Apathy is associated with faster global cognitive decline and early nursing home admission in dementia with Lewy bodies.

BACKGROUND: Little is known about the consequences of apathy in dementia with Lewy bodies (DLB), because previous research on apathy in dementia focused mainly on Alzheimer's disease (AD). METHODS: In this longitudinal study, we included patients with AD (n = 128) and patients with DLB (n = 81). At baseline, we analyzed the associations between apathy and cognition in the total sample and in AD and DLB separately. Generalized linear mixed models were used to investigate the association between apathy and Mini Mental State Examination (MMSE) over 4 years, and the Kaplan-Meier method was used to assess the association between apathy and survival or nursing home admission. RESULTS: In patients with DLB, apathy was associated with a faster global cognitive decline (MMSE) over 4 years. Patients with DLB and apathy had shorter time until nursing home admission than DLB patients without apathy and patients with AD, regardless of apathy. At baseline, patients with apathy had decreased performance on the Stroop color test and a composite executive function score. Neurocognition was unaffected by apathy in AD, but DLB patients with apathy had more verbal learning difficulties. CONCLUSIONS: Apathy seems to be associated with more serious symptomatology in DLB than in AD. It is important to focus on apathy in dementia because it is one of the most prevalent and disturbing behavioral and psychological symptoms.

A Longitudinal Study of Neurocognition in Dementia with Lewy Bodies Compared to Alzheimer's Disease.

INTRODUCTION: There are relatively few longitudinal studies on the differences in cognitive decline between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), and the majority of existing studies have suboptimal designs. AIM: We investigated the differences in cognitive decline in AD compared to DLB over 4 years and cognitive domain predictors of progression. METHODS: In a longitudinal study, 266 patients with first-time diagnosis of mild dementia were included and followed annually. The patients were tested annually with neuropsychological tests and screening instruments [MMSE (Mini-Mental Status Examination), Clinical Dementia Rating (CDR), the second edition of California Verbal Learning Test (CVLT-II), Trail Making Test A & B (TMT A & B), Stroop test, Controlled Oral Word Associations Test (COWAT) animal naming, Boston Naming Test, Visual Object and Space Perception Battery (VOSP) Cubes and Silhouettes]. Longitudinal analyses were performed with linear mixed effects (LME) models and Cox regression. Both specific neuropsychological tests and cognitive domains were analyzed. RESULTS: This study sample comprised 119 AD and 67 DLB patients. In TMT A, the DLB patients had a faster decline over 4 years than patients with AD (p = 0.013). No other longitudinal differences in specific neuropsychological tests were found. Higher executive domain scores at baseline were associated with a longer time to reach severe dementia (CDR = 3) or death for the total sample (p = 0.032). High or low visuospatial function at baseline was not found to be associated with cognitive decline (MMSE) or progression of dementia severity (CDR) over time. CONCLUSION: Over 4 years, patients with DLB had a faster decline in TMT A than patients with AD, but this should be interpreted cautiously. Beyond this, there was little support for faster decline in DLB patients neuropsychologically than in AD patients.

A longitudinal study of anxiety and cognitive decline in dementia with Lewy bodies and Alzheimer's disease.

BACKGROUND: Anxiety in dementia is common but not well studied. We studied the associations of anxiety longitudinally in Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). METHODS: In total, 194 patients with a first-time diagnosis of dementia were included (n = 122 patients with AD, n = 72 patients with DLB). Caregivers rated the patients' anxiety using the Neuropsychiatric Inventory, and self-reported anxiety was assessed with the anxiety and tension items on the Montgomery-Åsberg Depression Rating Scale. The Mini Mental State Examination was used to assess cognitive outcome, and the Clinical Dementia Rating (CDR)-Global and CDR boxes were used for dementia severity. Linear mixed effects models were used for longitudinal analysis. RESULTS: Neither in the total sample nor in AD or DLB was caregiver-rated anxiety significantly associated with cognitive decline or dementia severity over a 4-year period. However, in patients with DLB, self-reported anxiety was associated with a slower cognitive decline than in patients with AD. No support was found for patients with DLB with clinical anxiety having a faster decline than patients with DLB without clinical anxiety. Over the course of 4 years, the level of anxiety declined in DLB and increased in AD. CONCLUSIONS: Anxiety does not seem to be an important factor for the rate of cognitive decline or dementia severity over time in patients with a first-time diagnosis of dementia. Further research into anxiety in dementia is needed.

A systematic review of cognitive decline in dementia with Lewy bodies versus Alzheimer's disease.

INTRODUCTION: The aim of this review was to investigate whether there is a faster cognitive decline in dementia with Lewy bodies (DLB) than in Alzheimer's disease (AD) over time. METHODS: PsycINFO and Medline were searched from 1946 to February 2013. A quality rating from 1 to 15 (best) was applied to the included studies. A quantitative meta-analysis was done on studies with mini mental state examination (MMSE) as the outcome measure. RESULTS: A total of 18 studies were included. Of these, six (36%) reported significant differences in the rate of cognitive decline. Three studies reported a faster cognitive decline on MMSE in patients with mixed DLB and AD compared to pure forms, whereas two studies reported a faster decline on delayed recall and recognition in AD and one in DLB on verbal fluency. Mean quality scores for studies that did or did not differ were not significantly different. Six studies reported MMSE scores and were included in the meta-analysis, which showed no significant difference in annual decline on MMSE between DLB (mean 3.4) and AD (mean 3.3). CONCLUSIONS: Our findings do not support the hypothesis of a faster rate of cognitive decline in DLB compared to AD. Future studies should apply recent diagnostic criteria, as well as extensive diagnostic evaluation and ideally autopsy diagnosis. Studies with large enough samples, detailed cognitive tests, at least two years follow up and multivariate statistical analysis are also needed.

Insomnia symptoms, objectively measured sleep, and disease severity in chronic obstructive pulmonary disease outpatients.

BACKGROUND: Sleep disturbances are known to have a negative impact on a range of clinical outcomes in chronic obstructive pulmonary disease (COPD). We examined the associations of insomnia symptoms and objectively measured sleep parameters to a composite score for body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index (a multidimensional index of COPD severity), arterial blood gases, nocturnal respiratory disturbances, periodic limb movements (PLM), psychologic distress, pain, age, and sex. METHODS: The sample comprised 73 COPD outpatients (mean age, 63.6years; standard deviation {SD}, 7.5; range 47-85years; 41.1% women). Insomnia symptoms were measured with the Bergen Insomnia Scale (BIS) and sleep efficiency (SE), slow-wave sleep (SWS), and total sleep time (TST) were assessed with clinical polysomnography (PSG). RESULTS: BODE index was positively associated with composite BIS score (P=.040). Patients with more severe COPD presented more complaints of nonrestorative sleep compared to patients with less severe COPD (P=.010). In multivariate analysis, the composite BIS score was independently associated with PLM (P<.001), nocturnal respiratory disturbances (P=.001), pain (P=.031), and psychologic distress (P=.044) but not with the BODE index. Objectively measured sleep variables were not associated with any of the health-related variables. CONCLUSION: Insomnia symptoms in COPD patients result from a wide range of health-related factors. More severe COPD may be associated with a subjective experience of nonrestorative sleep but not with objectively measured sleep variables.

The frequency and correlates of anxiety in patients with first-time diagnosed mild dementia.

BACKGROUND: Anxiety in persons with dementia has received little attention despite its severe consequences. In this observational cross-sectional study, we investigated the frequency of anxiety and associations between anxiety and socio-demographic and clinical variables in an outpatient sample with first-time diagnosed mild dementia. METHODS: The study sample (n = 169) comprised participants recruited from clinics in geriatric medicine and old age psychiatry for a longitudinal dementia study. Symptoms of anxiety were rated by a caregiver on the Neuropsychiatric Inventory (NPI) and by the patient on the anxiety tension item on the Montgomery and Åsberg Depression Rating Scale. Measures of caregiver stress, dementia-related impairment (Clinical Dementia Rating (CDR) scale), and cognitive functioning were also included. RESULTS: According to caregiver reports, 19.5% had clinically significant anxiety and an additional 22.5% had subclinical anxiety. Half of the patients reported experiencing anxiety from time to time. Patients with Lewy-body dementia reported anxiety more often compared to patients with Alzheimer's disease. Anxiety was associated with depression, higher caregiver stress, and more dementia-related impairment, but not with cognitive test performance. Caregiver stress and higher CDR score increased the odds for anxiety significantly, even when controlling for depression. CONCLUSION: Anxiety is common in patients with mild dementia, and seems to be associated not so much with cognitive test performance than with caregiver distress and the patient's ability to function in daily life. Anxiety should be taken into account when assessing dementia, as well as screened for when examining patients with known dementia.

A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD.

BACKGROUND: Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). The current study examined the effect of cognitive behavioral therapy (CBT) in groups for co-morbid, clinically significant anxiety and depression in COPD outpatients of both sexes. METHODS: In a randomized, controlled trial, CBT (n = 25) was compared with enhanced standard care (n = 26). Participants in both conditions were followed up at 2 and 8 months from baseline. Main outcome measures comprised the Beck Anxiety Inventory and the Beck Depression Inventory-II. Measures of health status and sleep were included as secondary outcomes. The effects of sex and age were also investigated. RESULTS: CBT resulted in improvement in symptoms of anxiety and depression, with effect sizes of 1.1 and 0.9 at post-treatment, respectively. The improvement was maintained at the 8-month follow-up, with effect sizes of 1.4 and 0.9. In the control group, there was no significant change. Compared to men, women had higher symptom levels throughout the whole study period. Younger patients had more anxiety and depression, age had also differential effects in the two groups on change in depressive symptoms. Changes in sleep and health status were small in both groups. CONCLUSIONS: The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinically significant anxiety and depression, and underline the need for integrating mental health care into the overall medical regimen for COPD.

The effect of psychomotor physical therapy on subjective health complaints and psychological symptoms.

BACKGROUND AND PURPOSE: The objective of this study was to examine the effect of Norwegian psychomotor physical therapy on subjective health complaints and psychological symptoms. METHOD: A non-randomized waiting list controlled design was used. Physiotherapists in Norway recruited patients for a treatment group (n = 40) and waiting list control group (n = 22). Patients on the waiting list could only be included for 6 months, as they then started treatment. Symptoms registration was obtained from both groups at baseline and 6 months, and only for the treatment group also at 12 months. The following self-report forms were used; Subjective Health Complaints Inventory (SCH); Beck Depression Inventory-II (BDI-II); Spielberger State-Trait Anxiety Inventory-Trait (STAI-T); Bergen Insomnia Scale (BIS); Fatigue Questionnaire (FQ); Quality of Life Inventory (QOLI); The Client Satisfaction Questionnaire (CSQ). RESULTS: The patients had had widespread and clinically significant health problems for an average of 9 years upon entrance to the study. After 6 months in psychomotor physical therapy, all the measured symptoms in the treatment group were significantly reduced, but only quality of life was significantly reduced when compared to the waiting list control group. After 12 months in therapy, the patients in the treatment group had continued to improve on all measured variables. The symptoms of anxiety and depression, as well as quality of life, were improved from clinical to non-clinical level. CONCLUSIONS: Norwegian psychomotor physical therapy seems to have potential for reducing symptoms of subjective health complaints, depression, anxiety, insomnia, fatigue and improving quality of life, although the process takes time. Further research is needed to gain more rigorous data, and randomized controlled studies are highly welcomed.

Factors affecting health status in COPD patients with co-morbid anxiety or depression.

Health status questionnaires provide standardized measures of patients' perceptions of the impact of disease on their daily life and well-being. Factors associated with health status were examined in a sample of 58 outpatients with chronic obstructive pulmonary disease (COPD) and co-morbid anxiety and/or depression. A cross-sectional descriptive study was conducted with the following measures: The St. George's Respiratory Questionnaire (SGRQ); the Beck Anxiety Inventory (BAI); the Beck Depression Inventory, 2nd edition (BDI); the Pittsburgh Sleep Quality Index (PSQI); and spirometry. Disease severity as measured with spirometrywas not related to health status. Perceptions of poor health as implied by the health status scores were positively associated with symptoms of anxiety and depression, sleep disturbances, and level of daily functioning. There were statistically significant differences between men and women on COPD severity, age, and the BAI scores. The findings emphasize the importance of screening the patients at all stages of disease severity for anxiety, depression, and sleeping problems, in order to provide adequate care for these problems.