Lauren P. Wadsworth

Subjective cognitive complaints and amyloid burden in cognitively normal older individuals.

Accumulating evidence suggests that subjective cognitive complaints (SCC) may indicate subtle cognitive decline characteristic of individuals with preclinical Alzheimers disease (AD). In this study, we sought to build upon previous studies by associating SCC and amyloid-β deposition using positron emission tomography with Pittsburgh Compound B (PiB-PET) in cognitively normal older individuals. One-hundred thirty one subjects (mean age 73.5±6) were administered three subjective cognitive questionnaires and a brief neuropsychological battery. A relationship between a subjective memory complaints composite score and cortical PiB binding was found to be significant, even after controlling for depressive symptoms. By contrast, there were no significant relationships between objective cognitive measures of memory and executive functions and cortical PiB binding. Our study suggests that SCC may be an early indicator of AD pathology detectable prior to significant objective impairment.

Neuropsychiatric Symptoms and Global Functional Impairment along the Alzheimer’s Continuum

Background/Aims: Neuropsychiatric symptoms in Alzheimer’s disease (AD) are highly prevalent. We sought to determine whether neuropsychiatric symptoms were related to global functional impairment at baseline and over a 3-year period in older normal control (NC), mild cognitive impairment (MCI) and mild AD dementia subjects. Methods: Eight hundred and twelve subjects (229 NC, 395 MCI, 188 AD) from the Alzheimer’s Disease Neuroimaging Initiative study underwent cognitive and behavioral assessments over 3 years. Results: Greater hallucinations, anxiety and apathy were associated with greater global functional impairment at baseline, while the presence of hallucinations and apathy at baseline was associated with greater global functional impairment over time across all subjects. The following neuropsychiatric symptoms were not significantly associated with global functioning: delusions, agitation, depression, euphoria, disinhibition, irritability, aberrant motor behaviors, sleep and appetite. Conclusions: These results suggest that increased baseline hallucinations, apathy and anxiety are associated with current and future disease progression in AD.

Regional Cortical Thinning Predicts Worsening Apathy and Hallucinations Across the Alzheimer Disease Spectrum

OBJECTIVES To examine regions of cortical thinning and cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers associated with apathy and hallucinations in a continuum of individuals including clinically normal elderly, mild cognitive impairment, and mild AD dementia. DESIGN Cross-sectional and longitudinal studies. SETTING Fifty-seven research sites across North America. PARTICIPANTS Eight-hundred twelve community-dwelling volunteers; 413 participants in the CSF sub-study. MEASUREMENTS Structural magnetic resonance imaging data and CSF concentrations of amyloid-β 1-42, total tau, and phosphorylated tau derived from the Alzheimer Disease Neuroimaging Initiative database were analyzed. Apathy and hallucinations were measured at baseline and over 3 years using the Neuropsychiatric Inventory-Questionnaire. General linear models and mixed effects models were used to evaluate the relationships among baseline cortical thickness in seven regions, and baseline CSF biomarkers, apathy, and hallucinations at baseline and longitudinally. Covariates included diagnosis, sex, age, apolipoprotein E genotype, premorbid intelligence, memory performance, processing speed, antidepressant use, and AD duration. RESULTS Reduced baseline inferior temporal cortical thickness was predictive of increasing apathy over time, and reduced supramarginal cortical thickness was predictive of increasing hallucinations over time. There was no association with cortical thickness at baseline. CSF biomarkers were not related to severity of apathy or hallucinations in cross-sectional or longitudinal analyses. CONCLUSIONS These results suggest that greater baseline temporal and parietal atrophy is associated with worsening apathy and hallucinations in a large AD spectrum cohort, while adjusting for multiple disease-related variables. Localized cortical neurodegeneration may contribute to the pathophysiology of apathy and hallucinations and their adverse consequences in AD.

Validation of the Face Name Associative Memory Exam in Cognitively Normal Older Individuals

The recently developed Face Name Associative Memory Exam (FNAME), a challenging paired associative learning task, shows promise in detecting the subtle cognitive changes characteristic of preclinical Alzheimers disease. In this study, we evaluated the validity and reliability of the FNAME in 210 cognitively normal older individuals (58–90 years of age). Construct validity of the measure was assessed by principal components analysis, which revealed two independent factors. Correlations between the FNAME subtests and another episodic memory test were significant. The results indicated strong test–retest reliability in a subsample (n = 41). Normative data stratified by age were also generated.

Regional cortical thinning predicts worsening apathy and hallucinations in mild cognitive impairment and mild Alzheimer's disease dementia

in white matter (WM) structural integrity. Diffusion tensor imaging (DTI) is a neuroimaging technique that allows in vivo assessment ofWMfiber tract integrity and, thus, could support the diagnosis of AD as an additional biomarker. Current research focuses on machine learning (ML) methods to automatically detect AD specific structural WM changes. Therefore, the algorithms used must be robust and stable to work with data recorded across different scanners.Within the newly created framework of the EuropeanDTI study in Dementia (EDSD) we have collected data of more than 330 subjects from ten scanners located at nine sites. Objective: To assess the accuracy of ML classifiers for the detection of AD based on a large multicenter DTI data set using different approaches to reduce inter-site variability.Methods: After strict quality control we pooled the remaining 280 DTI and MRI scans derived from 137 patients with clinically probable AD and 143 healthy elderly controls. For classification we used fractional anisotropy (FA) maps and mean diffusivity (MD) maps and performed a tenfold cross validation. We selected discriminative voxels using the information gain criterion and classified the data with a Support VectorMachine. In a second step, we eliminated variance attributable to center and other covariates including age, education, gender, using principal component analysis (PCA) before repeating the classification procedure. Results: For FA and MD the feature selection identified areas in themedial temporal lobe and corpus callosum that had the strongest contribution to the group separation. We achieved an accuracy of 80% for FA and 83% for MD. For the tissue density maps we obtained 83% for WM and 89% for gray matter. The reduction of variance components arising from center, gender, age and education effects did not significantly change the classification results for FA and MD. Conclusions:Multicenter acquisition of DTI data in combination with multivariate ML approaches show promising results which can be compared to earlier monocenter DTI studies. Variance introduced by different scanners can be detected by PCA, but it seems not to affect the performance of the classifier.

Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital.

Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Method: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments.

Workplace policies and mental health among working-class, new parents

ABSTRACT Little research has explored linkages between workplace policies and mental health in working-class, employed parents, creating a gap in our knowledge of work–family issues across social class levels. The current US study addresses this gap by employing hierarchical linear modeling techniques to examine how workplace policies and parental leave benefits predicted parents’ depressive symptoms and anxiety in a sample of 125, low income, dual-earner couples interviewed across the transition to parenthood. Descriptive analyses revealed that, on average, parents had few workplace policies, such as schedule flexibility or child care supports, available to them. Results revealed, however, that, when available, schedule flexibility was related to fewer depressive symptoms and less anxiety for new mothers. Greater child care supports predicted fewer depressive symptoms for fathers. In terms of crossover effects, longer maternal leave predicted declines in fathers’ anxiety across the first year. Results are discussed with attention to how certain workplace policies may serve to alleviate new parents’ lack of time and resources (minimize scarcity of resources) and, in turn, predict better mental health during the sensitive period of new parenthood.

Patterns of Anxious Arousal During a Speech Task Between Nonanxious Controls and Individuals With Social Anxiety Disorder Pre- and Posttreatment

Although research indicates that anxious arousal in response to feared stimuli is related to treatment outcome (Heimberg et al., 1990), less is known about the patterns of anxious arousal. We identified patterns of anxious arousal in individuals with social anxiety disorder (SAD) at pre- (n= 61) and posttreatment (n= 40; 12-session CBGT, Heimberg & Becker, 2002), and in non-anxious controls (NACs; n= 31) using an assessment speech task administered at pretreatment (SAD) or the pretreatment equivalent (NACs), as well as at posttreatment (SAD only). We identified nine patterns of anxious arousal across groups that we further clustered into three groups: fear habituation, fear plateau, and fear increase. Chi-square and adjusted standardized residual analyses revealed that individuals in the pretreatment SAD group displayed the fear habituation patterns significantly more than chance and the fear plateau patterns significantly less than chance. In contrast, NACs displayed the fear plateau patterns significantly more than chance and the fear habituation patterns significantly less than chance. At posttreatment, treatment non-responders displayed fear habituation patterns significantly more than chance, whereas treatment responders displayed the fear habituation patterns significantly less than chance. Findings indicate that fear habituation during an anxiety-provoking assessment task is not necessary for treatment response.