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Query: UMLS:C0085632 (apathy)
 4,089 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A semi-structured interview was administered to the closest relatives of 50 patients with presenile or senile dementia of the Alzheimer type. The disturbances most frequently reported were: wandering/pacing (56%, cumulative percentage), aggressive behavior (44%) and - significantly related to more severe stages of dementia - apathy/loss of drive (58%), eating disturbances (46%) and disturbances of the sleep-waking cycle (32%). Depressive symptoms were observed in 58% of the patients, preferentially in the early stages of illness with preserved insight. Signs of paranoid delusions (46%), delusional misidentification (34%), visual (32%) and auditory hallucinations (16%) were encountered temporarily in a large number of patients. The importance of "non-cognitive" symptoms in Alzheimer's disease is underlined by their subjective significance for the caregivers.
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PMID:[Incidence and importance of "non-cognitive" symptoms in dementia of the Alzheimer type: productive psychotic symptoms, depressive disorders and behavioral disorders]. 769 80

Behavioral dysfunction in Alzheimer disease (AD) is a major influence on the morbidity and disability of patients and is central to decisions on patient institutionalization. Behavioral dysfunction ranges from withdrawal, apathy, and depression to hostility, anger, and aggression, with most patients exhibiting some symptoms during the course of the disease. Symptoms of depression are common in AD patients (17-30%) and are associated with broad behavioral dysfunction and increased functional disability. Furthermore, the occurrence of depression in patients correlates strongly with caregiver burden and depression. This report summarizes the relationship between caregiver distress and patient behavioral problems. Administration of the Revised Memory and Behavior Problem Checklist provided information on the frequency of behavioral problems and their association with caregiver distress. In one study of 201 patient-caregiver dyads, depression-related behaviors were confirmed as the most distressing to caregivers. In another, the rates of caregiver depression were high (75%) among those caring for clinically depressed AD patients. Indeed, in a third study, 100% of patients with depression had depressed caregivers. The vulnerability of caregivers to depression is linked to their own age, gender, physical ability, personality, and available social supports. Alleviation of caregiver distress, burden, and depression will be of great value in the improvement of AD patient care.
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PMID:Behavior and caregiver burden: behavioral problems in patients with Alzheimer disease and its association with caregiver distress. 933 71

Malignant middle cerebral artery (MMCA) infarction is associated with a mortality rate of 80% under conservative treatment. Decompressive hemicraniectomy (DH) reduces mortality and improves the functional outcome of surviving patients. The purpose of this study was to examine quality of life (QoL) and neurobehavioral deficits in patients with space-occupying infarctions of the right- or left-sided hemisphere at 6 months after stroke. The Sickness Impact Profile (SIP) was used to assess QoL in 19 out of 29 consecutive patients that underwent DH after a malignant MCA infarction (14 on the right and 5 on the left hemisphere). Behavioral changes were evaluated with the Frontal Behavioral Inventory and the Beck Depression Inventory. Patients and relatives were also asked if, knowing the present outcome, they would agree again, in retrospect, to a DH. Barthel Index >60 was seen in 37% of our patients. Functional outcome was related to age. We found a higher reduction in the SIP's physical domain than in the psychosocial domain. Depressive symptoms were present in 50% of the patients. We didn't find significant differences in QoL or functional outcome between patients with right or left-sided infarctions. The most frequent neurobehavioral symptoms were decreased speech output, apathy, reduced spontaneity and irritability. Most patients and their relatives would again give consent to hemicraniectomy. The results show that younger patients had a significantly better outcome. QoL seems to be acceptable in both left- and right-sided infarctions, and retrospective agreement to hemicraniectomy is high in both patients and their relatives.
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PMID:Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction. 1928 45

This study aimed to estimate the prevalence and explore the multidimensional complexity of the neuropsychiatric syndromes of AD. Neuropsychiatric symptoms and syndromes of 216 subjects with probable and possible AD diagnosed by NINCDS-ADRDA criteria were evaluated by the Korean version of behavior rating scale for dementia (BRSD-K). The prevalence rate of six neuropsychiatric syndromes (depressive symptoms, inertia, vegetative symptoms, irritability/aggression, behavioral dysregulation, psychotic symptoms) and comorbid neuropsychiatric syndromes were calculated according to the Clinical Dementia Rating scale. To investigate the relationship among neuropsychiatric syndromes, logistic regression analyses were performed. About 95% of patients with AD had one or more neuropsychiatric symptoms and syndromes during the past month. Among the neuropsychiatric syndromes, irritability/aggression (76.2%) was the most frequent, followed by apathy (72.3%) and depressive symptoms (68.0%). About 90% of the subjects had one or more comorbid neuropsychiatric syndromes. The mean numbers of comorbid neuropsychiatric syndromes were significantly varied according to the severity of disease (p<0.05). Depressive symptoms were significantly associated with vegetative symptoms and irritability/aggression (p<0.05). Inertia and psychotic symptoms were significantly associated with vegetative symptoms and behavioral dysregulation, respectively (p<0.05). This study demonstrated that neuropsychiatric syndromes of AD were highly prevalent and involved complex relationships among them.
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PMID:Prevalence of neuropsychiatric syndromes in Alzheimer's disease (AD). 2053 36

Corticobasal syndrome (CBS) and progressive supranuclear palsy syndrome (PSPS) are two of the atypical Parkinsonism syndromes, in that patients exhibit rigidity, occasional tremor and postural instability, but do not symptomatically respond to dopamine replacement. CBS and PSPS can often present with complex cognitive difficulties and neuropsychiatric disturbances. Symptoms of depression, apathy, or agitation can be subtle and are often overlooked as reactions to learning a new diagnosis of Parkinsonism. These symptoms may be the earliest presenting evidence of CBS or PSPS, and these syndromes can be misdiagnosed with a primary psychiatric disorder rather than a neurodegenerative condition. Patients may be inappropriately treated with antipsychotic medications that exacerbate the extra-pyramidal motor features of the syndromes. When symptoms are considered to comprise a neurodegenerative syndrome, it may be an inaccurate diagnosis as many features of CBS and PSPS not only overlap with each other, but also with other dementia syndromes. This review discusses similarities and differences between the syndromes of CBS and PSPS in terms of neuropsychiatric features. Improved characterization of the clinical syndromes is necessary to better predict underlying pathology. Improved education about these diseases would help patients, caregivers and clinicians to anticipate symptom progression and avoid premature nursing home placement.
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PMID:Neuropsychiatry of corticobasal degeneration and progressive supranuclear palsy. 2361 49

Depressive symptoms are common in patients with Alzheimer's disease (AD) and increase the caregiver burden, although the etiology and pathologic mechanism of depressive symptoms in AD patients remain unclear. In this study, we tried to clarify the cerebral blood flow (CBF) correlates of depressive symptoms in AD, excluding the effect of apathy and anxiety. Seventy-nine consecutive patients with AD were recruited from outpatient units of the Memory Clinic of Okayama University Hospital. The level of depressive symptoms was evaluated using the depression domain of the Neuropsychiatric Inventory (NPI). The patients underwent brain SPECT with 99mTc-ethylcysteinate dimer. After removing the effects of age, anxiety and apathy scores of NPI, and five subscales of Addenbrooke's Cognitive Examination-revised (ACE-R), correlation analysis of NPI depression scores showed a significant cluster of voxels in the left middle frontal gyrus (Brodmann area 9), similar to the areas in the simple correlation analysis. The dorsolateral prefrontal area is significantly involved in the pathogenesis of depressive symptoms in AD, and the area on the left side especially may be closely related to the depressive symptoms revealed by NPI.
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PMID:Depressive symptoms and regional cerebral blood flow in Alzheimer's disease. 2429 73

Patients with Alzheimer's disease after an initial response to cholinesterase inhibitors may complain a later lack of efficacy. This, in association with incident neuropsychiatric symptoms, may worsen patient quality of life. Thus, the switch to another cholinesterase inhibitor could represent a valid therapeutic strategy. The aim of this study was to investigate the effectiveness of the switch from one to another cholinesterase inhibitor on cognitive and affective symptoms in mild to moderate Alzheimer disease patients. Four hundred twenty-three subjects were included from the EVOLUTION study, an observational, longitudinal, multicentre study conducted on Alzheimer disease patients who switched to different cholinesterase inhibitor due either to lack/loss of efficacy or response, reduced tolerability or poor compliance. All patients underwent cognitive and neuropsychiatric assessments, carried out before the switch (baseline), and at 3 and 6-month follow-up. A significant effect of the different switch types was found on Mini-Mental State Examination score during time, with best effectiveness on mild Alzheimer's disease patients switching from oral cholinesterase inhibitors to rivastigmine patch. Depressive symptoms, when measured using continuous Neuropsychiatric Inventory values, decreased significantly, while apathy symptoms remained stable over the 6 months after the switch. However, frequency of both depression and apathy, when measured categorically using Neuropsychiatric Inventory cut-off scores, did not change significantly during time. In mild to moderate Alzheimer disease patients with loss of efficacy and tolerability during cholinesterase inhibitor treatment, the switch to another cholinesterase inhibitor may represent an important option for slowing cognitive deterioration. The evidence of apathy stabilization and the positive tendency of depressive symptom improvement should definitively be confirmed in double-blind controlled studies.
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PMID:Cognitive and affective changes in mild to moderate Alzheimer's disease patients undergoing switch of cholinesterase inhibitors: a 6-month observational study. 2458 3

The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and resources available to patients, caregivers, and health care providers.
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PMID:Firearms in Frail Hands: An ADL or A Public Health Crisis! 2510 33

Objective. Studies on the effect of subthalamic deep brain stimulation (STN-DBS) on executive functioning in Parkinson's disease (PD) are still controversial. In this study we compared self-reported daily executive functioning in PD patients before and after three months of STN-DBS. We also examined whether executive functioning in everyday life was associated with motor symptoms, apathy, and psychiatric symptoms. Method. 40 PD patients were examined with the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), the Symptom Checklist 90-Revised (SCL-90-R), and the Apathy Evaluation Scale (AES-S). Results. PD patients reported significant improvement in daily life executive functioning after 3 months of STN-DBS. Anxiety scores significantly declined, while other psychiatric symptoms remained unchanged. The improvement of self-reported executive functioning did not correlate with motor improvement after STN-DBS. Apathy scores remained unchanged after surgery. Only preoperative depressed mood had predictive value to the improvement of executive function and appears to prevent potentially favorable outcomes from STN-DBS on some aspects of executive function. Conclusion. PD patients being screened for STN-DBS surgery should be evaluated with regard to self-reported executive functioning. Depressive symptoms in presurgical PD patients should be treated. Complementary information about daily life executive functioning in PD patients might enhance further treatment planning of STN-DBS.
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PMID:Self-Reported Executive Functioning in Everyday Life in Parkinson's Disease after Three Months of Subthalamic Deep Brain Stimulation. 2616 29

Depressive symptoms may be the only expression of brain tumours. Thus, it is challenging to suspect a brain tumour when patients with depression have a normal neurological examination. We illustrate this by a case report regarding a meningiomatosis revealed by a treatment-resistant depressive syndrome that improved after surgery. This case highlights the importance of identifying signs of brain tumour in patients with depression. Although there is no consensus about whether brain imaging is indicated for depressive syndromes, it should be performed, particularly in late onset of depressive syndrome (after 50 years of age), treatment-resistant depression or in apathy with a reduced emotional response or without dysphoric manifestations.
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PMID:Meningiomatosis revealed by a major depressive syndrome. 2668 30


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