Emotional Disturbance in CADASIL: Its Impact on Quality of Life and Caregiver Burden

Abstract

Background and Purpose: Recurrent strokes and cognitive dysfunction are the major symptoms of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, emotional disturbances in CADASIL patients are incompletely understood. The aim of this study was to investigate emotional disturbances in CADASIL and their impact on the patients' quality of life (QOL) and caregiver burden. Methods: From 54 patients who were diagnosed as CADASIL between January 2000 and August 2012 in the Asan Medical Center, Seoul, Korea, 23 patients were enrolled in this study. The Montgomery-Asberg Depression Rating Scale was used for the assessment of depressive emotional disturbances (DED). For nondepressive emotional disturbances (NDED), the criteria of Kim and Choi-Kwon [Neurology 2000;54:1805-1810] were used for emotional incontinence (excessive/inappropriate expression of laughing or crying), and the modified Spielberger Trait Anger Scale was used for anger proneness (excessive/inappropriate expression of anger). Patients' QOL and caregiver burden were assessed with stroke-specific emotional QOL and the Sense of Competence Questionnaire (SCQ), respectively. Functional disability was assessed by the modified Rankin scale (mRS), and white matter ischemic changes and microbleeds were analyzed using brain magnetic resonance images. Results: Twelve patients (52.2%) had various emotional disturbances including DED (n = 10, 43.5%) and NDED (n = 7, 30.4%). The presence of any emotional disturbances was associated with thalamic (p = 0.012) and cortical (p = 0.037) microbleeds, mRS (p = 0.001), cognitive impairment (p = 0.002), patients' low QOL (p = 0.009) and increased caregiver burden (p = 0.002). DED was associated with multiple (≥10) microbleeds (p = 0.039), cognitive impairment (p = 0.030) and mRS (p = 0.030), and negatively influenced all domains of patients' QOL and caregiver burden. NDED was associated with cortical microbleeds (p = 0.017) and mRS (p = 0.014). Unlike DED, NDED was not associated with patients' poor QOL, except for thinking domain, but was significantly related to total SCQ and subscales 1 and 2 of SCQ (p = 0.012). Conclusions: More than half the CADASIL patients had emotional disturbances, either DED or NDED. Both are associated with patients' poor QOL and increased caregiver burden, the former more markedly than the latter. Considering that CADASIL is a progressive disease with deteriorating patients' QOL, physicians have to pay more attention to emotional problems in CADASIL patients. Treatment strategies should be investigated in this regard to improve patients' QOL and reduce caregiver burden.

Location, number and factors associated with cerebral microbleeds in an Italian-British cohort of CADASIL patients

“…Third, this is the first study to investigate the relationship of considerable number of clinical variables with CMB in CADASIL patients. In the literature, only data about cognitive profile and some psychiatric disturbances are reported [ 23 , 28 , 31 , 32 ], but data are missing about many other clinical features typical of CADASIL. Fourth, our sample is composed of patients from different countries and this could make our results more generalizable to the CADASIL patient community.…”

Association Between Cerebral Microbleeds and Depression in the General Elderly Population: A Meta-Analysis

“…It is thus unclear if the presence of CMBs is the independent predictor or rather severity of CSVD overall. In a special population of CADASIL, Park et al demonstrated that leukoaraiosis, not CMBs, is closely associated with depression ( 23 ), while Noh et al found depressive emotional disturbances was associated with multiple (≥10) CMBs, but not leukoaraiosis ( 24 ). Only a few studies adjusted the severity of leukoaraiosis in multivariate regression analyses ( 4 , 13 , 15 ).…”

Post-stroke Mood and Emotional Disturbances: Pharmacological Therapy Based on Mechanisms

“…Patients with PSF are more often unemployed, change their jobs [ 12 , 13 ], and fail to return to previous jobs [ 13 - 16 ] than those without PSF. Although the overall negative impacts of PSEI and PSAP are less marked than those of PSD, they still lead to distress and embarrassment, impair certain domains of patients’ quality of life, and increase caregiver burden [ 17 ].…”