Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment symptoms of depression, anxiety, irritability, and euphoria

Abstract

Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.

Profile of mild behavioral impairment and factor structure of the Mild Behavioral Impairment Checklist in cognitively normal older adults

“…Further investigation with longitudinal data will be required to explore this interesting finding. The robust longitudinal data suggesting that later life emergence of depression may often be the index manifestation of dementia, sometimes misdiagnosed as major depression, support the need to disentangle "major depression" from the mood and anxiety symptoms in preclinical and prodromal dementia (Almeida et al, 2017;Ismail et al, 2018b;Singh-Manoux et al, 2017;Tapiainen et al, 2017). The major immediate implication of the EFA relates the splitting or reorganization of some of the MBI-C domains.…”

“…This question is designed to capture anhedonia, and the cross loading observed could reflect different interpretation of this question among respondents because anhedonia is a symptom of depression as well as reflecting apathy, specifically emotional apathy. There is a growing recognition of the importance of the distinction between apathy and depression as markers of dementia (Ismail et al, 2018a;Palmer et al, 2010;Sherman et al, 2018;van Dalen et al, 2018), so it is interesting that there is some loading across both affective and motivation/drive items of the MBI-C. The suggestion here is that, at least in the cognitively normal population, some refinement to the wording of this particular question may be necessary to capture this distinction in the MBI-C. Alternatively, these data raise questions as to whether or not psychiatric constructs developed for a general population, often reflecting neurodevelopmental disorders, accurately represent the emergence of neuropsychiatric symptoms in older adults.…”

“…Mild Behavioral Impairment (MBI) is a neurobehavioral syndrome, which describes a spectrum of later life emergent, sustained, but sometimes subtle NPS. MBI centers around changes in behavior or personality in the domains of decreased interest, drive and motivation (apathy) (Sherman et al, 2018), affective/emotional dysregulation (mood and anxiety symptoms) (Ismail et al, 2018a), impulse dyscontrol (agitation, aggression, abnormal reward salience), social inappropriateness (impaired social cognition) (Desmarais et al, 2018) and abnormal thoughts and perception (psychotic symptoms i.e. delusions and hallucinations) (Fischer and Agüera-Ortiz, 2018).…”

Assessing Mild Behavioral Impairment with the Mild Behavioral Impairment-Checklist in People with Mild Cognitive Impairment

“…Second, while our study is focused on the MBI-C total score, differences in prediction of cognitive impairment based on the various aggregate domain scores need to be determined. In the ISTAART-AA MBI criteria, symptoms are divided into the following domains: decreased motivation [46,47], affective dysregulation [48,49], impulse dyscontrol [4,50], social inappropriateness [51,52], and abnormal though or perception [53,54]. Just as different NPS may be associated with different types of dementias, different MBI domains may predict different MCI and dementia subtypes, which may have implications for treatment [13].…”

Depressive disorders in the elderly and dementia: An update

“…It is worth noticing that psychiatric symptoms, like depression, anxiety, euphoria and irritability can occur in patients with the established diagnosis dementia. 29…”