Neuropsychiatric Symptoms in Mild Cognitive Impairment: A Literature Review

Martin, Evangelia; Velayudhan, Latha

doi:10.1159/000507078

Cited by 92 publications

(85 citation statements)

References 59 publications

(107 reference statements)

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“…In the present study, patients with a history of hallucination, anxiety, and memory deficits were more likely to receive a diagnosis of AD. Some of these symptoms together with the presence of cognitive deficits may be framed in the context of mild cognitive impairment construct, which can be an early clinical manifestation of prodromal dementia [16, 17]. In this regard, the lack of indications and guidelines for the assessment of cognitive impairment in primary care weakens the possibility for GPs to perform timely diagnosis and appropriately refer patients to dedicate second level services.…”

Section: Discussionmentioning

confidence: 99%

Detection and Prediction of Incident Alzheimer Dementia over a 10-Year or Longer Medical History: A Population-Based Study in Primary Care

Grande¹,

Vetrano²,

Mazzoleni³

et al. 2020

Dement Geriatr Cogn Disord

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Background: Despite the crucial role played by general practitioners in the identification and care of people with cognitive impairment, few data are available on how they may improve the early recognition of patients with Alzheimer dementia (AD), especially those with long (i.e., 10 years and longer) medical history. Aims: To investigate the occurrence and the predictors of AD during a 10-year or longer period prior AD diagnosis in primary care patients aged 60 years or older. Materials and Methods: A cohort study with a nested case-control analysis has been conducted. Data were extracted from the Italian Health Search Database (HSD), an Italian database with primary care data. AD cases have been defined in accordance with the International Classification of Diseases, ninth edition (ICD-9-CM) codes and coupled with the use of anti-dementia drugs. Prevalence and incidence rates of AD have been calculated. To test the association between candidate predictors, being identified in a minimum period of 10 years, and incident cases of AD, we used a multivariate conditional logistic regression model. Results: As recorded in the primary care database, AD prevalence among patients aged 60 years or older was 0.8% during 2016, reaching 2.4% among nonagenarians. Overall, 1,889 incident cases of AD have been identified, with an incidence rate as high as 0.09% person-year. Compared with 18,890 matched controls, history of hallucinations, agitation, anxiety, aberrant motor behavior, and memory deficits were positively associated with higher odds of AD (p < 0.001 for all) diagnosis. A previous diagnosis of depression and diabetes and the use of low-dose aspirin and non-steroidal anti-inflammatory drugs were associated with higher odds of AD (p < 0.05 for all). Conclusion: Our findings show that, in accordance with primary care records, 1% of patients aged 60 years and older have a diagnosis of AD, with an incident AD diagnosis of 0.1% per year. AD is often under-reported in primary care settings; yet, several predictors identified in this study may support general practitioners to early identify patients at risk of AD.

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Section: Discussionmentioning

confidence: 99%

Detection and Prediction of Incident Alzheimer Dementia over a 10-Year or Longer Medical History: A Population-Based Study in Primary Care

Grande¹,

Vetrano²,

Mazzoleni³

et al. 2020

Dement Geriatr Cogn Disord

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“…Little research conceptualized NPS as a complex of symptoms. Increasing evidence indicates that NPS usually manifest as a cluster of behavioral and psychological symptoms of various combinations, severities and frequencies, even the earlier disease stage 15,79,80 . Given this, the European Alzheimer's Disease Consortium published a consensus review paper, which recommended that the evaluation of an intervention's efficacy should focus on its effects on overall NPS rather than a single domain 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Of these seven studies, five 60,65,67,72,74 reported significant treatment effects, whereas the remaining two 59,71 did not. Table 2 15,79,80 Given this, the European Alzheimer's Disease…”

Section: Crucial Components Of Effective Interventionsmentioning

confidence: 99%

The effectiveness of non‐pharmacological interventions targeting neuropsychiatric symptoms among persons with preclinical and mild dementia: A systematic review and network meta‐analysis

Lin

et al. 2020

Int J Geriat Psychiatry

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Objectives To conduct a systematic review and network meta‐analysis examining the effects of non‐pharmacological interventions on neuropsychiatric symptoms (NPS) in a community‐dwelling population with preclinical and mild dementia to identify the design characteristics of more effective interventions. Methods A comprehensive search was conducted in 10 electronic databases. Two reviewers independently appraised the methodological quality of studies using the Risk of Bias 2.0 tool. A pairwise meta‐analysis was performed to estimate the standardized mean differences (SMD) with 95% confidence intervals. Network meta‐analysis was then used to estimate the relative effects and rankings of different interventions. Results Twenty‐one studies involving 1773 participants were included. Seven studies focused on preclinical dementia, and 14 studies focused on mild dementia. The majority of studies reported a single domain of NPS (depression, anxiety, apathy or agitation) rather than overall NPS. Data on depression were pooled. Pairwise analysis and network meta‐analysis indicated that multimodal interventions (SMD = −0.47, p = 0.01) were superior to psycho‐behavioral educative interventions (SMD = −0.04; p = 0.65), cognitive training (SMD = −0.27, p = 0.10), and art‐based interventions for improving depression. The more crucial design characteristics included those that emphasized skill transferal into daily life, psycho‐behavioral content to encourage a positive outlook and self‐identity, and disease‐specific educational content to improve symptom management. Conclusions This review indicated that multimodal interventions with cognitive, psycho‐behavioral and educative components were the most effective approaches for improving depression in patients with preclinical and mild dementia. More comprehensive evaluations using standardized and robust measures of NPS in patients with preclinical dementia are warranted.

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“…The absence of dementia or of mild cognitive impairment will not be good enough for a task which needs permanent mental and physical strength over long periods of time. Some of the following features may serve as markers of im-minent cognitive failure and help to identify candidates at risk: the statistical risk which comes with very old age; a record of failures and how they were dealt with; signs of physical frailty and the kind of multimorbidity which may impact on endurance and cognitive capacity in due course; impaired fluency or limited communicative content, rambling style, ideological phrases instead of focused pragmatism [25]; unsubstantiated pride relying on previous achievements; mild behavioral impairment [26]; tiring easily, memory lapses; mild cognitive impairment; supportseeking gestures [27]; a tightly knitted and manipulative entourage pursuing their own interests. This is not an attempt to rewrite political history as a history of senility or a general warning against candidates over the age of 65.…”

Section: Discussionmentioning

confidence: 99%

Aging Heads of State: The Politics of Dementia and Geriatric Cognitive Disorders

Förstl

2020

Dement Geriatr Cogn Disord

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Background: Increasing life expectancy may explain why more elderly candidates appear to be running for office. This raises general questions regarding the specific risks of old age and frailty in demanding political positions. Therefore, I tried to give important contemporary examples of elderly leaders, study the mean age of leading political figures over the last 3 decades and present historical examples of heads of state with age-associated brain diseases and cognitive deficits. I reviewed the literature on mental illness and politics and analyzed the ages of international political leaders in 1990, 2000, 2010 and 2020. Summary: There are several impressive contemporary examples of elderly politicians. The mean age of political leaders has not increased significantly in most parts of the world over the last 3 decades with the exception of the Gulf States and sub-Saharan Africa. Health problems of heads of state in earlier centuries had not been primarily age associated. After 1900, dementia but also mild cognitive and mild behavioral impairment became important issues in politically critical situations, for example international peace negotiations, the rise of Nazi Germany, the breakup of communism, the Arab Spring and others. Key Messages: This paper collects anecdotal evidence of cognitive frailty in ageing politicians; it is not an in-depth analysis of political history. Observations confirm that a very long time in power may obviously increase the risk of age-associated problems; dynamic revolutionary or entrepreneurial idols may be misled to rely on their irreplaceable charisma for too long. However, caution must be exercised against ageism on one side versus silent acquiescence towards leaders with failing mental powers on the other, who may become victims of obscure parties and their decompensating personality disorders.

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Neuropsychiatric Symptoms in Mild Cognitive Impairment: A Literature Review

Cited by 92 publications

References 59 publications

Detection and Prediction of Incident Alzheimer Dementia over a 10-Year or Longer Medical History: A Population-Based Study in Primary Care

Detection and Prediction of Incident Alzheimer Dementia over a 10-Year or Longer Medical History: A Population-Based Study in Primary Care

The effectiveness of non‐pharmacological interventions targeting neuropsychiatric symptoms among persons with preclinical and mild dementia: A systematic review and network meta‐analysis

Aging Heads of State: The Politics of Dementia and Geriatric Cognitive Disorders

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