The Diagnostic Challenge of Young-Onset Dementia Syndromes and Primary Psychiatric Diseases: Results From a Retrospective 20-Year Cross-Sectional Study

Tsoukra, Paraskevi; Velakoulis, Dennis; Wibawa, Pierre; Malpas, Charles B; Walterfang, Mark; Evans, Andrew; Farrand, Sarah; Kelso, Wendy; Eratne, Dhamidhu; Loi, Samantha M

doi:10.1176/appi.neuropsych.20100266

Cited by 24 publications

(37 citation statements)

References 32 publications

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“…YOD occurs at a period when individuals and their carers are likely to be at their maximal earning capacity, have financial responsibilities and are caring for dependents. The diagnostic process can be protracted, 12,13 and by the time the disease is confirmed, families are likely to have gone through an extremely difficult period, involving confusion and uncertainty, 14 likely job loss, 15 and financial costs in engaging health care services and significant disruption to what had been ‘normal’ family practices 16 . After diagnosis, people with YOD and their families generally find there is very little dedicated support or resources available to help them understand, cope and deal with the disease and its various impacts on their lives 8,17 …”

Section: Introductionmentioning

confidence: 99%

Carer burden and psychological distress in young‐onset dementia: An Australian perspective

Kang

Farrand

Walterfang

et al. 2022

Int J Geriat Psychiatry

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Objectives: Carer burden in dementia is associated with poor outcomes, including early nursing home placement for people with dementia and psychological distress for their carers. Carers of people with young-onset dementia (YOD) are particularly vulnerable to carer burden. Yet they are often overlooked by clinicians as dementia services are generally designed for older people. We sought to estimate the rate of burden and psychological distress in carers of YOD at a state-wide tertiary service based in Australia. Methods: We conducted a cross-sectional study examining 71 dyads from a Neuropsychiatry service. We collected patient demographic and clinical data including the Neuropsychiatry Unit Cognitive Assessment tool (NUCOG) and Mini-Mental State Examination (MMSE). Carer data, such as demographics and psychological distress, were obtained using Depression Anxiety Stress Scale 21 (DASS-21).Carer burden was rated using the Zarit Burden Inventory-short version (ZBI).Results: Higher carer burden, measured using ZBI, was associated with longer duration of dementia and greater severity of overall cognitive impairment. Carers who felt burdened reported higher levels of stress, depression, and anxiety measured using DASS-21. Multiple linear regression analysis found carer burden was independently predicted by duration of dementia, total cognition score and carers experiencing psychological stress.Discussion: We found that patient variables of dementia duration and cognitive impairment and carer variable of carer stress to be associated with carer burden.Poor executive function was associated with carer stress. Early identification and management of carer burden and psychological distress is important for outcomes.Ideally, this should be provided by a specialist YOD service. K E Y W O R D Scarer burden, carer psychological distress, carer wellbeing, early-onset dementia, young-onset dementiaThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Introductionmentioning

confidence: 99%

Carer burden and psychological distress in young‐onset dementia: An Australian perspective

Kang

Farrand

Walterfang

et al. 2022

Int J Geriat Psychiatry

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“…Few symptoms of the disease among them are different. When selecting the articles for the proposed study, we tried focusing on the symptoms related to PD [ 103 , 104 ]. As mentioned in column (B5), the data extraction criteria from the various sources are important to focus on the area of interest in the study [ 51 , 104 ].…”

Section: Discussionmentioning

confidence: 99%

“…When selecting the articles for the proposed study, we tried focusing on the symptoms related to PD [ 103 , 104 ]. As mentioned in column (B5), the data extraction criteria from the various sources are important to focus on the area of interest in the study [ 51 , 104 ]. The various AI models used in the studies are mentioned in column (B6), and it has been seen that in most of the article, ML algorithms were used to detect PD.…”

Section: Discussionmentioning

confidence: 99%

Bias Investigation in Artificial Intelligence Systems for Early Detection of Parkinson’s Disease: A Narrative Review

et al. 2022

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Background and Motivation: Diagnosis of Parkinson’s disease (PD) is often based on medical attention and clinical signs. It is subjective and does not have a good prognosis. Artificial Intelligence (AI) has played a promising role in the diagnosis of PD. However, it introduces bias due to lack of sample size, poor validation, clinical evaluation, and lack of big data configuration. The purpose of this study is to compute the risk of bias (RoB) automatically. Method: The PRISMA search strategy was adopted to select the best 39 AI studies out of 85 PD studies closely associated with early diagnosis PD. The studies were used to compute 30 AI attributes (based on 6 AI clusters), using AP(ai)Bias 1.0 (AtheroPointTM, Roseville, CA, USA), and the mean aggregate score was computed. The studies were ranked and two cutoffs (Moderate-Low (ML) and High-Moderate (MH)) were determined to segregate the studies into three bins: low-, moderate-, and high-bias. Result: The ML and HM cutoffs were 3.50 and 2.33, respectively, which constituted 7, 13, and 6 for low-, moderate-, and high-bias studies. The best and worst architectures were “deep learning with sketches as outcomes” and “machine learning with Electroencephalography,” respectively. We recommend (i) the usage of power analysis in big data framework, (ii) that it must undergo scientific validation using unseen AI models, and (iii) that it should be taken towards clinical evaluation for reliability and stability tests. Conclusion: The AI is a vital component for the diagnosis of early PD and the recommendations must be followed to lower the RoB.

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“…3 Behavioural variant frontotemporal dementia (bvFTD) is particularly prone to misdiagnosis, as it mimics PSY. 4 Differentiating between ND and PSY is difficult, resulting in a high rate of misdiagnoses, further compounding the burden of these disorders. A large clinical trial found that 35% of patients with a clinical diagnosis of AD had negative amyloidbeta positron emission tomography scans.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid neurofilament light improves accurate distinction between neurodegenerative and psychiatric disorders at a cognitive neuropsychiatry service

Kang

Eratne

Dobson

et al. 2022

Preprint

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Objective: People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. Methods: We collected longitudinal diagnostic information (mean=36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other), and PSY. We pre-specified NfL>582pg/mL as indicative of ND/MCI/other. Results: Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. Conclusions: CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.

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The Diagnostic Challenge of Young-Onset Dementia Syndromes and Primary Psychiatric Diseases: Results From a Retrospective 20-Year Cross-Sectional Study

Cited by 24 publications

References 32 publications

Carer burden and psychological distress in young‐onset dementia: An Australian perspective

Carer burden and psychological distress in young‐onset dementia: An Australian perspective

Bias Investigation in Artificial Intelligence Systems for Early Detection of Parkinson’s Disease: A Narrative Review

Cerebrospinal fluid neurofilament light improves accurate distinction between neurodegenerative and psychiatric disorders at a cognitive neuropsychiatry service

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