Neuropsychiatric symptoms and their impact on quality of life in multiple system atrophy

Background: Multiple system atrophy (MSA) is a sporadic neurodegenerative disorder characterized by severe dysautonomia and atypical Parkinsonism or cerebellar dysfunction. Disease-modifying treatment is not available and the mainstream of care is supportive. Neuropsychiatric symptoms are frequent in MSA and their successful management can improve patients’ quality of life (QOL). This study aimed to define a comprehensive neuropsychiatric profile in MSA patients in relation to QOL. Methods: In 48 MSA patients and 40 controls neuropsychiatric symptoms were assessed using Neuropsychiatric Inventory. MSA patients completed Beck Depression Inventory and QOL questionnaire (SF12), including Mental and Physical subscales. Results: Eighty-seven percent of MSA patients had neuropsychiatric symptoms as compared with 10.4% of controls. Depression (56%), apathy (48%), anxiety (27%), and agitation (27%) predominated. The Physical SF-12 scores were lower in the patients as compared with the controls. Neuropsychiatric Inventory (NPI) scores did not correlate with QOL measures. Depression, as reflected by the BDI, correlated with the mental component score of the SF-12 in MSA patients. Conclusions: Neuropsychiatric symptoms are very frequent in patients with MSA and are dominated by depression and apathy. They appear independent from physical disability and loosely map onto the known brain pathology of MSA. Only depression, as reflected by the BDI, negatively affected mental QOL. The discrepancy between the BDI and NPI-depression scores likely stems from the different approaches to symptoms by these questionnaires

Vascular dementia in a population-based autopsy study

BACKGROUND: The validity of the clinical diagnosis of vascular dementia (VaD) remains suboptimal. OBJECTIVE: To investigate clinicopathologic correlations in VaD. METHODS: We used the medical records-linkage system of the Rochester Epidemiology Project to identify incident cases of dementia in Rochester, Minn, from January 1, 1985, through December 31, 1989. Dementia and Alzheimer disease (AD) were defined by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Vascular dementia was defined by criteria including imaging results. Pathological characteristics of AD were quantified by means of standard scoring methods for neurofibrillary tangles and neuritic plaques. Vascular pathological findings were assessed by expert neuropathological opinion. RESULTS: Of 419 patients with dementia who died before the study, neuropathological examination results were available in 89 (21%) with median age at onset of 80 years (range, 50-96 years; 52 [58%] women). Pathological diagnoses were AD in 45 patients (51%), pure VaD in 12 (13%), combined AD and VaD in 11 (12%), and other diagnoses in the remaining 21 patients. Criteria for VaD that required either a temporal relationship between a stroke and dementia onset or worsening, or bilateral infarctions in specified locations demonstrated on imaging results (Mayo Clinic criteria) had 75% sensitivity and 81% specificity for pure VaD (positive likelihood ratio, 3.9; 95% confidence interval, 2.2-6.7). Five cases of pure VaD lacked the temporal relationship and accounted for the imperfect sensitivity of the criteria. CONCLUSIONS: In this population-based autopsy study, the presence of vascular pathological characteristics in the absence of major AD pathological findings was common. Pure VaD without overt clinical strokes remains a challenge for antemortem diagnosis

Association between global brain volume and the rate of cognitive change in elderly humans without dementia

Patients with mild cognitive deficits experience different types of evolution. They are at increased risk of developing dementia, but they have also a chance of remaining stable in cognition or of improving. We investigated whether global brain volume, callosal size and hippocampal size are associated with the rate of cognitive change in elderly without dementia. Volumetric MR images were recorded from 39 controls and 35 patients with questionable dementia who were followed up longitudinally for a mean of 2.3 years. The outcome measure was the annual change in the test score in the Structured Interview for the Diagnosis of Alzheimer's Dementia and Multi-Infarct Dementia, which includes all items of the Mini-Mental State Examination. Global brain volume, grey matter volume and white matter volume were the only significant independent predictors of the rate of cognitive change