Advances in Neurodegenerative Diseases

[No abstract available

Associations between neuropsychiatric symptoms and incident Alzheimer’s dementia in men versus women

Objective: To examine whether associations between individual neuropsychiatric symptoms (NPS) and incident Alzheimer’s dementia (AD) differ in men versus women. Methods: Data were acquired from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set. Two sets of older (≥ 60 years) participants were formed: one of cognitively unimpaired (CU) individuals, and one of participants with mild cognitive impairment (MCI). NPS were assessed using the Neuropsychiatric Inventory Questionnaire. Cox proportional hazards models examined associations between individual NPS and AD incidence separately for each participant set. These models featured individual NPS, sex, NPS by sex interactions as well as a number of covariates. Results: The analysis involved 9,854 CU individuals followed for 5.5 ± 3.8 years and 6,369 participants with MCI followed for 3.8 ± 3.0 years. NPS were comparably associated with future AD in men and women with MCI. Regarding CU participants, the following significant sex by NPS interactions were noted: female sex moderated the risk conferred by moderate/severe apathy (HR = 7.36, 3.25–16.64) by 74%, mitigated the risk conferred by moderate/severe depression (HR = 3.61, 2.08–6.28) by 52%, and augmented the risks conferred by mild depression (HR = 1.00, 0.60–1.68) and agitation (HR = 0.81, 0.40–1.64) by 83% and 243%, respectively. Conclusions: Apathy, depression and agitation were differentially associated with incident AD in CU men and women. No individual NPS was associated with different risks of future AD in men versus women with MCI. © 2022, The Author(s)

Vitamin D serum levels in patients with migraine: A meta-analysis

Background/Purpose: Dietary habits and nutrients have been associated with migraine. The present study comprises a meta-analysis of observational studies evaluating serum levels of 25-hydroxyvitamin D (25(OH)D) in patients with migraine and healthy controls. Methods: MEDLINE and Cochrane databases were comprehensively searched. References from retrieved observational studies, reviews and meta-analyses were manually screened. Quality assessment was performed based on the Newcastle-Ottawa Scale. 25(OH)D concentrations were assessed by estimates of mean differences (MD) and their precision [95% confidence intervals (95% CIs)]. Random effects (RE) or fixed effects (FE) model was used based on heterogeneity among trials (homogeneity determined when PQ > 0.1 and I2 < 50%). Publication bias was assessed by funnel plots. Results: Eight studies were included in the primary analysis, while nine studies were involved overall (in primary and secondary analyses). Serum levels of 25(OH)D were determined significantly lower in migraine patients (n = 952) in comparison with healthy controls (n = 8013) [eight studies, PQ < 0.1, I2 = 94%, RE model MD = −4.11, 95% CI = (−6.48, −1.74)]. Secondary analysis revealed no difference between patients with migraine (n = 269) compared to patients with other primary headache disorders (n = 223) [three studies, PQ = 0.51, I2 = 0%, FE model MD = −0.15, 95% CI = (−1.57, 1.05)], as well as between patients with tension type headache (n = 295) in comparison with healthy controls (n = 267) [three studies, PQ < 0.1, I2 = 96%, RE model MD = −7.11, 95% CI = (−15.50, 1.27)]. Conclusions: 25(OH)D concentration is lower in patients with migraine than healthy individuals. In view of this finding, investigation of the effect of vitamin D supplementation in patients suffering from migraine is warranted. © 2020 Elsevier Masson SA

The Relationship between Neuropsychiatric Symptoms and Cognitive Performance in Older Adults with Normal Cognition

Background and Objectives: To explore whether specific Neuropsychiatric Symptoms (NPS) are related to worse performance in particular cognitive domains. Materials and Methods: A cross-sectional analysis of the baseline evaluations of older (≥60 years), cognitively unimpaired (CU) participants from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set was performed. Data were derived from 43 Alzheimer’s Disease Research Centers. Cognitively impaired individuals, participants with psychiatric disorders and/or under treatment with antipsychotic, anxiolytic, sedative, or hypnotic agents were excluded. NPS were assessed using the Neuropsychiatric Inventory Questionnaire. The association of NPS with participants’ performance on episodic memory, semantic memory, language, attention, processing speed and executive function was analysed using an adjusted (considering important demographic and medical factors) multivariate general linear model. Results: A total of 7179 CU, older, predominantly female, Caucasian, and well-educated participants were included in the present analysis. Among them, 1856 individuals had one or more NPS. Our analysis revealed that moderate/severe anxiety was related to worse performance on semantic memory, attention and executive function, the presence of hallucinations was linked to worse processing speed and executive function scores, while the presence of elation/euphoria and aberrant motor behaviour were associated with poorer attention and language performance, respectively. In the context of a secondary, exploratory analysis, the presence of moderate/severe delusions was related to worse processing speed and executive function performance. Conclusions: The relationship between specific NPS and worse performance in particular cognitive domains could inform the formulation of individualized preventive strategies directed to the ‘‘fortification’’ of specific cognitive functions in CU individuals with NPS. © 2022 by the authors

Association between Motor Signs and Cognitive Performance in Cognitively Unimpaired Older Adults: A Cross-Sectional Study Using the NACC Database

Aiming to examine whether specific motor signs are associated with worse performance in specific cognitive domains among cognitively unimpaired (CU) individuals, we performed a cross-sectional analysis of data from the baseline evaluations of older, CU participants from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set. In total, 8149 CU (≥60 years) participants were included. Of these, 905 individuals scored ≥ 2 on at least one of the motor domains of the Unified Parkinson’s Disease Rating Scale part III (UPDRSIII). Cognitively impaired individuals, participants with psychiatric disorders and/or under treatment with antipsychotic, anxiolytic, sedative or hypnotic agents were excluded. Nine motor signs were examined: hypophonia, masked facies, resting tremor, action/postural tremor, rigidity, bradykinesia, impaired chair rise, impaired posture/gait and postural instability. Their association with performance on episodic memory, semantic memory, language, attention, processing speed or executive function was assessed using crude and adjusted linear regression models. Individuals with impaired chair rise had worse episodic memory, semantic memory, processing speed and executive function, while those with bradykinesia had worse language, processing speed and executive function. Sensitivity analyses, by excluding participants with cerebrovascular disease or PD, or other Parkinsonism, produced similar results with the exception of the relationship between bradykinesia and language performance. © 2022 by the authors

Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta-Analysis

Background: Sleep disorders and circadian dysregulation appear to be associated with primary headache disorders. Objective: The aim of this study was to review the existing evidence for the deployment of melatonin in migraine prophylaxis. Initially, case-control studies investigating nocturnal melatonin and 6-sulphatoxymelatonin (aMT6s, melatonin metabolite discarded by the urine) levels in patients with migraine and healthy controls (HC) would be reviewed and meta-analyzed. Second, results from randomized controlled trials (RCTs) and non-randomized studies evaluating the use of melatonin in migraine would be synthesized. Methods: MEDLINE EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey were comprehensively searched. The quality of studies was assessed according to the Newcastle-Ottawa Scale (case-control studies) and the Risk-of-Bias Cochrane tool (RCTs). Random-effects (RE) or fixed-effects (FE) model was used based on heterogeneity among studies (homogeneity assumed when PQ &gt; 0.1 and I2 &lt; 30%). Publication bias was assessed by funnel plots. Results: Literature search provided 11 case-control studies. Evidence was compatible with lower nocturnal serum [5 of 6 studies were synthesized due to deficient reporting of 1 abstract, migraine n = 197, HC n = 132, RE MD = −12.29 pg/ml, 95%CI = (−21.10, −3.49)] and urinary melatonin [3 studies, migraine n = 30, HC n = 29, RE MD = −0.12 nmol/nocturnal (12 hours) urinary collection, 95%CI = (−0.22, −0.03)], as well as urine aMT6s levels [1 study, migraine n = 146, HC n = 74, MD = −11.90 μg/nocturnal (12 hours) urine collection, 95%CI = (−19.23, −4.57)] in adult migraine patients compared to HC [1 study involving children did not reveal any difference regarding nocturnal urine aMT6s, n = 18 per group, MD = −6.00 μg/nocturnal (12 hours) urine collection, 95%CI = (−21.19, 9.19)]. Regarding the treatment-prevention of migraine, 7 RCTs and 9 non-randomized studies were retrieved. Data synthesis was not feasible for the comparison of melatonin and placebo due to the existing clinical and methodological heterogeneity of the 5 relevant RCTs. Overall, melatonin was more efficacious and equally safe with placebo in the prevention of migraine in adults (3 of 4 RCTs provided superior efficacy results for melatonin, 1 RCT revealed no difference regarding Headache Frequency -HF-), while there are limited data for children (1 RCT revealed no difference against placebo regarding HF). Additionally, no difference was revealed between melatonin and amitriptyline (1 RCT), sodium valproate (1 RCT) or propranolol (1 non-randomized study) with respect to their efficacy in adults with migraine, while melatonin was more effective than pizotifen (1 RCT). In children with migraine, amitriptyline is more efficacious regarding most assessed parameters (2 studies, n = 85 per group, HF: RE MD = 4.03, 95%CI = (2.64, 5.42), Headache Duration: RE MD = 0.72, 95%CI = (0.41, 1.03), Headache Severity: FE MD = 1.57, 95%CI = (1.13, 2.00), Response to Treatment: FE MD = 0.33, 95%CI = (0.16, 0.69), Headache Induced Disability Severity: RE MD = 6.07, 95%CI = (−11.87, 24.01), Analgesic Consumption – assessed in 1 study, n = 40 per group – MD = 1.11, 95%CI = (−0.10, 2.32)), although melatonin presents a superior safety profile than amitriptyline both in adults and in children. Conclusions: Melatonin may be of potential benefit in the treatment-prevention of migraine in adults, but complementary evidence from high-quality RCTs is required. © 2020 American Headache Societ

Assessment of the reporting quality of RCTs for novel oral anticoagulants in venous thromboembolic disease based on the CONSORT statement

Randomized controlled trials (RCTs) are the cornerstone of evidence based medicine. Ιt is crucial that RCTs have transparent reporting to facilitate their interpretation. The purpose of the present study is the evaluation of the reporting quality of RCTs for novel oral anticoagulants (NOACs) in venous thromboembolism (VTE) based on the CONSORT statement. MEDLINE was meticulously searched, while quoted references by retrieved RCTs were manually screened. The primary objective was to establish the mean CONSORT compliance of RCTs for NOACs in VTE. Secondary objectives were the calculation of compliance per CONSORT item and the investigation for probable determining factors with regards to the reporting quality of RCTs. Reporting above 70% of the items was defined as adequate compliance to the CONSORT statement. A total of 83 articles were considered eligible. Mean adherence to the CONSORT statement was 61.84%, standard deviation (SD) = 18.72. Among retrieved studies, 35 (42.17%) reported above 70% of the items, while 48 (57.83%) described less than 70% of the items. Inter-rater agreement was satisfactory (Cohen’s kappa ≥ 0.75). Items with respect to randomization and blinding were principally underreported, whereas the rest of the methodological features and results were more sufficiently reported. Logistic regression failed to demonstrate significant effect for any of the factors investigated. Impact factor [odds ratio (OR) = 1.347, 95% confidence interval (CI) (0.994, 1.826), p = 0.055], number of authors [OR = 1.277, 95% CI (0.975, 1.672), p = 0.076] and presentation of participant flow-diagram [OR = 55.358, 95% CI (0.914, 3351.765), p = 0.055], came closer to significance. Exploratory analysis revealed significant, strong, positive correlation between abstract and article adherence to the CONSORT guidelines (r = 0.851, p < 0.001). Reporting quality of RCTs for NOACs in VTE is moderate. A superior reporting quality is desirable, especially relating to randomization and blinding. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Visual disorders and driving ability in persons with dementia: A mini review

Background: Impaired driving ability in patients with Alzheimer’s disease (AD) is associated with a decline in cognitive processes and a deterioration of their basic sensory visual functions. Although a variety of ocular abnormalities have been described in patients with AD, little is known about the impact of those visual disorders on their driving performance. Aim: Aim of this mini-review is to provide an update on the driving ability of patients with dementia and summarize the primary visual disorders affecting their driving behavior. Methods: Databases were screened for studies investigating dementia, associated visual abnormalities and driving ability. Results: There is consistent evidence that dementia affects driving ability. Patients with dementia present with a variety of visual disorders, such as visual acuity reduction, visual field defects, impaired contrast sensitivity, decline in color vision and age-related pathological changes, that may have a negative impact on their driving ability. However, there is a paucity in studies describing the impact of oculovisual decline on the driving ability of AD subjects. A bidirectional association between cognitive and visual impairment (VI) has been described. Conclusion: Given the bidirectional association between VI and dementia, vision screening and cognitive assessment of the older driver should aim to identify at-risk individuals and employ timely strategies for treatment of both cognitive and ocular problems. Future studies should characterize the basic visual sensory status of AD patients participating in driving studies, and investigate the impact of vision abnormalities on their driving performance. Copyright © 2022 Papageorgiou, Tsirelis, Lazari, Siokas, Dardiotis and Tsironi

Burnout Evaluation and Potential Predictors in a Greek Cohort of Mental Health Nurses

Background: Job burnout is one of the most serious occupational health hazards, especially, among mental health nurses. It has been attributed among others to staff shortages, health service changes, poor morale and insufficient employee participation in decision-making. Aim: The aim of this study was to measure burnout among mental health nurses, investigate relations between burnout and organizational factors and examine potential predictors of nurses’ burnout. Specifically, this study aimed to investigate whether role conflict, role ambiguity, organizational commitment and subsequent job satisfaction could predict each of the three dimensions of burnout. Design/methodology/approach: During current cross sectional, the survey was administered to 232 mental health nurses, employed in four private psychiatric clinics in the region of Larissa, Thessaly, Greece in May 2015. Our findings were based on the responses to 78 usable questionnaires. Different statistical analyses, such as correlation analyses, regression analyses and analyses of variance were performed in order to explore possible relations. Findings: High emotional exhaustion (EE) accounted for 53.8% of the sample, while high depersonalization (DP) and high personal accomplishment (PA) accounted for 24.4% and 25.6%, respectively. The best predictors of burnout were found to be role conflict, satisfaction with workload, satisfaction with training, role ambiguity, satisfaction with pay and presence of serious family issues. Practical implications: These findings have implications for organizational and individual interventions, indicating that mental health nurses’ burnout could be reduced, or even prevented by team building strategies, training, application of operation management, clear instructions and psychological support. © 2018 Elsevier Inc