Importance of Lack of Interest in Patients With Mild Cognitive Impairment

Robert, Philippe; Berr, Claudine; Volteau, Magali; Bertogliati-Fileau, Christelle; Benoît, Michel; Guérin, Olivier; Sarazin, Marie; Legrain, S.; Dubois, Bruno

doi:10.1097/jgp.0b013e31817e73db

Cited by 89 publications

(88 citation statements)

References 30 publications

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“…We found a sevenfold increased risk of AD progression in amnestic-MCI patients with a diagnosis of Apathy, in line with previous findings [12][13][14]. One study [14] reported an increased two-year dementia risk in MCI patients with Apathy.…”

Section: Discussionsupporting

confidence: 92%

“…Symptoms of anxiety [9] can predict which MCI patients will develop dementia, and some studies [10] report an increased AD risk in MCI patients with depression, whereas others [9,11] report no increased risk. Recent evidence suggests that apathy increases the risk of conversion from cognitive impairment to dementia [12][13][14], but the interpretation of these findings is hampered by short follow-ups (one/two years) [12,14], the outcome of all dementia types, and the MCI criteria applied; one study used the Mini-Mental State Examination (MMSE) based definition [12,13] and another included all MCI subtypes [14]. Thus, there is a need for studies investigating the role of apathy and depression on the development specifically of AD, with longer follow-up periods, and an extensive clinical diagnosis of the amnestic form of MCI.…”

Section: Introductionmentioning

confidence: 99%

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Neuropsychiatric Predictors of Progression from Amnestic-Mild Cognitive Impairment to Alzheimer's Disease: The Role of Depression and Apathy

Palmer

Iulio

Varsi

et al. 2010

JAD

256

216

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Abstract. The aim of the study is to evaluate whether depression or apathy in patients with amnestic-mild cognitive impairment (MCI) increases the risk of progressing to Alzheimer's disease (AD). We investigated 131 consecutive memory-clinic outpatients with newly-diagnosed amnestic-MCI (mean age 70.8, SD = 6.5). Psychiatric disorders were diagnosed at baseline according to the criteria for depression and apathy in AD. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory (NPI). Follow-up examinations were conducted after six months and annually for four years. Neurologists diagnosed AD at follow-up using NINCDS-ADRDA criteria. Cox proportional hazard models with 95% confidence intervals were used to test the hypothesis that apathy or depression increases the risk of developing AD. At baseline, 36.6% amnestic-MCI patients had a diagnosis of depression and 10.7% had apathy. Patients with both amnestic-MCI and an apathy diagnosis had an almost sevenfold risk of AD progression compared to amnestic-MCI patients without apathy (HR = 6.9; 2.3-20.6), after adjustment for age, gender, education, baseline global cognitive and functional status, and depression. Furthermore, the risk of developing AD increased 30% per point on the NPI apathy item (HR = 1.3; 1.1-1.4). There was no increased risk of developing AD in amnestic-MCI patients with either a diagnosis or symptoms of depression. In conclusion, apathy, but not depression, predicts which patients with amnestic-MCI will progress to AD. Thus, apathy has an important impact on amnestic-MCI and should be considered a mixed cognitive/psychiatric disturbance related to ongoing AD neurodegeneration.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric Predictors of Progression from Amnestic-Mild Cognitive Impairment to Alzheimer's Disease: The Role of Depression and Apathy

Palmer

Iulio

Varsi

et al. 2010

JAD

256

216

View full text Add to dashboard Cite

show abstract

“…Apathy is the most frequent and severe behavioral symptom in both MCI [1] and Alzheimer's disease (AD) [2,3] and may characterize a subset of MCI subjects at higher risk of progression to dementia [4][5][6][7]. The functional neuroanatomy of apathy has been studied primarily in AD patients, where it was found that bilateral frontal, temporal, and cingulate area hypoperfusion and hypometabolism are associated with apathy severity [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

White Matter Microstructure and Apathy Level in Amnestic Mild Cognitive Impairment

Cacciari

Moraschi

Paola

et al. 2010

JAD

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Abstract. In this study, we assessed white matter microstructural deficit correlates of apathy level in 20 patients with amnestic mild cognitive impairment by means of diffusion tensor imaging. Mean diffusivity correlated positively with apathy level in the right temporal portion of the uncinate, middle longitudinal and inferior longitudinal fasciculi and in the parathalamic white matter, the fornix and the posterior cingulum of the right hemisphere. Fractional anisotropy results confirmed evidence of disconnection associated with apathy in all white matter areas except the middle longitudinal fasciculus. These results support the view that alterations in the neural mechanisms underlying apathy level occur in the early phase of degenerative dementias.

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“…31 This finding has relevance to recommendations that emphasize identification of APOE e4-enriched samples for interventional studies that aim to delay dementia. 32 To date, studies primarily focused on 1 or 2 neuropsychiatric symptoms 5,7 ; only a small number of studies examined the incidence of dementia by a wide variety of neuropsychiatric symptoms in MCI subjects. 4,33,34 For instance, investigators from Johns Hopkins University used a clinical sample assembled by the National Alzheimer's Coordinating Center database to examine the risk of incident dementia by baseline neuropsychiatric symptoms among 1,821 subjects with prevalent MCI whom they followed for less than 2 years.…”

mentioning

confidence: 99%

Neuropsychiatric symptoms, APOE ε4, and the risk of incident dementia

et al. 2015

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Objective: To investigate the population-based interaction between a biological variable (APOE e4), neuropsychiatric symptoms, and the risk of incident dementia among subjects with prevalent mild cognitive impairment (MCI). Methods:We prospectively followed 332 participants with prevalent MCI (aged 70 years and older) enrolled in the Mayo Clinic Study of Aging for a median of 3 years. The diagnoses of MCI and dementia were made by an expert consensus panel based on published criteria, after reviewing neurologic, cognitive, and other pertinent data. Neuropsychiatric symptoms were determined at baseline using the Neuropsychiatric Inventory Questionnaire. We used Cox proportional hazards models, with age as a time scale, to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Models were adjusted for sex, education, and medical comorbidity.Results: Baseline agitation, nighttime behaviors, depression, and apathy significantly increased the risk of incident dementia. We observed additive interactions between APOE e4 and depression (joint effect HR 5 2.21; 95% CI 5 1.24-3.91; test for additive interaction, p , 0.001); and between APOE e4 and apathy (joint effect HR 5 1.93; 95% CI 5 0.93-3.98; test for additive interaction, p 5 0.031). Anxiety, irritability, and appetite/eating were not associated with increased risk of incident dementia.Conclusions: Among prevalent MCI cases, baseline agitation, nighttime behaviors, depression, and apathy elevated the risk of incident dementia. There was a synergistic interaction between depression or apathy and APOE e4 in further elevating the risk of incident dementia. Dementia is one of the leading causes of morbidity and mortality in late life. It presents several challenges, not least of which are the economic consequences.1 Therefore, it is critical to prevent or delay dementia.2 Identification of high-risk groups is a key step toward the prevention of dementia. Mild cognitive impairment (MCI) is the intermediate stage between cognitive aging and dementia and is associated with an increased risk of dementia. Clinic-based samples have indicated that neuropsychiatric symptoms in prevalent MCI increase the risk of incident dementia.4-6 However, only a few studies were derived from population-based settings. 7,8 In addition, studies derived from clinical samples including our own team have reported the synergistic interaction between a neuropsychiatric symptom (e.g., depression) and APOE e4 in increasing the risk of incident dementia. 9-11While APOE e4 and neuropsychiatric symptoms are independent risk factors for incident dementia, little is known about the interaction between APOE e4 and a broad spectrum of neuropsychiatric symptoms in increasing the risk of incident dementia in a population-based

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Importance of Lack of Interest in Patients With Mild Cognitive Impairment

Cited by 89 publications

References 30 publications

Neuropsychiatric Predictors of Progression from Amnestic-Mild Cognitive Impairment to Alzheimer's Disease: The Role of Depression and Apathy

Neuropsychiatric Predictors of Progression from Amnestic-Mild Cognitive Impairment to Alzheimer's Disease: The Role of Depression and Apathy

White Matter Microstructure and Apathy Level in Amnestic Mild Cognitive Impairment

Neuropsychiatric symptoms, APOE ε4, and the risk of incident dementia

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