Detection of anxiety symptoms in persons with dementia: A systematic review

Goodarzi, Zahra; Samii, Leyla; Azeem, Feeha; Sekhon, Ramnik; Crites, Stephanie; Pringsheim, Tamara; Smith, Eric E.; Ismail, Zahinoor; Holroyd‐Leduc, Jayna

doi:10.1016/j.dadm.2019.02.005

Cited by 18 publications

(10 citation statements)

References 22 publications

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“…The increased prevalence of phobic changes in our FTD cohort is in line both with clinical experience and previous single-case studies ( Clark et al., 2014 ). This finding foregrounds a symptom that has been largely overlooked by standard instruments in the field ( Cummings et al., 1994 ; Goodarzi et al., 2019 ; Goyal, Bergh, Engedal, Kirkevold, & Kirkevold, 2017 ), while extending previous evidence that anxiety is a common symptom in dementia, especially FTD ( Porter et al., 2003 ). More specifically, development of new phobic reactivity appears to be a hallmark of FTD, at odds both with the direction of phobic alterations observed in the present AD group and with previous work indicating that phobic reactivity tends to become attenuated in healthy older people ( Byers et al., 2010 ; Chou et al., 2011 ; Grenier et al., 2019 ; Sigström et al., 2016 ; Stinson et al., 2007 ).…”

Section: Discussionsupporting

confidence: 78%

Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis

Jiménez

Bond

Requena-Komuro

et al. 2020

Cortex

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Introduction Abnormal behavioural and physiological reactivity to emotional stimuli is a hallmark of frontotemporal dementia (FTD), particularly the behavioural variant (bvFTD). As part of this repertoire, altered phobic responses have been reported in some patients with FTD but are poorly characterised. Methods We collected data (based on caregiver reports) concerning the prevalence and nature of any behavioural changes related to specific phobias in a cohort of patients representing canonical syndromes of FTD and Alzheimer's disease (AD), relative to healthy older controls. Neuroanatomical correlates of altered phobic reactivity were assessed using voxel-based morphometry. Results 46 patients with bvFTD, 20 with semantic variant primary progressive aphasia, 25 with non-fluent variant primary progressive aphasia, 29 with AD and 55 healthy age-matched individuals participated. Changes in specific phobia were significantly more prevalent in the combined FTD cohort (15.4% of cases) and in the bvFTD group (17.4%) compared both to healthy controls (3.6%) and patients with AD (3.5%). Attenuation of phobic reactivity was reported for individuals in all participant groups, however new phobias developed only in the FTD cohort. Altered phobic reactivity was significantly associated with relative preservation of grey matter in left posterior middle temporal gyrus, right temporo-occipital junction and right anterior cingulate gyrus, brain regions previously implicated in contextual decoding, salience processing and reward valuation. Conclusion Altered phobic reactivity is a relatively common issue in patients with FTD, particularly bvFTD. This novel paradigm of strong fear experience has broad implications: clinically, for diagnosis and patient well-being; and neurobiologically, for our understanding of the pathophysiology of aversive sensory signal processing in FTD and the neural mechanisms of fear more generally.

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Section: Discussionsupporting

confidence: 78%

Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis

Jiménez

Bond

Requena-Komuro

et al. 2020

Cortex

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“…In a systematic review about the ways to evaluate anxiety symptoms in persons with dementia (Goodarzi et al, 2019 ), three validated tools were identified: the Geriatric Anxiety Inventory, Penn State Worry Questionnaire, and the Rating Anxiety in Dementia (RAID) scale. Goodarzi et al ( 2019 ) reported that the RAID has the highest sensitivity for anxiety and was specifically designed for those experiencing dementia; thus, it may be useful to take advantage of these scales. However, information about the impact of anxiety on capacity to consent to treatment in individuals with dementia is insufficient.…”

Section: Discussionmentioning

confidence: 99%

Anxiety Impacts Consent Capacity to Treatment in Alzheimer's Disease

et al. 2021

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This study aimed to clarify how behavioral and psychological symptoms of dementia (BPSD) and cognitive function affect the decision-making capacity of persons with Alzheimer's disease (AD) in a real informed consent situation about anti-dementia drug prescriptions. The participants were 76 patients with AD. We used the MacArthur Competence Assessment Tool to assess the capacity for consent to treatment (MacCAT-T). We simultaneously used the Mini-Mental State Examination, Executive Interview, Executive Clock Drawing Task, Logical Memory I of the Wechsler Memory Scale-Revised (LM I), LM II, and Neuropsychiatric Inventory (NPI) to assess cognitive function and psychiatric symptoms. We calculated the correlations between the MacCAT-T scores and the demographic, neuropsychological, and psychiatric variables. Once the univariable correlations were determined, we performed simple linear regression analyses to examine if the regression equations were significant. In the final analyses, we incorporated significant variables into stepwise multiple linear regression analyses to determine the most significant predictors of mental capacity. Age (β = −0.34), anxiety (β = −0.27), and LM I (β = 0.26) were significant predictors of “understanding” (adjusted R2 = 0.29). LM II (β = 0.39), anxiety (β = −0.29), and education (β = 0.21) were significant predictors of “understanding of alternative treatments” (adjusted R2 = 0.30). Anxiety (β = −0.36) and age (β = −0.22) were significant predictors of “appreciation” (adjusted R2 = 0.18). Age (β = −0.31) and anxiety (β = −0.28) were significant predictors of explained variance in “reasoning” (adjusted R2 = 0.17). Patients with anxiety had lower scores on all five MacCAT-T subscales: “understanding,” without 3.8 [SD = 1.2] vs. with 2.6 [SD = 1.1]; “understanding of alternative treatments,” without 2.9 [SD = 2.2] vs. with 1.3 [SD = 1.8]; “appreciation,” without 2.9 [SD = 1.1] vs. with 1.9 [SD = 1.2]; “reasoning,” without 4.0 [SD = 2.0] vs. with 2.7 [SD = 1.7]; and “expressing a choice,” without 1.9 [SD = 0.4] vs. with 1.5 [SD = 0.6]. Considering the effects of BPSD, cognitive function, and age/education when assessing consent capacity in persons with AD is important. Reducing anxiety may contribute to improved capacity in persons with AD.

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“…Sixty subjects were diagnosed with dementia and excluded, while the remaining 299 were diagnosed with normal cognition ( n = 117) or MCI ( n = 182) and were enrolled in the study. Subjects with dementia were excluded because of concerns they would not be able to reliably answer the study questionnaires since we did not use dementia‐specific tools 49,50 for the screening of anxiety and depression (see later). The study is part of a wider research project carried out at our geriatric unit and designed to collect data on different characteristics of outpatients.…”

Section: Methodsmentioning

confidence: 99%

Different dimensions of social support differentially predict psychological well‐being in late life: opposite effects of perceived emotional support and marital status on symptoms of anxiety and of depression in older outpatients in Italy

et al. 2020

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Background Social support is important to psychological well‐being in late life. However, findings in the literature regarding its effects are mixed, less information is available for anxiety than for depressive symptoms, and few studies have been carried out in Italy. Therefore, the aim of this study was to investigate the influence of social support on symptoms of anxiety and of depression in a sample of geriatric outpatients in Italy. Methods This cross‐sectional study consecutively enrolled 299 outpatients without dementia (age ≥ 65, all neuropsychologically tested). Social support was assessed with the ENRICHD Social Support Instrument and by interview. Symptoms of anxiety and of depression were evaluated with short versions of the State‐Trait Personality Inventory Trait Anxiety and Geriatric Depression scales. The relationship between social support and psychological well‐being was examined by multiple linear regression models with socio‐demographic and clinical variables, including cognitive performance, as potential confounders. Results Perceived emotional support was a negative predictor of symptoms of anxiety (standardised beta coefficient (β) ‐0.288, standard error (SE) 0.074, P < 0.001) and symptoms of depression (β −0.196, SE 0.040, P < 0.001). On the contrary, marital status (i.e. being married) was a positive predictor of symptoms of anxiety (β 0.199, SE 0.728, P = 0.003) and symptoms of depression (β 0.142, SE 0.384, P = 0.035). Conclusions Different dimensions of social support differentially affect psychological well‐being. The protective effect of perceived emotional support is consistent with social cognitive models of health. The harmful effect of being married may be capturing the distress of the pre‐bereavement period. Alternatively, it may reflect oppression by gender roles within marriage in a predominantly female sample in a traditional society. Our findings provide insight into the relationship between social support and psychological well‐being, and identify potential targets for psychosocial interventions promoting mental health in late life.

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Detection of anxiety symptoms in persons with dementia: A systematic review

Cited by 18 publications

References 22 publications

Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis

Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis

Anxiety Impacts Consent Capacity to Treatment in Alzheimer's Disease

Different dimensions of social support differentially predict psychological well‐being in late life: opposite effects of perceived emotional support and marital status on symptoms of anxiety and of depression in older outpatients in Italy

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