Barbara Vicini Chilovi

Differential Impact of Apathy and Depression in the Development of Dementia in Mild Cognitive Impairment Patients

Background and Aims: Neuropsychiatric symptoms may accompany mild cognitive impairment (MCI) and assist in identifying incipient dementia. The aim of this study was to evaluate the role of apathy and depression in the conversion to dementia among MCI subjects. Methods: 124 MCI outpatients were investigated. Diagnosis of apathy and depression was based on clinical criteria. The main endpoint was the development of dementia within 2 years from the enrolment. Results: 50 (40.3%) subjects were classified as MCI normal, 38 (30.7%) as MCI depressed, 21 (16.9%) as MCI depressed-apathetic and 15 (12.1%) as apathetic. The rates of conversion were 24% for MCI normal, 7.9% for MCI depressed, 19% for MCI depressed-apathetic and 60% for MCI apathetic. Diagnosis of apathy was a risk factor for conversion apart from age, functional and cognitive status at baseline (OR = 7.07; 95% CI 1.9–25.1; p = 0.003). In contrast, MCI depressed subjectshad a reduced risk of conversion (OR = 0.10; 95% CI 0.02–0.4; p = 0.001). Conclusion: These findings argue for a differential role of apathy and depression in the development of dementia, and suggest the need of dissecting in MCI patients apathy and depression symptoms in the reading of mood disorders.

Anxiety symptoms in mild cognitive impairment

Anxiety disorders are less well studied in elderly people than other disorders such as depression. In particular the diagnosis of anxiety is more difficult in patients with Mild Cognitive Impairment (MCI) since the current definition of MCI does not mention neuropsychiatric symptoms.

Efficacy of SSRIs on cognition of Alzheimer's disease patients treated with cholinesterase inhibitors

BACKGROUNDnThis study examines the joint effect on cognition of selective serotonin re-uptake inhibitors (SSRIs) and cholinesterase inhibitors (AChEIs) in depressed patients affected by Alzheimers disease (AD) living at home.nnnMETHODSnThe study was conducted in two different outpatient neurological clinics. 338 patients with probable AD were treated with ChEis (donepezil, rivastigmine and galantamine) as per the clinicians judgment and were observed for nine months. At study entry, participants underwent a multidimensional assessment evaluating cognitive, functional and psychobehavioral domains. All patients were evaluated at baseline, after one (T1), three (T2) and nine months (T3). Patients were grouped in three different categories (patients not depressed and not treated with SSRIs, patients depressed and treated with SSRIs, and patients depressed but not treated with SSRIs).nnnRESULTSnAt baseline 182 were diagnosed as not depressed and not treated with SSRIs, 66 as depressed and treated with SSRIs, and 90 as depressed but not treated with SSRIs. The mean change in MMSE score from baseline to nine months showed that depressed patients not treated worsened in comparison with those not depressed and not treated with SSRIs (mean change -0.8 +/- 2.3 vs 0.04 +/- 2.9; p = 0.02) and patients depressed and treated with SSRI (mean change -0.8 +/- 2.3 vs 0.1 +/- 2.5; p = 0.03).nnnCONCLUSIONSnIn AD patients treated with AChEIs, SSRIs may exert some degree of protection against the negative effects of depression on cognition.

The Importance of Alzheimer Disease Assessment Scale-cognitive Part in Predicting Progress for Amnestic Mild Cognitive Impairment to Alzheimer Disease

The aim of this study was to verify the usefulness of Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-Cog), in screening participants at risk of developing Alzheimer disease (AD) among populations with amnestic mild cognitive impairment(aMCI). 98 outpatients with aMCI were recruited. Participants were revaluated after 1 year: 44 (44.9%) were progressed to AD (progressors), while 54 (55.1%) did not convert (nonprogressors MCI). At baseline, cognitive performances were more impaired in progressors assessed by MMSE and by a neuropsychological battery. When tested with the ADAS-Cog subscale, the 2 groups of participants at baseline, progressors, and nonprogressors MCI, were significantly different regarding total score, memory, and nonmemory subitems. Considering a cutoff of 9.5 total score, adjusted for education, ADAS-Cog subscale showed a good performance (area under the curve = 0.67; sensitivity = 0.62%; specificity = 0.73%) in predicting conversion from aMCI to AD. Progressors aMCI were characterized at baseline by a greater cognitive impairment. ADAS-Cog subscale is a useful and brief cognitive assessment tool to screen aMCI participants converting to AD within 1 year.

Cognitive and Psychopathologic Response to Rivastigmine in Dementia With Lewy Bodies Compared to Alzheimer’s Disease: A Case Control Study

Cholinesterase inhibitors (ChEIs) are effective in improving cognition and behavior in patients affected by Alzheimer’s disease (AD) as well as by Lewy bodies dementia (DLB). The authors compared the effect of rivastigmine in the treatment of cognitive impairment and behavioral and psychological symptoms of dementia (BPSD) in 30 AD and in 30 DLB patients. At baseline, DLB compared to AD patients showed a greater number of extrapyramidal symptoms (P < .005) and were similar regarding cognitive symptoms and BPSD. After treatment, both groups showed a comparable cognitive and psycho-behavioral improvement. A significant difference between AD and DLB patients was found for hallucinations (P < .002). Rivastigmine produces comparable cognitive benefits in patients with DLB and AD and also a significant improvement of behavioral disorders. These findings support the view that ChEIs should be considered a first-line treatment of the cognitive and psycho-behavioral symptoms of both AD and DLB.

Mild parkinsonian signs and psycho-behavioral symptoms in subjects with mild cognitive impairment

BACKGROUNDnMild cognitive impairment (MCI) may be accompanied by extra pyramidal signs (EPS), which are related to the severity and type of cognitive impairment. We aimed to elucidate further the relationship between MCI and EPS, analyzing the correlation between the severity of EPS and cognitive functions, and the presence of EPS and neuro-psychiatric features.nnnMETHODSnData were obtained from a longitudinal study of 150 MCI outpatients. Participants underwent a clinical assessment including the Unified Parkinson Disease Rating Scale, the Neuropsychiatric Inventory, the Tinetti Scale, and a standardized neuropsychological battery. Mild EPS could be defined as being present (MCI with mild EPS) using a subscale of UPDRS, based on three specific symptoms: bradykinesia, rigidity and tremor.nnnRESULTSnThe two groups, one with mild EPS (24%) and one without EPS (76%), differed in gait abnormalities and presence of extrapyramidal symptoms. Groups did not differ in terms of general cognitive functions evaluated using the Mini-mental State Examination, while subjects with MCI with mild EPS performed significantly worse than those with MCI without EPS in total global score and in non-memory items of the Alzheimers Disease Assessment Scale. Moreover, severity of EPS was significantly correlated with low performance on executive functions and with high performance on episodic memory. The group with MCI with mild EPS were observed to have a greater prevalence of patients with anxiety, depression, apathy and sleep disturbances than in MCI without EPS.nnnCONCLUSIONnMCI may be associated with mild parkinsonian signs, the severity of which are related to the severity of cognitive impairment, in particular of non-memory functions, and to a differential pattern of psycho-behavioral symptoms.

Acetylcholinesterase inhibitors and depressive symptoms in patients with mild to moderate Alzheimer’s Disease

Background and aims: Acetilcholinesterase inhibitor (AChEis) therapy in Alzheimer Disease (AD) has been shown to provide cognitive benefits and to slow progression of the disease. AChEis have also been demonstrated to improve behavioral symptoms, although there seem to be subtle differences in the magnitude of response. The aim of our study was to evaluate the effect of 16 weeks treatment with AChEis on depressive symptoms in a selected sample of AD patients in routine clinical practice. Subjects and methods: A study of 135 patients with Alzheimer’s disease. All subjects were assessed at baseline (upon initiation of AChEis therapy) and re-evaluated after 16 weeks. Results: At baseline, «Depressed» and «Not depressed» patients were categorized according to DSM IV criteria for depression in Alzheimer Disease. After 16 weeks of treatment with AchEis, we observed an improvement of mood in the “Depressed” patients. In this group “Mood symptoms”, measured with GDS, were independently associated with GDS “Mood symptoms” at baseline, but not with improvement on cognition (mean change of MMSE), age or sex. Conclusions: In depressed AD subjects, AChEis treatment improves depressive symptoms evaluated by GDS. This improvement is independent of cognition enhancement.

Changes in characteristics of Alzheimer patients at first visit to centers for dementia: a 10-year follow-up study

Background and aims: The Cronos Project is an observational study on Alzheimer’s disease (AD), created by Italy’s Ministry of Public Health in 2000. The aim of our study was to evaluate whether the clinical characteristics of patients at their first visit to the Alzheimer Evaluation Unit (UVA) changed from September 2000 to December 2009, and to examine possible reasons for changes noted. Methods: 1532 consecutive patients were enrolled in two UVAs (September 2000 to December 2009) in a retrospective, descriptive study, with medical records as the primary source of data. Results: Patients’ age at the first visit was not different throughout the period of observation. No differences were observed with regard to education or functional characteristics. However, a reduction in the severity of cognitive impairment was found during the period of evaluation: patients consecutively recruited in the first years were more cognitively, functionally, and psycho-behaviorally compromised than patients recruited in the following years. Conclusions: Data show changes in characteristics at the first visit in patients affected by cognitive deterioration during the years of observation. This finding indicates new clinical needs of patients, requiring changes in pharmacological treatment and in general of the clinical approach.

Diagnosis disclosure and advance care planning in Alzheimer disease: opinions of a sample of Italian citizens.

Background and aimsIn current Alzheimer disease (AD) research there is growing asymmetry between the modest benefits of the currently available treatments, in contrast to the possibility to diagnose AD early in its natural history. This complex situation brings along a number of important ethical issues about diagnosis disclosure and end-of-life decisions that need to be addressed. The principal aim of the study was to investigate the attitudes towards disclosure of a diagnosis of AD and disposition towards completion of advance care planning, in a sample of Italian citizens.MethodsA convenience sample of 1,111 Italian citizens recruited from a community hospital in Brescia were interviewed using a structured questionnaire with both yes/no and multiple choice format questions about AD.ResultsThe majority of the sample (83xa0%) wanted disclosure for themselves. Women and caregivers were significantly less likely to agree that their hypothetically afflicted relative should be informed of a diagnosis of AD. The majority of the sample (81xa0%) was in favor of advance care planning completion, most of all younger participants and non-caregivers. Less than a third of the sample (24xa0%) was aware of the existence a judicially appointed guardian for patients affected by dementia.ConclusionThe majority of the participants wanted a potential diagnosis of AD to be disclosed to them and to their relatives if they were to be afflicted. The utility of completion of advance care planning and designation of a judicially appointed guardian is frequently endorsed by the sample.

Knowledge and attitudes about Alzheimer’s disease in the lay public: influence of caregiving experience and other socio-demographic factors in an Italian sample

Background and aims: Despite increasing attention on the knowledge of dementia among patients and family members, little is known about the general public’s level of understanding about dementia. The aim of this study was to assess the influence of the caregiving experience, sex and age on the knowledge of AD. Methods: Eleven hundred and eleven individuals were enrolled. They fulfilled a questionnaire made of 25 questions. The questionnaires were submitted in the waiting rooms of several departments of the Hospital “Spedali Civili di Brescia”. The questionnaires assessed several issues, including the general knowledge about Alzheimer’s disease, the management and ethical problems. The present study is focused on the analysis of 9 of the 25 questions included in the questionnaire, highlighting aspects about knowledge of symptoms, risk factors, therapies and services. Results: The percentage of correct responses was significantly greater among the caregivers. The group of old respondents gave similar answers, independently of their caregiving status. Women, caregivers or not, are the more knowledgeable group. Conclusion: The entire population needs accurate information, but education programs should be specifically tailored for the different sections of the population because they may start with different levels of knowledge.