期刊
INTERNATIONAL PSYCHOGERIATRICS
卷 30, 期 2, 页码 185-196出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S1041610217001880
关键词
depression; anxiety; euphoria; irritability; affective dysregulation; mild behavioral impairment; neuropsychiatric symptoms; prodromal dementia
资金
- Canadian Institutes of Health Research
- Canadian Consortium on Neurodegeneration in Aging
- Hotchkiss Brain Institute
- Alzheimer Society Calgary
- BrightFocus Foundation
- Alzheimer's Association
- Rogers Family Foundation
- Harvard Medical School Department of Psychiatry
- Australian National Health and Medical Research Council (NHMRC)
- Australian Research Council (ARC) Dementia Research Development Fellowship [1102028]
- NATIONAL INSTITUTE OF MENTAL HEALTH [R25MH094612] Funding Source: NIH RePORTER
Background:Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research.Methods:Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: mild cognitive impairment, dementia, prodromal dementia, preclinical dementia, Alzheimer's, depression, dysphoria, mania, euphoria, bipolar disorder, and irritability.Results:Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset.Conclusion:Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
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