Patient-reported efficacy of adjunctive brexpiprazole in major depressive disorder in a phase 4, open-label, interventional study.

Objectives: In ENGAGE, patients with major depressive disorder (MDD) demonstrated improvements in patient-reported depression and life engagement while taking adjunctive brexpiprazole. This analysis aimed to further characterize patient perspectives on the effects of adjunctive brexpiprazole, using patient diary data from ENGAGE, and describe development of a 'word of the day' activity.

Methods: Prior to ENGAGE, word lists describing a 'good,' 'average,' and 'bad' day with depression were generated from semi-structured interviews with patients with MDD.

Brexpiprazole for anxiety symptoms in schizophrenia: a pooled analysis of short- and long-term trials.

Objective: For people with schizophrenia and their caregivers, anxiety is among the top symptoms for which they would like an effective treatment. The aims of this analysis of clinical trial data were to characterize the efficacy, safety and tolerability of brexpiprazole on anxiety symptoms in adults with schizophrenia, and to investigate the relationships between anxiety symptoms, functioning, and patient life engagement.

Methods: Data were pooled for brexpiprazole 2-4 mg/day and placebo from three 6-week, randomized, double-blind trials of brexpiprazole in adult inpatients with schizophrenia (ClinicalTrials.

Recommendations for management and future investigation of psychosis in neurodegenerative disease: Findings from the International Psychogeriatric Association (IPA) working group.

Introduction: Psychosis is frequently observed in patients with neurodegenerative disease and may precede onset of cognitive symptoms. Additionally, the presence of psychosis in neurodegenerative disease is often associated with adverse effects including increased progression of cognitive decline and conversion to dementia, increased caregiver burden, and increased rates of placement in long-term care. Moreover, existing pharmacological treatments, which consist principally of off-label antipsychotic medications, may be associated with increased risk of harm, making management of symptoms challenging.

Diagnosis and Management of Alzheimer's Disease in Primary Care: A Real-World Study in Ontario, Canada.

Objective: To understand the real-world clinical practice patterns and variation in Alzheimer's disease (AD) diagnostic and screening tool utilization by primary care physicians (PCPs), including tools used for assessing dementia/AD severity and subsequent treatment patterns.

Methods: This retrospective observational study used de-identified primary care data from electronic medical records (EMR) data provided by the researchers from Queen's University, Ontario, Canada from August 2011 to August 2021. Individuals ≥50 years old with dementia or AD were identified using AD and dementia-related diagnostic codes, medications, and keywords searched using natural language processing (NLP) and Artificial Intelligence (AI) algorithms from EMR chart notes.

Enhancing Alzheimer Disease Detection Using Neuropsychiatric Symptoms: The Role of Mild Behavioural Impairment in the Revised NIA-AA Research Framework.

BackgroundAs the prevalence of Alzheimer disease (AD) rises, early identification of at-risk individuals is essential for effective intervention. Mild behavioral impairment (MBI), which captures emergent and persistent neuropsychiatric symptoms (NPS) in later life, may enhance early detection of AD; however, its associations with 2024 NIA-AA Core 1 biomarkers remain unexplored. We investigated associations between MBI and cerebrospinal fluid (CSF) amyloid β-42 (Aβ42) and phosphorylated tau-181 (p-tau181).

The impact of lifetime excessive alcohol use on behavioural and psychological symptoms of dementia.

Introduction: Excessive alcohol use (EAU) elevates the risk of dementia through various mechanisms, yet its impact on the behavioural and psychological symptoms of dementia (BPSDs) remains uncertain.

Methods: In this exploratory cross-sectional analysis of baseline data from the Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov/NCT03672201), we included individuals with Alzheimer's disease and related dementias requiring BPSD treatment.

Creating a Clinical Care Pathway for Depressive Symptoms and Disorders in Long-Term Care: A Modified Delphi Process.

Objectives: To create an evidence- and expert-informed clinical care pathway focused on identifying and treating depressive symptoms and disorders in long-term care (LTC) residents.

Design: Modified Delphi survey.

Setting And Participants: Delphi participants were LTC health care providers, LTC administrators, friend/family caregivers of residents living in LTC, and residents of LTC.

The Mild Behavioral Impairment Checklist for Parkinson's Disease: An Ancillary Instrument in Cognitive Assessment.

Background: Mild behavioral impairment (MBI) is a syndrome characterized by the later-life onset of neuropsychiatric symptoms (NPS) and serves as a potential marker for dementia. In Parkinson's disease (PD), MBI has been associated with worse cognition, cortical atrophy, and altered connectivity. Unlike existing instruments that assess NPS in PD, the MBI Checklist (MBI-C) leverages sustained behavioral changes to identify patients at risk of cognitive impairment and neurodegeneration.

Mild Behavioral Impairment and Cortical Thinning: Biomarkers of Early Neurodegeneration.

Background: Mild Behavioral Impairment(MBI) is increasingly recognized as an early phenotypic marker of neurodegeneration, characterized by neuropsychiatric symptoms(NPS) emerging prior to overt cognitive decline. While structural neuroimaging studies link cortical thinning with NPS, the relationship between MBI and cortical morphology remains underexplored in diverse, community-based cohorts. This study investigated whether early behavioral alterations, assessed via the Mild Behavioral Impairment Checklist(MBI-C), correlate with region-specific cortical thinning in a Southeast Asian cohort.

Pre-psychosis in later life as a risk factor for progressive cognitive decline: Findings from the IPA psychosis in neurodegenerative disease working group.

Pre-clinical Alzheimer's disease (AD) has traditionally been characterized by subtle cognitive deficits alongside biomarker changes. However, emerging evidence suggests a spectrum of neuropsychiatric changes, including apathy, affective disturbances, agitation, impulse control deficits, and psychosis, may precede cognitive decline. Late-onset psychotic disorders, such as Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP), differ from pre-psychosis, the latter presenting with subtle symptoms and retained insight.

Mild behavioural impairment-apathy and core Alzheimer's disease cerebrospinal fluid biomarkers.

Apathy is a common neuropsychiatric symptom (NPS) in Alzheimer's disease (AD) but can emerge earlier in prodromal and even preclinical stages as part of mild behavioural impairment (MBI-apathy), a syndrome defined by emergent and persistent NPS. In dementia, apathy is associated with higher morbidity, mortality, and caregiver distress. However, the significance of MBI-apathy in dementia-free persons, including its associations with AD biomarkers, remains unclear.

Correlation of Depression and Anxiety Responses on the Mild Behavioral Impairment Checklist With the Cornell Scale for Depression in Dementia and Abbreviated Version of the Penn State Worry Questionnaire.

Introduction: Cognitive disorders are often accompanied by depression and anxiety. The Mild Behavioral Impairment Checklist (MBI-C) was developed to capture neuropsychiatric symptoms that predict risk for dementia and includes questions on mood, but has not been validated for identifying significant depression or anxiety symptoms. Our objective was to determine whether MBI-C mood domain scores predict responses on 2 previously validated scales: the Cornell Scale for Depression in Dementia (CSDD) and the Penn State Worry Questionnaire-Abbreviated version (PSWQ-A) scales.

Exploring the association between mild behavioral impairment and plasma p-tau217: Implications for early detection of Alzheimer's disease.

Introduction: Mild behavioral impairment (MBI), marked by late-onset persistent neuropsychiatric symptoms (NPS), may signal early dementia risk. While MBI is linked to previously established amyloid-beta (Aβ) and tau biomarkers, its association with plasma p-tau217, a promising blood-based biomarker for Alzheimer's disease (AD), remains unexplored. Here, we investigated the association between MBI and plasma p-tau217 in dementia-free individuals from the Alzheimer's Disease Neuroimaging Initiative.

Vascular risk factor associations with subjective cognitive decline and mild behavioural impairment.

Subjective cognitive decline and mild behavioural impairment identify older persons more likely to have early Alzheimer's disease. Vascular co-pathologies may also contribute to new onset and persistent cognitive and behavioural symptoms later in life. We investigated vascular risk factor associations with subjective cognitive decline and mild behavioural impairment.

Agitation in individuals with Alzheimer's disease: An assessment of behaviors using the cohen-mansfield agitation inventory in community-dwellers and impact on caregiver experience.

BackgroundAgitation is a common neuropsychiatric symptom of Alzheimer's disease; however, limited information exists on how measurable changes in agitated behaviors relate to overall caregiver experience. We sought to describe agitated behaviors measured by the Cohen-Mansfield Agitation Inventory (CMAI) score among individuals with Alzheimer's disease living in US community-based settings and experience of their caregivers.MethodsAn online survey was conducted (08/26/2021-09/24/2021) among adult caregivers who lived with and provided unpaid care for an individual with Alzheimer's disease.

Validation of the standard assessment of global everyday activities (SAGEA) scale for dementia diagnosis.

Background: Standardised questionnaires of cognitive symptoms and cognitive-related function can assist in diagnosing dementia. The Standardised Assessment of Global Everyday Activities (SAGEA) is a 15-item questionnaire, developed to measure functional status by capturing cognitive symptoms, basic and instrumental activities of daily living, participation in activites, and mobility.

Objective: The aim of this study was to validate the SAGEA as a tool for assessing cognitive dysfunction in dementia.

Red flags for remote cognitive diagnostic assessment: A Delphi expert consensus study by the Canadian Consortium on Neurodegeneration in Aging.

Despite the potential benefits of remote cognitive assessment for dementia, it is not appropriate for all clinical encounters. Our aim was to develop guidance on determining a patient's suitability for comprehensive remote cognitive diagnostic assessment for dementia. A multidisciplinary expert workgroup was convened under the auspices of the Canadian Consortium on Neurodegeneration in Aging.

Neuropsychiatric symptoms and progression to pathologically confirmed Alzheimer's disease.

Whether or not neuropsychiatric symptoms (NPS) in advance of dementia are associated with Alzheimer disease (AD) and/or other neurodegenerative dementias remains to be determined. The mild behavioural impairment (MBI) construct selects persons with NPS that are later-life emergent and persistent to identify a high-risk group for cognitive decline and incident dementia. Here, in older adults without dementia at baseline, we examined whether postmortem AD and other neurodegenerative pathologies were associated with MBI in the five years before death.

A Cross Sectional and Longitudinal Assessment of Neuropsychiatric Symptoms and Brain Functional Connectivity in Patients With Mild Cognitive Impairment, Cerebrovascular Disease and Parkinson Disease.

Introduction: Mild Behavioral Impairment (MBI) is characterized by later-life emergent and persistent neuropsychiatric symptoms (NPS) in older adults without dementia, serving as a potential precursor to various forms of dementia. This study explores the association between NPS and functional connectivity (FC) of the default mode network (DMN), executive control network (ECN), and salience network (SN) across three cohorts: mild cognitive impairment due to AD (MCI), cerebrovascular disease (CVD), and Parkinson's disease (PD). Additionally, the effect of CNS medication on NPS-FC associations was explored.

Cannabis Use Prevalence and Correlates in Patients Attending a Canadian Cognitive Clinic.

Background: Since cannabis was legalized in Canada in 2018, its use among older adults has increased. Although cannabis may exacerbate cognitive impairment, there are few studies on its use among older adults being evaluated for cognitive disorders.

Methods: We analyzed data from 238 patients who attended a cognitive clinic between 2019 and 2023 and provided data on cannabis use.

Escitalopram for agitation in Alzheimer's dementia: a randomized controlled phase 3 trial.

Citalopram is effective in treating agitation in Alzheimer's dementia (AD), but it is associated with cognitive and cardiac risks, likely due to its R-enantiomer. Escitalopram, the S-enantiomer, may be an alternative. In this double-masked randomized (1:1) placebo-controlled trial, we assessed the efficacy and safety of escitalopram in treating agitation in AD after failure of a psychosocial intervention (PSI).

Determining the Role of Sex and APOE4 status on Psychosis in Alzheimer's Disease.

BackgroundPsychosis occurs in approximately 41% of patients living with Alzheimer's disease. Previous findings from our group based on analyses of a neuropathological cohort suggest that among AD patients with Lewy Body pathology, female APOE4 homozygotes are at significantly greater risk of psychosis. This study aims to replicate this finding in a clinical cohort using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset.

Early life factors and dementia risk: A study of adverse childhood experiences and later-life cognition and behaviour.

Objectives: Adverse childhood experiences (ACE) are associated with brain alterations and cognitive decline. In later life, cognitive impairment and mild behavioural impairment (MBI) are associated with greater dementia risk. We investigated whether more severe ACE are cross-sectionally associated with worse later-life cognitive and behavioural symptoms.

The Canadian Coalition for Seniors' Mental Health Canadian Clinical Practice Guidelines for Assessing and Managing Behavioural and Psychological Symptoms of Dementia (BPSD).

In Canada, approximately 730,000 people are currently living with dementia. Over 75% will experience behavioural and psychological symptoms of dementia (BPSD). There is a lack of consensus on best practices for the assessment and management of BPSD.