Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Cognitive impairment is a common nonmotor symptom in Parkinson's disease (PD). Individuals of Latino background are traditionally underrepresented in research on PD. Despite the fact that Latinos comprise 18% of the U.S. population, they commonly make up less than 5% of samples in studies of PD. Emerging evidence suggests that Latino individuals with PD may experience disparities relative to White non-Latinos in terms of having more severe motor symptoms, more severe depressive symptoms, and worse health-related quality of life. The purpose of the present study was to investigate differences in cognitive performance between Latino and White non-Latino individuals with PD and examine correlates of cognitive performance.

Methods: Data were obtained from the Parkinson's Progression Markers Initiative. Participants included 60 Latino individuals with PD and 1,009 White non-Latino individuals with PD, all of whom were followed annually for up to 5 years. Participants completed neuropsychological tests of attention and working memory, processing speed, visuospatial functioning, verbal fluency, and immediate and delayed memory and recall.

Results: Relative to White non-Latino individuals with PD, Latino individuals with PD had significantly lower scores on the global measure of cognitive functioning, a test of processing speed, and tests of working memory and attention. Years of education was the strongest correlate of performance in these three cognitive domains among individuals in the Latino group.

Conclusions: These findings provide initial evidence of disparities in cognitive functioning among Latino individuals with PD. Educational disadvantages may be one potential driver of these disparities.

Objective: Mild traumatic brain injury (mTBI) can lead to psychiatric and somatic symptoms for some patients, including posttraumatic headache (PTH) and depression. This study attempted to further establish the relationship between PTH and depression following mTBI and investigate whether the presence of PTH immediately following injury can identify patients at risk for developing depressive symptoms up to 6 months later.

Methods: This study was a secondary analysis of data from Head Injury Serum Markers for Assessing Response to Trauma (HeadSMART), a prospective study of adult patients in the emergency department with head injury. Participants included 265 patients who met criteria for mTBI and completed the Rivermead Post-Concussion Symptoms Questionnaire, to identify PTH within 24 hours after injury, and the Patient Health Questionnaire-9, to assess depressive symptoms during follow-up. Measures were completed at the initial visit immediately after the injury in the emergency department and at 1-, 3-, and 6-month follow-up visits.

Results: Patients with acute PTH (aPTH) at time of injury were more likely to report PTH at 1, 3, and 6 months. They also had more severe depressive symptoms and a greater likelihood of clinically significant depression at all time points.

Conclusions: Patients with aPTH within 24 hours after injury were more likely to report continued symptoms of PTH and clinically significant depression at 1, 3, and 6 months. These findings provide support for using the presence of aPTH in the emergency department following mTBI as an indicator for monitoring persistent PTH and depressive symptoms in the postacute recovery period.

Objective: The purpose of the present study was to assess the psychiatric manifestations of early to middle stages of fragile X-associated tremor-ataxia syndrome (FXTAS) and their relationship with executive function and FMR1 cytosine-guanine-guanine (CGG) repeat numbers across genders.

Methods: Cross-sectional data from 100 participants (62 men, 38 women; mean±SD age=67.11±7.90 years) with FXTAS stage 1, 2, or 3 were analyzed, including demographic information, cognitive measures, psychiatric assessments (Symptom Checklist-90-Revised and Behavioral Dyscontrol Scale-II [BDS-II]), and CGG repeat number.

Results: Participants with FXTAS stage 3 exhibited significantly worse psychiatric outcomes compared with participants with either stage 1 or 2, with distinct gender-related differences. Men showed differences in anxiety and hostility between stage 3 and combined stages 1 and 2, whereas women exhibited differences in anxiety, depression, interpersonal sensitivity, obsessive-compulsive symptoms, and somatization, as well as in the Global Severity Index, the Positive Symptom Distress Index, and the Positive Symptom Total. Among male participants, negative correlations were observed between BDS-II total scores and obsessive-compulsive symptoms, as well as between anxiety and CGG repeat number.

Conclusions: These findings suggest that even at early FXTAS stages, patients have significant cognitive and other psychiatric symptoms, with notable gender-specific differences. This study underscores the clinical and prognostic relevance of comorbid psychiatric conditions in FXTAS, highlighting the need for early intervention and targeted support for individuals with relatively mild motor deficits.

Substance use disorders, including methamphetamine use disorder, are prevalent, causing extensive morbidity and death. Despite advances in evidence-based treatments for methamphetamine use disorder, many patients do not respond to these interventions, and new approaches are needed. Deep brain stimulation (DBS) involves the surgical implantation of a device to modulate nervous system function and has proven efficacy in the management of movement disorders. Recent studies of DBS for the management of substance use disorders have shown promise, and the authors of this review are currently investigating DBS for the treatment of patients with methamphetamine use disorder. However, acute and chronic intoxication with methamphetamine can result in various systemic abnormalities and medical comorbid conditions, presenting challenges for the neurosurgeon, the anesthesiologist, and other medical providers. This narrative review aims to provide a comprehensive overview of methamphetamine's systemic effects and associated medical comorbid conditions for clinicians engaged in the perioperative care of this patient population. The systemic effects and related medical comorbid conditions that may complicate the perioperative course of patients with methamphetamine use disorder are presented by organ system. With diligent preoperative planning and perioperative management, patients with methamphetamine use disorder can be successfully treated with DBS surgery. A thorough understanding of these effects and comorbid conditions is crucial for both the prevention and the rapid recognition of perioperative complications, resulting in improved outcomes in this patient population.

Objective: Apathy is a prevalent neuropsychiatric feature of Parkinson's disease (PD), marked by reduced goal-directed behavior. Apathy is distinct from depression and significantly affects daily functioning and quality of life. Despite this, the DSM-5 does not acknowledge apathy as its own diagnostic category. The authors sought to examine how individuals with PD who score high on a self-report apathy scale are diagnostically classified by psychiatrists within a clinical setting.

Methods: Fifty-five individuals with "pure apathy" were identified from a larger clinical convenience sample of 458 patients with PD. The pure-apathy group consisted of patients who scored above the clinical cutoff on a self-report measure of apathy but whose symptoms were below the cutoffs for depression and anxiety measures. These patients also received a standard clinical psychiatric evaluation using DSM-5 criteria. The authors examined the diagnoses provided by psychiatrists who were unaware of results of the mood scales.

Results: More than half (53%) of the pure-apathy group had received no psychiatric diagnosis. The remainder had received the following diagnoses: anxiety (27%), depression (5%), comorbid depression and anxiety (5%), and other psychiatric diagnoses (9%). The most common anxiety diagnoses were unspecified or other specified anxiety disorders and generalized anxiety disorder. The most common depression diagnoses were unspecified or other specified depressive disorders.

Conclusions: This study highlights a gap in diagnosing psychiatric conditions in PD, specifically for individuals with primarily apathetic presentations. More than 50% of PD patients in the pure-apathy group had received no psychiatric diagnosis, possibly resulting in unmet clinical needs.

Objective: Using a multi-informant approach, the authors assessed the psychiatric symptoms of adolescents and young adults with or without the huntingtin gene expansion and examined the association of psychiatric symptoms with cumulative disease exposure, a measure taking into account age and genetic data.

Methods: The sample included 110 participants with (N=71) or without (N=39) the gene expansion, along with 85 family members who provided collateral reports. Saliva samples were used for genetic testing. Participants reported psychiatric symptoms with the age- and informant-appropriate Achenbach System of Empirically Based Assessment measure.

Results: Family member ratings indicated that young people (ages 10-39) with the gene expansion were more likely to exhibit depression symptoms, attention difficulties, and behavior problems compared with those without the gene expansion. Self-reports of these symptoms did not differ between the two groups and indicated elevated depression symptoms, attention difficulties, thought problems, and obsessive-compulsive symptoms in both groups. In family member reports, 25% and 15% of the individuals with the gene expansion exceeded the clinical cutoffs for internalizing and attention difficulties, respectively. Little support was found for an association between psychiatric symptoms and cumulative disease exposure.

Conclusions: These findings suggest that young people from families affected by Huntington's disease are at elevated risk for psychiatric symptoms regardless of gene status or cumulative disease exposure. However, findings differed depending on the informant type. These results emphasize a need to screen for and monitor the psychiatric symptoms of all young people from families affected by Huntington's disease regardless of gene status.

Objective: Cognitive impairment is a common nonmotor symptom among individuals with Parkinson's disease (PD). Although cognitive impairment generally develops progressively, individuals with PD-associated mild cognitive impairment (PD-MCI) may revert to being cognitively normal (CN), which is referred to as PD-MCI reversion. Previous studies are inconsistent in whether PD-MCI reverters are at greater risk for PD-MCI recurrence relative to CN individuals. Even less is known about how PD-MCI reverters compare with CN individuals or PD-MCI nonreverters in terms of neurodegenerative biomarkers. The authors examined group differences (CN, PD-MCI reversion, and PD-MCI nonreversion) in cerebrospinal fluid (CSF) markers of Alzheimer's disease (AD), including amyloid beta, tau (total [t-tau] and phosphorylated [p-tau]), and alpha-synuclein.

Methods: Data from the longitudinal international multisite Parkinson Progression Marker Initiative were used. Participants were newly diagnosed as having PD (N=430) and completed a battery of neurocognitive assessments at baseline and annual follow-ups for up to 5 years. Participants were classified as CN, PD-MCI reverters, or PD-MCI nonreverters on the basis of the first two neurocognitive assessments.

Results: The PD-MCI nonreversion group had greater p-tau:amyloid beta and t-tau:amyloid beta ratios relative to the PD-MCI reversion group. The CN and PD-MCI reversion groups did not significantly differ in any of the CSF markers.

Conclusions: PD-MCI reverters may have a more favorable trajectory in terms of AD pathology relative to PD-MCI nonreverters. Future studies are needed to verify whether PD-MCI reversion may represent an intermediate prognostic group between CN individuals and those with MCI nonreversion.