Prevalence of Depressive Symptoms in a Memory Clinic Cohort: A Retrospective Study

Loreto, Flavia; Fitzgerald, Anna; Golemme, Mara; Gunning, Stephen; Win, Zarni; Patel, Neva; Carswell, Christopher; Perry, Richard; Kennedy, Angus; Edison, Paul; Malhotra, Paresh

doi:10.3233/jad-220170

Cited by 6 publications

(11 citation statements)

References 34 publications

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“…Comorbid depressive symptoms are a frequent feature in patients with AD 8 , but the nature of this link is still unclear. Where possible (n=83), we classified patients according to whether they had past (n=7), ongoing (n=24), or no (n=51) depressive symptoms at the time of presentation to our clinic (see Loreto et al, 2022 for classification procedure).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, research into its earlier phases has highlighted that AD is a continuum, rather than a discrete clinical entity, that goes from normal cognitive status to mild cognitive impairment to dementia 2 3 . Moreover, AD often coexists with other neuropathologies 4 or clinical comorbidities 5-8 that contribute to interindividual heterogeneity. In a recent study evaluating a memory clinic cohort, we have found that about half of patients requiring biomarker confirmation of AD due to diagnostic uncertainty also reported depressive symptoms 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, AD often coexists with other neuropathologies 4 or clinical comorbidities [5][6][7][8] that contribute to interindividual heterogeneity. In a recent study evaluating a memory clinic cohort, we have found that about half of patients requiring biomarker confirmation of AD due to diagnostic uncertainty also reported depressive symptoms 8 . Hypertension, heart disease and diabetes are also commonly comorbid with AD.…”

Section: Introductionmentioning

confidence: 99%

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Examining real-world Alzheimer’s disease heterogeneity using neuroanatomical normative modelling

Loreto

Verdi

Kia

et al. 2022

Preprint

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Alzheimer′s disease (AD) has been traditionally associated with episodic memory impairment and medial temporal lobe atrophy. However, recent literature has highlighted the existence of atypical forms of AD, presenting with different cognitive and radiological profiles. Failure to appreciate the heterogeneity of AD in the past has led to misdiagnoses, diagnostic delays, clinical trial failures and risks limiting our understanding of the disease. AD research requires the incorporation of new analytic methods that are as free as possible from the intragroup homogeneity assumption underlying case-control approaches according to which patients belonging to the same group are comparable to each other. Neuroanatomical normative modelling is a promising technique allowing for modelling the variation in neuroimaging profiles and then assessing individual deviations from the respective distribution. Here, neuroanatomical normative modelling was applied for the first time to a real-worldclinical cohortof Alzheimer′s disease patients (n=86) who had a positive amyloid PET scan and a T1-weighted MR performed as part of their diagnostic workup. The model indexed normal cortical thickness distributions using a separate healthy reference dataset (n= 33,072), employing hierarchical Bayesian regression to predict cortical thickness per region using age and sex. Transfer learning was used to recalibrate the normative model on avalidation cohort(n=20) of scanner-matched cognitively normal individuals. Brain heterogeneity was quantified as z-scores at each of the 148 ROIs generated within each AD patient. Z-scores < -1.96 defined as outliers. Clinical features including disease severity, presenting phenotypes and comorbidities were collected from health records to explore their association with outlier profiles. Amyloid quantification was performed using an automated PET-only driven method to examine the association between amyloid burden and outliers. The total number of individual outliers (total outlier count) in biomarker-confirmed AD clinical patients ranged between 1 and 120 out of 148 (median 21.5). The superior temporal sulcus was the region with the highest count of outliers (60%) in AD patients. The mean proportion of outliers was higher in the temporal (31.5%) than in the extratemporal (19.1%) regions and up to 20% of patients had no temporal outliers. We found higher mean outlier count in patients with non-amnestic phenotypes, at more advanced disease stages and without depressive symptoms. Amyloid burden was negatively associated with outlier count. This study corroborates the heterogeneity of brain atrophy in AD and provides evidence that this approach can be used to explore anatomo-clinical correlations at an individual level.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Examining real-world Alzheimer’s disease heterogeneity using neuroanatomical normative modelling

Loreto

Verdi

Kia

et al. 2022

Preprint

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“…All 77 patients included in this study were scanned using a Siemens Biograph 64 PET/CT scanner. The amyloid PET procedure and clinical interpretation were performed as described elsewhere 36,37 . Briefly, images were acquired following post‐injection interval of intravenous 18F‐Florbetapir or 18F‐Florbetaben and were visually read as positive or negative by an experienced nuclear medicine radiologist.…”

Section: Methodsmentioning

confidence: 99%

Visual atrophy rating scales and amyloid PET status in an Alzheimer's disease clinical cohort

Loreto

Gontsarova

Scott

et al. 2023

Ann Clin Transl Neurol

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Objectives Visual rating scales (VRS) are the quantification method closest to the approach used in routine clinical practice to assess brain atrophy. Previous studies have suggested that the medial temporal atrophy (MTA) rating scale is a reliable diagnostic marker for AD, equivalent to volumetric quantification, while others propose a higher diagnostic utility for the Posterior Atrophy (PA) scale in early‐onset AD. Methods Here, we reviewed 14 studies that assessed the diagnostic accuracy of PA and MTA, we explored the issue of cut‐off heterogeneity, and assessed 9 rating scales in a group of patients with biomarker‐confirmed diagnosis. A neuroradiologist blinded to all clinical information rated the MR images of 39 amyloid‐positive and 38 amyloid‐negative patients using 9 validated VRS assessing multiple brain regions. Automated volumetric analyses were performed on a subset of patients (n = 48) and on a group of cognitively normal individuals (n = 28). Results No single VRS could differentiate amyloid‐positive from amyloid‐negative patients with other neurodegenerative conditions. 44% of amyloid‐positive patients were deemed to have age‐appropriate levels of MTA. In the amyloid‐positive group, 18% had no abnormal MTA or PA scores. These findings were substantially affected by cut‐off selection. Amyloid‐positive and amyloid‐negative patients had comparable hippocampal and parietal volumes, and MTA but not PA scores correlated with the respective volumetric measures. Interpretation Consensus guidelines are needed before VRS can be recommended for use in the diagnostic workup of AD. Our data are suggestive of high intragroup variability and non‐superiority of volumetric quantification of atrophy over visual assessment.

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“…The impact of a diagnosis of Alzheimer’s disease (AD) is one of the most devastating stressful life events at the end of life. Depending on the premorbid psychopathological situation of patients, especially that related to mood disorders, comorbid disorders that accelerate cognitive, functional, and structural deterioration in frontotemporal brain areas are to be expected [ 1–3 ].…”

Section: Introductionmentioning

confidence: 99%

Mindfulness Prevents Depression and Psychopathology in Elderly People with Mild to Moderate Alzheimer’s Disease: A Randomized Clinical Trial

Quintana-Hernández¹,

Rojas-Hernández

Santana-del-Pino

et al. 2023

JAD

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Background: This longitudinal study addressed whether mindfulness practice prevents psychological and behavioral symptoms, especially mood disorders, in Alzheimer’s disease (AD). Objective: To assess the incidence of depression in the course of AD and to determine which non-pharmacological treatment (NPT) is most effective in preventing psychopathological symptoms. Methods: We conducted a longitudinal, non-inferiority and equivalence randomized clinical trial, repeated-measures design, with a control group and three experimental treatments: mindfulness, cognitive stimulation, and relaxation. Each experimental group performed three weekly sessions for two years. The pharmacological treatment of all participants was donepezil (10 mg). Participants were patients with probable AD without diagnosed depression from the public neurology services of the Canary Health Service, Spain. Psychological evaluation was performed using the Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), and Neuropsychiatric Inventory (NPI-Q). The statistical analysis included only patients who attended at least 75% of the sessions. A nonparametric, repeated-measures analysis was performed with Kruskal-Wallis H test and between-group differences with Mann-Whitney U test with Bonferroni correction (p < 0.008). Effect size was calculated with partial eta-squared. Results: The results showed significant differences with large effect sizes (η2p>0.14) between mindfulness and the rest of the experimental groups as well as the control in the GDS, HDRS, and NPI-Q scales. Conclusion: Compared to the other experimental groups, only mindfulness prevented the onset of depression and other psychopathologies in early-stage AD. Based on its effectiveness in maintaining cognitive functions and preventing psychopathology, we recommend mindfulness as the first-choice NPT for mild to moderate AD.

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Prevalence of Depressive Symptoms in a Memory Clinic Cohort: A Retrospective Study

Cited by 6 publications

References 34 publications

Examining real-world Alzheimer’s disease heterogeneity using neuroanatomical normative modelling

Examining real-world Alzheimer’s disease heterogeneity using neuroanatomical normative modelling

Visual atrophy rating scales and amyloid PET status in an Alzheimer's disease clinical cohort

Mindfulness Prevents Depression and Psychopathology in Elderly People with Mild to Moderate Alzheimer’s Disease: A Randomized Clinical Trial

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