Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment

A new clinical investigation published in the Journal of the American Geriatrics Society.examines if personality changes that begin early, when MCI memory loss becomes noticeable, might help predict Alzheimer’s disease at its earliest stages.

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Abstract

Background/Objectives

Behavioral problems in individuals with Alzheimer’s disease (AD) impose major management challenges. Current prevention strategies are anchored to cognitive outcomes, but behavioral outcomes may provide another, clinically relevant opportunity for preemptive therapy. We sought to determine whether personality changes that predispose to behavioral disorders arise during the transition from preclinical AD to mild cognitive impairment (MCI).

Design

Longitudinal observational cohort study.

Setting

Academic medical center.

Participants

Members of an apolipoprotein E (APOE) ɛ4 genetically enriched cohort of Maricopa County residents who were neuropsychiatrically healthy at entry (N = 277). Over a mean interval of 7 years, 25 who developed MCI and had the Neuroticism, Extraversion, and Openness Personality Inventory—Revised (NEO-PI-R) before and during the MCI transition epoch were compared with 252 nontransitioners also with serial NEO-PI-R administrations.

Intervention

Longitudinal administration of the NEO-PI-R and neuropsychological test battery.

Measurements

Change in NEO-PI-R factor scores (neuroticism, extraversion, openness, agreeableness, conscientiousness) from entry to the epoch of MCI diagnosis or an equivalent follow-up duration in nontransitioners.

Results

NEO-PI-R neuroticism T-scores increased significantly more in MCI transitioners than in nontransitioners (mean 2.9, 95% confidence interval (CI) = 0.9–4.9 vs 0, 95% CI = −0.7–0.7, P = .02), and openness decreased more in MCI transitioners than in nontransitioners (−4.8, 95% CI = −7.3 to −2.4 vs −1.0, 95% CI = −1.6 to −0.4, P < .001). Concurrent subclinical but statistically significant changes in behavioral scores worsened more in MCI transitioners than nontransitioners for measures of depression, somatization, irritability, anxiety, and aggressive attitude.

Conclusion

Personality and subclinical behavioral changes begin during the transition from preclinical AD to incident MCI and qualitatively resemble the clinically manifest behavioral disorders that subsequently arise in individuals with frank dementia.

 

The full article is available from Wiley

Full reference: Caselli, R. J., et al. | Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment| Journal of the American Geriatrics Society|2018 |DOI: 10.1111/jgs.15182fbfdbsvyczbbbaffrrzxxeyeszrtrrcrqar

 

 

Impact of cognitive decline in stroke survivors

Preliminary research presented at the American Stroke Association’s International Stroke Conference 2018 in Los Angeles, has shown that a diet created by researchers at Rush University Medical Center may slow cognitive decline in stroke survivors. 

 

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The new diet  is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets; both of these have been found to reduce the risk of cardiovascular conditions such as hypertension, heart attack and stroke.   The team from Rush University have called it MIND diet as it  stands for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay.   They developed the MIND diet  from years of research about what foods and nutrients have good, and bad, effects on the functioning of the brain. The MIND diet  includes vegetables, berries, fish and olive oil which help to promote brain health.

The diet has been associated with reduced Alzheimer’s risk in seniors who adhered to its recommendations. Even people who moderately adhered had reduced risk of Alzheimer’s disease and cognitive decline.

 

Science Daily has the full story 

 

Dementia prevention, intervention, and care

Livingston, G. et al. | Dementia prevention, intervention, and care | The Lancet , Volume 390 , Issue 10113 , 2673 – 2734

This article argues that there is a potential for better disease prevention and for care to offer more improvements to the lives of a growing number of people with dementia.

To reduce dementia incidence, article authors recommend active treatment of hypertension for all people over 45 without dementia. Furthermore, they estimate that interventions into such risk factors as childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity might have the potential to delay or prevent a third of dementia cases.

Full paper available via The Lancet

 

Psychosocial interventions for people with dementia

New research finds good evidence to suggest that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills for people with dementia | Aging & Mental Health

Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works.

Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted.

Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews.

Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.

Full reference: McDermott, O et al. | Psychosocial interventions for people with dementia: a synthesis of systematic reviews |Aging & Mental Health | Published online 17 Jan 2018

View the full article here