Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Positive signs are clinical signs that are not explained by a structural neurological lesion and are considered the hallmark of functional neurological disorder (FND). In the literature and in clinical experience, positive signs are observed among patients without FND. The aim of the study was to examine the significance of positive signs among headache patients.

Methods: The authors of this prospective study recruited patients in headache consultation at the University Hospital Inselspital, Bern, Switzerland. Inclusion criteria were headache or facial pain in the past 3 months and age ≥18 years. The exclusion criterion was a known diagnosis of FND. All patients were examined for 14 validated positive signs: give-way weakness, co-contraction, sternocleidomastoid sign, trapezius elevation test, head flexion test, drift without pronation, Hoover I and II, spinal injury test, arm drop test, lip-pulling sign, midline splitting, splitting of vibration sign at the front, and expressive behavior sign.

Results: In total, 101 patients were recruited (69% female; mean±SD age=40.8±16.3 years), of whom 43% showed positive signs. Splitting of vibration was the most common sign (27%); the other signs were less frequent (≤10%). Patients with positive signs were older than patients without such signs and had more monthly headache days and exacerbations as well as more intense headache at examination. Multivariable logistic regression revealed a significant association between positive signs and exacerbation days per month (OR=1.08, 95% CI=1.01-1.14, per exacerbation day; p=0.019).

Conclusions: Positive signs are frequent among headache patients and point toward a more severe headache condition. This finding suggests overlapping mechanisms in headache and FND.

Objective: Depression is known to be highly heterogeneous, with distinct clusters of symptoms. Whether this heterogeneity exists after traumatic brain injury (TBI) and how clusters of depression symptoms after TBI may relate to clinical symptoms, functional outcomes, and underlying neurobiology are largely unknown.

Methods: The authors investigated depression symptom clusters after subacute TBI and evaluated their clinical, functional, and neural correlates. Community-dwelling participants with complicated mild, moderate, or severe TBI (N=53) were evaluated on average 5 months postinjury. Participants were administered the 17-item Hamilton Depression Rating Scale (HDRS), the Rivermead Post-Concussion Symptom Questionnaire, the Glasgow Outcome Scale-Extended, and a neuropsychological test battery. A subset of participants completed a resting-state functional MRI scan.

Results: Principal component analysis on the HDRS items yielded a two-component solution that accounted for 40% of the variance. Component 1 encompassed mood and affective symptoms as well as agitation and loss of libido, and component 2 encompassed anxiety, insomnia, and most somatic symptoms of the HDRS. Component 2 was associated with greater TBI symptom burden and disability and worse executive functions but not resting-state functional connectivity. Component 1 was not related to TBI symptom burden, neuropsychological function, or disability, but there was a trend-level association between higher negative affect scores and greater functional connectivity between the dorsal attention and default mode networks.

Conclusions: The findings suggest that depression after TBI may not be a unitary syndrome but rather may be composed of clusters of symptoms that have different associations with TBI symptom burden, disability, and brain connectivity.

Objective: The authors used data from the Rochester Epidemiology Project (REP) and the population-based Mayo Clinic Study of Aging (MCSA) to examine how depression relates to cognitive outcomes.

Methods: Depression data were acquired from electronic medical records (EMRs) via the REP for a sample of MCSA participants who were cognitively unimpaired at baseline. Participants were classified as having depression if a depression diagnosis was noted in the EMR or if a medication for depression was indicated. The authors calculated hazard ratios (HRs) with Cox proportional hazards models to elucidate the relationship between depression and incident mild cognitive impairment (MCI) and dementia. Linear mixed-effects models were used to study depression with the outcomes of global and domain-specific cognitive z scores. All models were adjusted for pertinent covariates.

Results: The study included 1,805 community-dwelling adults (51% men) with a mean±SD age of 74.5 ± 7.3 years. Depression was associated with a significantly increased risk for progression to MCI (HR=1.37, 95% CI=1.13 to 1.65) and dementia (HR=1.33, 95% CI=1.04 to 1.70). In sensitivity analyses, only participants taking antidepressants were at increased risk for progressing to these outcomes, relative to those without depression. Depression was also associated with lower baseline cognitive z scores in all domains except memory. Associations with longitudinal cognitive trajectories were noted only when the timing of depression (no depression, before MCSA baseline only, at MCSA baseline only, or at both times) was considered.

Conclusions: Depression was associated with baseline and longitudinal measures of cognition among community-dwelling older adults. Only individuals receiving antidepressants had a significantly increased risk for incident MCI and dementia.

Objective: COVID-19 has been associated with a wide range of systemic and neurological complications, known as long COVID or postacute sequelae of COVID-19 (PASC). Such sequelae can be observed among all infected individuals, even among those with a mild disease course. Dysbiosis, a common condition associated with low-grade inflammation, has been proposed as a potential mechanism of PASC by altering levels of circulating lipopolysaccharide (LPS) and the tryptophan pathway metabolites kynurenine and quinolinic acid, known to affect neurocognitive function. The authors evaluated the evolution of neurological, neurocognitive, and neuropsychiatric COVID-19 sequelae and their relationship with circulating LPS and kynurenine and quinolinic acid levels.

Methods: A prospective, longitudinal, and analytical study was conducted. Neurological, neurocognitive, and neuropsychiatric assessments of participants who had recovered from COVID-19 and did not require hospitalization during the acute stages of the infection were performed. Peripheral levels of LPS and tryptophan metabolites were measured 1, 3, 6, and 12 months after infection.

Results: Of 95 participants recruited, 67 COVID-19-convalescent individuals and 20 COVID-19-free individuals were included. Significantly higher occurrences of asthenia, olfaction and taste alterations, headache, memory dysfunction, and systemic symptoms such as dyspnea, cough, and periodontal diseases were found among participants in the COVID-19-convalescent group compared with participants in the comparison group. A significant decrease in kynurenine levels, which correlated with cognitive impairment, was observed among PASC convalescents.

Conclusions: Significant neurocognitive and neuropsychiatric impairments were observed among COVID-19-convalescent individuals, along with decreased kynurenine levels, which recovered during a 12-month follow-up period.

Objective: Cortical regions such as parietal area H (PH) and the fundus of the superior temporal sulcus (FST) are involved in higher visual function and may play a role in dementia with Lewy bodies (DLB), which is frequently associated with hallucinations. The authors evaluated functional connectivity between these two regions for distinguishing participants with DLB from those with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and from cognitively normal (CN) individuals to identify a functional connectivity MRI signature for DLB.

Methods: Eighteen DLB participants completed cognitive testing and functional MRI scans and were matched to AD or MCI and CN individuals whose data were obtained from the Alzheimer's Disease Neuroimaging Initiative database (https://adni.loni.usc.edu). Images were analyzed with data from Human Connectome Project (HCP) comparison individuals by using a machine learning-based subject-specific HCP atlas based on diffusion tractography.

Results: Bihemispheric functional connectivity of the PH to left FST regions was reduced in the DLB group compared with the AD and CN groups (mean±SD connectivity score=0.307±0.009 vs. 0.456±0.006 and 0.433±0.006, respectively). No significant differences were detected among the groups in connectivity within basal ganglia structures, and no significant correlations were observed between neuropsychological testing results and functional connectivity between the PH and FST regions. Performances on clock-drawing and number-cancelation tests were significantly and negatively correlated with connectivity between the right caudate nucleus and right substantia nigra for DLB participants but not for AD or CN participants.

Conclusions: The functional connectivity between PH and FST regions is uniquely affected by DLB and may help distinguish this condition from AD.

Objective: The authors of this prospective cohort study sought to examine associations between mid- and late-life physical activities and incident clinical depression and anxiety among community-dwelling older adults.

Methods: The sample included 2,630 adults to examine the outcome of clinical depression (median follow-up length=5.4 years) and 2,444 to examine clinical anxiety (median follow-up length=5.6 years). Participants were ages ≥70 years, were enrolled in the Mayo Clinic Study of Aging, and did not have dementia or the respective neuropsychiatric symptoms at baseline. Mid- and late-life physical activities were assessed as predictors with a validated questionnaire, and physical activity composite scores were calculated. Outcomes of interest were new onset of clinical depression and anxiety, measured with the Beck Depression Inventory (score >13) and Beck Anxiety Inventory (score >7), respectively. The authors used Cox proportional hazard models, adjusted for age (timescale), sex, education, apolipoprotein E ε4 genotype status, and comorbid medical conditions.

Results: Higher overall physical activity in late life was associated with a decreased risk for incident clinical depression (hazard ratio [HR]=0.85, 95% CI=0.74-0.98, p=0.025). Higher late-life overall physical activity (HR=0.79, 95% CI=0.71-0.89, p<0.001) and moderate-to-vigorous physical activity (MVPA; HR=0.86, 95% CI=0.77-0.95, p=0.003) were associated with a decreased risk for incident clinical anxiety. Higher midlife overall physical activity (HR=1.16, 95% CI=1.05-1.28, p=0.003) and MVPA (HR=1.12, 95% CI=1.02-1.23, p=0.019) were associated with an increased risk for new-onset clinical anxiety but not depression.

Conclusions: Engagement in late-life physical activity was associated with reduced risk for new-onset depression and anxiety among community-dwelling older adults without dementia.

Objective: Suicidal ideation has not been extensively studied in spinocerebellar ataxias (SCAs). The authors examined whether individuals with SCAs have increased suicidal ideation and related factors.

Methods: The authors studied patients with genetically confirmed SCAs enrolled in the Clinical Research Consortium for the Study of Cerebellar Ataxia cohort, examining the percentages of patients with SCA subtypes 1, 2, 3, and 6 who reported suicidal ideation and comparing findings with nationally representative data from the National Survey on Drug Use and Health (NSDUH). Clinical characteristics that may contribute to suicidal ideation in SCAs, including age, disease duration, sex, ataxia severity, depression, and SCA subtype, were also studied.

Results: Suicidal ideation was present among 12% of 769 patients with SCAs and 4.3% of individuals in the general population recorded in the NSDUH. Compared with individuals in the general population, SCA patients had higher odds of suicidal ideation (OR=2.72). Compared with patients with SCA without suicidal ideation, patients with SCA and suicidal ideation had a longer disease duration (mean±SD=13.1±8.2 years vs. 11.2±9.4 years), more severe ataxia (Scale for the Assessment and Rating of Ataxia mean score=15.9±8.6 vs. 12.9±7.6), and more severe depression. Having suicidal ideation at baseline significantly increased the odds of suicidality later in the disease course (OR=58.73, 95% CI=36.00-98.40).

Conclusions: Suicidal ideation was more prevalent among patients with SCAs than in the general population. The findings of this study underscore the importance of continuous suicidal risk screening among individuals with SCAs and the need for effective depression management.