We examined whether either psychotic features (e.g., delusions and hallucinations) or EEG abnormalities are associated with more rapid progression of Alzheimer's disease (AD). AD patients with psychosis have exhibited more EEG abnormalities than those without psychosis, and both abnormal EEG and psychosis have been noted to be predictors of functional and cognitive decline in AD. Ninety-five probable AD patients participating in a longitudinal study of dementia had an EEG and a semistructured psychiatric interview at baseline. Using EEG spectral analysis, we classified records as normal/abnormal based on the parasagittal mean frequency. Patients with abnormal EEGs were more functionally (e.g., Blessed Rating Scale for activities of daily living) and cognitively (e.g., Mini-Mental State) impaired than patients with normal EEG. AD patients with psychosis were only more functionally impaired than patients without psychosis. A two-factor analysis showed no interaction between abnormal EEG and psychosis. In addition, using a Cox proportional hazard model adjusted for age and education, the presence of an abnormal EEG or psychotic symptom at study entry was associated with higher risk of reaching severe cognitive and functional impairment during follow-up. Neither abnormal EEG nor the presence of psychosis predicted death. These results indicate that both abnormal EEG and psychosis are independent predictors of disease progression but not of physical survival.
Background There is still a lack of knowledge about attitudes and cognitions that are related to bipolar disorder. Theoretically, it was proposed that exaggerated beliefs about the self, relationships, the need for excitement, and goal-related activities might lead to mania in vulnerable individuals, however, the few studies that examined this hypothesis provided mixed results. One of the unresolved issues is if such a cognitive style is associated with current mood symptoms or with different stages of the illness, i.e. at-risk versus diagnosed bipolar disorder. Therefore, the present study aimed at evaluating depression and mania-related cognitive style in individuals at-risk for mania. Method In an online survey, we collected data of 255 students of the University of Klagenfurt, Austria. All participants completed the Hypomanic Personality Scale (HPS), the Cognition Checklist for Mania – Revised (CCL-M-R), the Dysfunctional Attitude Scale (DAS), the Beck Depression Inventory (BDI), and the Internal State Scale (ISS). Results In a hierarchical regression, HPS was positively related to scores of all subscales of the CCL-M-R. The HPS did not significantly predict scores of the DAS. Current manic and depressive symptoms significantly contributed to the models. Conclusion The present results suggest that a trait-like risk for mania is associated with mania-related but not depression-related cognitions.
Reply from the Authors: We thank Claus et al. for their interesting comments regarding our article,' in which we found that abnormal spectral EEG at baseline examination was associated with cognitive and functional decline in probable AD, but not with death. They performed a similar analysis in their cohort, and found that abnormal baseline EEG was associated with cognitive and functional decline, and also with death. They felt that the discrepancy between the studies was that they followed their patients for a longer period of time and that we used an EEG composite measure (parasagittal mean frequency).We agree with Claus et al. that age is a predictor of death in AD. However, longitudinal studies that compared early versus late-onset AD have shown that early onset AD is associated with faster time to death,? although this is not a universal Other studies have found that older age (>70 years) is associated with death in AD.4 The reasons for these discrepancies are not clear, and may be due to sample characteristics, size of the cohorts, and other unidentified variables. For example, AD patients with late onset (age >65 years) have more cerebrovascular risk factors than those with an early onset,7 which may contribute to shorter survival.Comorbid medicalheurologic conditions can affect survival. All our patients had probable AD; none of them had a history of strokes or transient ischemic attacks or "silent" infarcts detected on neuroimaging studies a t the time of EEG. Furthermore, because our longitudinal study was oriented to examine AD in its "purest" form, there were strict selection criteria in terms of cerebrovascular risk factors. Patients with poor control hypertension (e.g., inadequate medical control of the medication, inadequate patient compliance) or secondary forms of hypertension with poor therapeutic response were excluded, as were those with severe uncontrolled ischemic heart disease (e.g., signs and symptoms of congestive heart failure, cardiac dysrhythmia, history of myocardial infarction within the previous 6 months). None of these patients had diabetes mellitus. Thus, these age-related health factors were less likely to affect survival in our sample.Finally, we have repeated our analysis in the same cohort. As of December 31, 1997, 51/95 (54%) patients have died, and the follow-up time is longer (mean, 4.24 ? 2.4 years; range, 0.9 to 12.3 years). Using a Cox proportional analysis adjusted by age, sex, education, severity of the symptoms of dementia (Mini-Mental State Examination), and duration of follow-up, we did not find an association between separate spectral EEG bands (as recommended by Claus et al.) at baseline and time to death. In addition, we reanalyzed composite spectral measures, including the parasagittal mean frequency, theta-beta, and the combined delta + theta percentage, and did not find an association between these parameters and survival.Abnormal EEG in AD patients appears to be a strong predictor of cognitive and functional decline. The relation between abnormal EEG and deat...
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