Agitation and impulsivity in mid and late life as possible risk markers for incident dementia

To identify knowledge gaps regarding new-onset agitation and impulsivity prior to onset of cognitive impairment or dementia the International Society to Advance Alzheimer's Research and Treatment Neuropsychiatric Syndromes (NPS) Professional Interest Area conducted a scoping review. Extending a series of reviews exploring the pre-dementia risk syndrome Mild Behavioral Impairment (MBI), we focused on late-onset agitation and impulsivity (the MBI impulse dyscontrol domain) and risk of incident cognitive decline and dementia. This scoping review of agitation and impulsivity pre-dementia syndromes summarizes the current biomedical literature in terms of epidemiology, diagnosis and measurement, neurobiology, neuroimaging, biomarkers, course and prognosis, treatment, and ongoing clinical trials. Validations for pre-dementia scales such as the MBI Checklist, and incorporation into longitudinal and intervention trials, are needed to better understand impulse dyscontrol as a risk factor for mild cognitive impairment and dementia.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.Daniel Bateman receives support from the Indiana University Richard M. Fairbanks Chair of Aging Research, the Indiana University Cornelius and Yvonne Pettinga Chair of Medicine, and funding from the National Institute on Aging (NIA) grants K23AG059914 and P30AF10133. Sascha Gill receives funding from a University of Calgary Graduate Student Research Award. Sophie Hu receives funding from a Cana dian Institute of Health Research (CIHR) Master’s Research Award. Erin Foster: none. Myuri Ruthirakuhan receives funding from a CIHR Doctoral Research Award. Allis Sellek receives funding from Alzheimer Foundation of Costa Rica. Moyra Mortby receives support from the Australian National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) Dementia Research Development Fellowship #1102028. Veronika Matušková receives support from MH CZ – DRO, Motol University Hospital, Prague, Czech Republic 00064203 and Czech Ministry of Health grant 16-27611A. Kok Pin Ng: none. Rawan Tarawneh receives support from the Ohio State University Chronic Brain Injury Discovery Themes. Yvonne Freund-Levi:none. Sanjeev Kumar receives research support from Brain and Behavior Foundation, National institute on Ageing, BrightFocus Foundation, Brain Canada, Canadian Institute of Health Research, Centre for Ageing and Brain Health Innovation, Weston Brain Institute, and Centre for Mental Health and Addiction Foundation and University of Toronto. Serge Gauthier receives support from the CIHR, Weston, and the National Institutes of Health (NIH). Paul Rosenberg receives funding from the National Institute on Aging (NIA) grants R01AG049872 and R01 AG054771. Fabricio Ferreira de Oliveira has a grant from FAPESP - The State of São Paulo Research Foundation (grant #2015/10109-5). Devangere Devanand: none. Clive Ballard: none. Zahinoor Ismail has received funding from Alzheimer’s Society of Calgary via the Hotchkiss Brain Institute.published version, accepted version (12 month embargo), submitted versio

Is it time to revise the diagnostic criteria for apathy in brain disorders? the 2018 international consensus group

International audienceBackground. Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies.Methods. The expert panel (N=17) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed onthe occasion of the 26th European Congress of Psychiatry held in Nice (France).Results. Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient’s previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient’s environment.Conclusions. The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target

Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline

Successfully assisting older adults to maintain or improve cognitive function, particularly when they are dealing with neurodegenerative disorders such as Alzheimer’s disease (AD), remains a major challenge. Cognitive training may stimulate neuroplasticity thereby increasing cognitive and brain reserve. Commercial brain training programs are computerized, readily-available, easy-to-administer and adaptive but often lack supportive data and their clinical validation literature has not been previously reviewed. Therefore, in this review, we report the characteristics of commercially available brain training programs, critically assess the number and quality of studies evaluating the empirical evidence of these programs for promoting brain health in healthy older adults, and discuss underlying causal mechanisms. We searched PubMed, Google Scholar and each program’s website for relevant studies reporting the effects of computerized cognitive training on cognitively healthy older adults. The evidence for each program was assessed via the number and quality (PEDro score) of studies, including Randomized Control Trials (RCTs). Programs with clinical studies were subsequently classified as possessing Level I, II or III evidence. Out of 18 identified programs, 7 programs were investigated in 26 studies including follow-ups. Two programs were identified as possessing Level I evidence, three programs demonstrated Level II evidence and an additional two programs demonstrated Level III evidence. Overall, studies showed generally high methodological quality (average PEDro score = 7.05). Although caution must be taken regarding any potential bias due to selective reporting, current evidence supports that at least some commercially available computerized brain training products can assist in promoting healthy brain aging