Neuropsychiatric Symptoms and Functional Decline in Alzheimerʼs Disease and Lewy Body Dementia

Borda, Miguel Germán; Aarsland, Dag; Tovar‐Rios, Diego Alejandro; Giil, Lasse Melvær; Ballard, Clive; González, María; Brønnick, Kolbjørn; Alves, Guido; Oppedal, Ketil; Soennesyn, Hogne; Vik‐Mo, Audun Osland

doi:10.1111/jgs.16709

Cited by 21 publications

(16 citation statements)

References 39 publications

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“…Each item was scored from 1 to 4 (Alone = 1, with some help = 2, with a lot of help = 3 and Can Not perform = 4) and then divided over the number of items. We summarized the total mean score of the aforementioned items yearly, over a 5‐year follow‐up 35 36 A higher score indicates a higher level of functional decline.…”

Section: Methodsmentioning

confidence: 99%

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Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Borda

Jaramillo‐Jimenez

Oesterhus

et al. 2021

Int J Geriat Psychiatry

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Objectives We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5‐year follow‐up. Methods This is a longitudinal analysis of a Norwegian cohort study entitled “The Dementia Study of Western Norway” (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD‐ADep). Linear mixed‐effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale—2, and cognition measured with the Mini‐Mental State Examination. Results Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD‐ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. Conclusions BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.

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Section: Methodsmentioning

confidence: 99%

“…We summarized the total mean score of the aforementioned items yearly, over a 5-year follow-up. 35,36 A higher score indicates a higher level of functional decline.…”

Section: Functional Decline In Adlmentioning

confidence: 99%

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Borda

Jaramillo‐Jimenez

Oesterhus

et al. 2021

Int J Geriat Psychiatry

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“…We are not in a position to assess REM sleep behavioral disorder as a core feature, as our cohort contained too few patients with REM sleep behavioral disorder and a positive 123I-FP-CIT SPECT result. Another study confirmed such observations, showing that neuropsychiatric symptoms in DLB are more closely related to the extent of functional decline than to any specific symptomology ( Borda et al, 2020 ). Furthermore, our study delivers evidence that 123I-FP-CIT SPECT -positive DLB patients onset more often have a psychiatric-onset (52%), and less often characterized by an MCI-onset of DLB (26%), supporting the relevance of depressive symptoms in suspected DLB patients as the only obvious syndrome at disease onset.…”

Section: Discussionmentioning

confidence: 69%

“…As these studies reveal a mismatch between diagnosis during life and post-mortem, we should be aiming to improve the early diagnosis of DLB. An DLB diagnosis is often impeded by a severe psychiatric presentation ( Borda et al, 2020 ; McKeith et al, 2020 ; Segers et al, 2020 ). Visual hallucinations as a psychiatric symptom are one of DLB’s core clinical features associated with locating Lewy-body pathology ( Sakai et al, 2019 ) and is incompatible with other psychiatric disorders such as schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Assessing Nigrostriatal Dopaminergic Pathways via 123I-FP-CIT SPECT in Dementia With Lewy Bodies in a Psychiatric Patient Cohort

Hansen

Lange

Timäus

et al. 2021

Front. Aging Neurosci.

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Background(123)-I-2-ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortro- pane single photon emission computed tomography (123I-FP-CIT SPECT) was validated to distinguish Alzheimer’s dementia from dementia with Lewy Bodies (DLB) by European medical agencies. Little evidence exists that validates 123 I-FP-CIT SPECT as a supplementary method to diagnose probable DLB in a psychiatric cohort of patients with psychiatric symptomatology and suspected DLB. We aim to elucidate differences in the clinical phenotype of DLB between those patients with and those without a positive 123 I-FP-CIT SPECT indicating a nigrostriatal deficit.MethodsTo investigate this, we included 67 patients from the Department of Psychiatry and Psychotherapy at University Medical Center Göttingen (UMG) in our study who had undergone 123I-FP-CIT SPECT in the Department of Nuclear Medicine (UMG) by evaluating their patient files.Results55% with a positive-123I-FP-CIT SPECT and probable DLB after the 123I-FP-CIT SPECT exhibited psychiatric features. The number of probable DLB patients in those exhibiting psychiatric symptoms was higher post-123I-FP-CIT SPECT than pre-123I-FP-CIT SPECT assessed cross-sectionally over a 6-year period (p < 0.05). In addition, prodromal DLB and prodromal DLB patients with a psychiatric-phenotype yielded higher numbers post-123I-FP-CIT SPECT than pre-123I-FP-CIT SPECT (p < 0.05). Furthermore, we discovered no phenotypical differences between those DLB patients with a positive and those with a negative 123I-FP-CIT SPECT. 123I-FP-CIT SPECT-positive DLB patients in our psychiatric cohort revealed a psychiatric onset more often (52%); DLB was less often characterized by an MCI onset (26%) (p < 0.005).ConclusionsOur findings support 123I-FP-CIT SPECT as an adjuvant tool for improving the diagnosis of probable DLB and prodromal DLB in a cohort of psychiatric patients with often concomitant psychiatric symptomatology. The psychiatric-onset is more frequent than an MCI-onset in DLB patients presenting nigrostriatal dysfunction, giving us an indication of the relevance of deep clinical phenotyping in memory clinics that includes the assessment of psychopathology.

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“…BPSD consist of changes in behavior, mood, thoughts, and perception that can be very stressful for the individual and their informal caregivers (family members) [ 2 ]. Furthermore, BPSD are associated with poorer cognitive and everyday functioning, which can increase the risk of early transfer from home to permanent nursing home care and reduce life expectancy [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial

Gedde

Husebø

Mannseth

et al. 2022

BMC Med

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Background There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers. Methods LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD’s regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change. Results Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not. Conclusions Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population. Trial registration ClinicalTrials.gov: NCT04043364; registered 15/03/2019.

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Neuropsychiatric Symptoms and Functional Decline in Alzheimerʼs Disease and Lewy Body Dementia

Cited by 21 publications

References 39 publications

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Assessing Nigrostriatal Dopaminergic Pathways via 123I-FP-CIT SPECT in Dementia With Lewy Bodies in a Psychiatric Patient Cohort

The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial

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