Locus coeruleus connectivity alterations in late-life major depressive disorder during a visual oddball task

The Locus Coeruleus (LC) is the major source of noradrenergic neurotransmission. Structural alterations in the LC have been observed in neurodegenerative disorders and at-risk individuals, although functional connectivity studies between the LC and other brain areas have not been yet performed in these populations. Patients with late-life major depressive disorder (MDD) are indeed at increased risk for neurodegenerative disorders, and here we investigated LC connectivity in late-life MDD in comparison to individuals with amnestic type mild cognitive impairment (aMCI) and healthy controls (HCs). We assessed 20 patients with late-life MDD, 16 patients with aMCI, and 26 HCs, who underwent a functional magnetic resonance scan while performing a visual oddball task. We assessed task-related modulations of LC connectivity (i.e., Psychophysiological Interactions, PPI) with other brain areas. A T1-weighted fast spin-echo sequence for LC localization was also obtained. Patients with late-life MDD showed lower global connectivity during target detection in a cluster encompassing the right caudal LC. Specifically, we observed lower LC connectivity with the left anterior cingulate cortex (ACC), the right fusiform gyrus, and different cerebellar clusters. Moreover, alterations in LC-ACC connectivity correlated negatively with depression severity (i.e., Geriatric Depression Scale and number of recurrences). Reduced connectivity of the LC during oddball performance seems to specifically characterize patients with late-life MDD, but not other populations of aged individuals with cognitive alterations. Such alteration is associated with different measures of disease severity, such as the current presence of symptoms and the burden of disease (number of recurrences)

Self-Perceived Quality of Life Among Patients with Alzheimer's Disease: Two Longitudinal Models of Analysis

Abstract. The objective was to analyze the factors that influence self-perceived quality of life (QoL) in patients with Alzheimer's disease (AD), contrasting two different longitudinal models. A total of 127 patients were followed up over 24 months. The instruments applied were: Quality of Life in Alzheimer's Disease scale (QoL-AD), Geriatric Depression Scale-15, Anosognosia Questionnaire-Dementia, Disability Assessment in Dementia, Neuropsychiatric Inventory, and the Mini-Mental State Examination. Two models for grouping patients were tested: 1) Baseline score on the QoL-AD (QoLBaseline), and 2) Difference in QoL-AD score between baseline and follow-up (QoL-Change). Generalized estimating equations were used to analyze longitudinal data, and multinomial regression analyses were performed. Over the follow-up period the QoL-Baseline model showed greater variability between groups (Wald χ 2 = 172.3, p < 0.001) than did the QoLChange model (Wald χ 2 = 1.7, p = 0.427). In the QoL-Baseline model the predictive factors were greater depression (odds ratio [OR] = 1.20; 95% CI: 1.00-1.45) and lower functional ability (OR = 0.92; 95% CI: 0.85-0.99) for the Low QoL group (< 33 QoL-AD), and less depression (OR = 0.68; 95% CI: 0.52-0.88), more anosognosia (OR = 1.07; 95% CI: 1.01-1.13), and fewer neuropsychiatric symptoms (OR = 0.95; 95% CI: 0.91-0.99) for the High-QoL group (>37 QoL-AD). The model based on baseline scores (QoL-Baseline) was better than the QoL-Change model in terms of identifying trajectories and predictors of QoL in AD

Clinical differences in patients with alzheimer's disease according to the presence or absence of anosognosia: implications for perceived quality of life

This study aimed to determine the factors that predict anosognosia in patients with Alzheimer's disease (AD) and to examine the effect of anosognosia on patient and caregiver perceptions of the patient's quality of life (QoL-p), using a cross-sectional design with 164 patients and their caregivers. Instruments of measurement included Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Quality of Life in AD (QoL-AD), Disability Assessment for Dementia, Neuropsychiatric Inventory, and the Global Deterioration Scale (GDS). A binary logistic regression analysis was performed to identify the factors that predict anosognosia, while a linear regression analysis was conducted to determine the factors associated with QoL-AD. The degree of anosognosia increased in line with GDS stage (F (2,161) = 41.3, p < 0.001). In the binary regression analysis, the variables that predicted anosognosia were more neuropsychiatric symptoms (OR = 1.11, 95% CI: 1.06-1.17, p < 0.001), deficits in ADL (OR = 0.88, 95% CI: 0.83-0.94, p < 0.001), less depression (OR = 0.66, 95% CI: 0.54-0.82, p < 0.001), and older age (OR = 1.08, 95% CI: 1.00-1.15, p = 0.027). With regards to QoL-p, the multiple linear regression analysis for patients (r2 = 0.486) showed that less depression (β = -0.52, p < 0.001) and greater anosognosia (β = 0.40, p < 0.001) explained 33% and 10% of the variance in QoL-AD, respectively. Greater anosognosia was associated with better perceived QoL-p, especially in advanced GDS stages. Anosognosia was associated with greater caregiver burden and a greater discrepancy between patient and caregiver ratings of QoL-p

Prevalencia de la anosognosia en la enfermedad de Alzheimer

Fundamento y objetivo: La presencia de anosognosia es un trastorno que afecta a la presentación clínica de la enfermedad de Alzheimer (EA), incrementándose su frecuencia con la evolución de la EA. El objetivo fue determinar la prevalencia de anosognosia y analizar los factores asociados y predictores. Pacientes y método: Estudio multicéntrico transversal, observacional y analítico de 345 pacientes con EA. La anosognosia se evaluó mediante la Anosognosia Questionnaire in Dementia (AQ-D) y el estadio evolutivo con la Global Deterioration Scale (GDS). Se utilizaron los tests MMSE, DAD y NPI para valorar la cognición, el estado funcional y los síntomas neuropsiquiátricos, respectivamente. Se ajustaron modelos de regresión lineal para determinar las variables asociadas y de regresión logística binaria(RLog) para analizar los factores predictores de la anosognosia. Resultados: La prevalencia global de la anosognosia fue del 46,7% (intervalo de confianza del 95% [IC95%] 41,3-52,1). La prevalencia en los estadios fue de 28,4% (GDS 4), 64,6% (GDS 5) y 91,4% (GDS 6). La RLog identificó como variables predictoras la mayor edad (odds ratio [OR] 1,04; IC 95% 1,01-1,09), la menor capacidad funcional (OR 0,96; IC 95% 0,93-0,98), el menor nivel cognitivo (OR 0,9; IC 95% 0,88-0,99), y la mayor apatía (OR 1,1; IC 95% 1,03-1,18), desinhibición (OR 1,2; IC 95% 1,09-1,50), irritabilidad (OR 1,1; IC 95% 1,09-1,50) y trastornos motores (OR 1,2; IC 95% 1,09-1,50). Conclusiones: La anosognosia se incrementa con el mayor deterioro. En los pacientes en fase leve las variables predictoras fueron la apatía, la desinhibición y los trastornos motores