
A high cerebrospinal fluid soluble TREM2 level i s associated with slow clinical progression of Alzheimer’s disease.
Introduction: The progression rate of Alzheimer’s disease (AD) varies and might be affected by the triggering receptor expressed on myeloid cells (TREM2) activity. We explored if cerebrospinal fluid (CSF) soluble TREM2 (sTREM2), a proxy of microglial activity, is associated with clinical progression rate.
Methods: Patients with clinical AD (N = 231) were followed for up to 3 years after diagnosis. Cognitively healthy controls (N = 42) were followed for 5 years. CSF sTREM2 was analyzed by enzyme‐linked immunosorbent assay. Group‐based trajectory modeling revealed distinct clinical progression groups.
Results: Higher CSF sTREM2 was associated with slow clinical progression. The slow‐ and medium‐progressing groups had higher CSF sTREM2 than the cognitively healthy, who had a similar level to patients with rapid clinical progression.
Discussion: CSF sTREM2 levels were associated with clinical progression in AD, regardless of core biomarkers. This could be useful in assessing disease development in relation to patient care and clinical trial recruitment.
Journal of Alzheimer's Disease, 2020
Vitamin D Levels, APOE Allele, and MRI Volumetry Assessed by NeuroQuant in Norwegian Adults with Cognitive Symptoms.
Background: Allele ɛ4 of the apolipoprotein (APOE∈4) gene is the strongest known genetic risk factor for late-onset sporadic Alzheimer’s disease. A possible relationship between vitamin D and APOE is not yet clear.
Objective: In this exploratory, cross-sectional study, we examined the association between serum levels of 25-hydroxyvitamin D [25(OH)D] and brain volumes and the associations of both serum levels of 25(OH)D and APOE polymorphism to brain volumes in 127 persons (mean age 66 years) with cognitive symptoms.
Methods: All subjects were examined with fully automated software for MRI volumetry, NeuroQuant.
Results: After adjustment for relevant covariates, higher serum 25(OH)D levels were associated with greater volumes of cortical gray matter on both left (p = 0.02) and right (p = 0.04) sides. When both 25(OH)D levels and APOE genotype were used as the main covariates, no significant associations were found between vitamin D level and brain volume in any of the 11 brain regions. In adjusted models, only homozygous but not heterozygous APOE∈4 allele carriers had significantly larger inferior lateral ventricles (p = 0.003) and smaller hippocampal volume (p = 0.035) than those without ɛ4. Homozygous APOE∈4 carriers also had significantly higher vitamin D levels (p = 0.009) compared to persons without the APOE∈4 allele.
Conclusion: Higher vitamin D levels might have a preserving effect on cortical grey matter volume.
International Psychogeriatrics, 2020
COVID-19 pandemic: a multinational report providing professional experiences in the management of mental health of elderly.
There is a huge amount of information on SARS-CoV-2 (COVID-19), but its influence on mental health is still lacking. Although all age groups are at risk of contracting COVID-19, older people face significant risk of developing severe illness (Kluge, Reference Kluge2020). The old age is an independent factor for the COVID-19-related death (RR = 9.45) (Zhao et al., Reference Zhao2020). This pandemic might affect this population’s mental health. Retrospective studies of the Severe Acute Respiratory Syndrome epidemic demonstrated that suicide rates raised among elderly during this period (Kluge, Reference Kluge2020). This data emphasize the urgency of studying COVID-19 mental health impact in real time, since it has brought consequences such as psychological suffering, fear, depression and anxiety (Courtin and Knapp, Reference Courtin and Knapp2017; Fiorillo and Gorwood, Reference Fiorillo and Gorwood2020).
Researchers and health professionals from Brazil, Norway and Portugal documented their health professional experiences facing this novel pandemic to advise health services. These countries were selected due to their position in the worldwide ranking on the 2019 Human Development (HD) Report (http://www.hdr.undp.org/en/2019-report). HD classifies countries according to indices such as economic and gender inequality, health, education, dignity and respect for human rights. Among the 100 countries in that report, Norway (1st), Portugal (40th) and Brazil (75th) are top, middle and bottom listed, respectively. Could the differences between these countries counteract the assistance to elderly in the COVID-19 pandemic age? This report aims to provide an overview of each country’s response from the authors’ perspective based on their informal interviews with a multidisciplinary health professional range.