The relationship between psychiatric symptoms and regional cortical metabolism in Alzheimer's disease
Journal of NeuropsychiatryPublished 1 November 1995
David L. Sultzer, Michael E. Mahler, M. Mandelkern, Jeffrey L. Cummings, Wilfred G. van Gorp, Charles H. Hinkin
Citations202
SJR quartileQ1
SJR score0.90
SNIP0.86
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The results suggest that psychiatric symptoms are fundamental expressions of the cortical dysfunction of Alzheimer's disease.
Abstract
Cognitive and noncognitive psychiatric symptoms were systematically evaluated in 21 patients with Alzheimer's disease by using the Neurobehavioral Rating Scale. Regional cerebral metabolic activity was measured in each patient by [18F]fluorodeoxyglucose PET. Significant correlations emerged between global cortical metabolic activity and the Agitation/Disinhibition factor score, Cognition factor score, and total score. Relationships between noncognitive symptoms and metabolic activity were regionally specific, with significant correlations between Agitation/Disinhibition factor score and metabolism in the frontal and temporal lobes, between Psychosis factor score and metabolism in the frontal lobe, and between Anxiety/Depression factor score and metabolism in the parietal lobe. These results suggest that psychiatric symptoms are fundamental expressions of the cortical dysfunction of Alzheimer's disease.
Keywords
MedicineNeuroscience
Journal of Psychiatric Research“Mini-mental state”
86,858 Citations1975Marshal F. Folstein, Susan E. Folstein +1 more
A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
NeurologyClinical diagnosis of Alzheimer's disease
27,993 Citations1984Guy M. McKhann, David A. Drachman +4 more
The criteria proposed are intended to serve as a guide for the diagnosis of probable, possible, and definite Alzheimer's disease; these criteria will be revised as more definitive information becomes available.
Annals of NeurologyTomographic measurement of local cerebral glucose metabolic rate in humans with (F‐18)2‐fluoro‐2‐deoxy‐D‐glucose: Validation of method
2,433 Citations1979M. E. Phelps, S.C. Huang +4 more
The data indicate that cerebral FDG‐6‐PO4 in humans increases for about 90 minutes, plateaus, and then slowly decreases, and that cerebral blood FDG activity levels were found to be a minor fraction of tissue activity.
Annals of NeurologySynapse loss in frontal cortex biopsies in Alzheimer's disease: Correlation with cognitive severity
2,413 Citations1990Steven T. DeKosky, Stephen W. Scheff
The loss of neuronal connectivity, indexed by loss of synapses, predicted the degree of cognitive impairment in the patients who underwent biopsy and indicated a degree of structural change in AD brain not likely to be affected by pharmacotherapy.
Archives of NeurologyFrontal-Subcortical Circuits and Human Behavior
2,273 Citations1993Jeffrey L. Cummings
Frontal-subcortical circuits mediate many aspects of human behavior, including executive function deficits occur with lesions of the dorsolateral prefrontal circuit, disinhibition with injuries of the orbitofrontal circuit, and apathy with injury to the anterior cingulate circuit.
PubMedEfficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution.
1,369 Citations1986K. Hamacher, Heinz H. Coenen +1 more
An aminopolyether mediated synthesis of fluorine-18 (18F) 2-fluoro-2-deoxy-D-glucose (FDG) has been developed and gives epimerically pure 2-18FDG with an uncorrected radiochemical yield of a maximum 50% in a synthesis time of approximately 50 min from EOB.
Archives of General PsychiatryReduction of Prefrontal Cortex Glucose Metabolism Common to Three Types of Depression
1,314 Citations1989Lewis R. Baxter
Using positron emission tomography, cerebral glucose metabolism in drug-free, age- and sex-matched, right-handed patients with unipolar depression, bipolar depression, obsessive-compulsive disorder (OCD) with secondary depression, OCD without major depression, and normal controls is studied.
Frontal Lobe Function and Dysfunction
1,238 Citations1991
This work focuses on the role of the frontal lobes in memory response preparation and motor functioning in patients with frontal lobe lesions and the effects of frontal lobe damage on these functions.
BrainMOOD DISORDERS IN STROKE PATIENTS: IMPORTANCE OF LOCATION OF LESION
1,116 Citations1984Robert G. Robinson, Kenneth L. Kubos +3 more
It is found that the severity of depression was significantly increased in patients with left anterior lesions as opposed to any other lesion location, and that there is a graded effect of lesions location on severity of mood change.
American Journal of PsychiatryPsychiatric symptoms and nursing home placement of patients with Alzheimer's disease
758 Citations1990Cynthia Steele, Barry W. Rovner +2 more
It is suggested that potentially treatable (noncognitive) behavioral and psychiatric symptoms are risk factors for institutionalization, and that treating these symptoms might delay or prevent institutionalization of some patients.
American Journal of PsychiatryOverview of depression and psychosis in Alzheimer's disease
684 Citations1989R E Wragg, Dilip V. Jeste
The authors reviewed 30 studies on Alzheimer's disease to determine the prevalence and phenomenology of affective and psychotic symptoms in patients with this disorder and found Paranoid delusions was the most common psychotic symptoms reported.
Journal of the American Geriatrics SocietyA Metaanalysis of Controlled Trials of Neuroleptic Treatment in Dementia
656 Citations1990Lon S. Schneider, Vicki E. Pollock +1 more
Clinically, neuroleptics treatment changed the improvement rate in agitated dementia patients from .41 to .59 (binomial effect‐size display), which indicates that 18 of 100 dementia patients benefited from neuroleptic treatment (beyond that of placebo) and is consistent with the modest efficacy described in previous qualitative reviews.
Journal of Neurology Neurosurgery & PsychiatryThe neurobehavioural rating scale: assessment of the behavioural sequelae of head injury by the clinician.
485 Citations1987Harvey S. Levin, Walter M. High +7 more
Although the findings provide support for utilising clinical ratings of behaviour to investigate sequelae of head injury, extension of this technique to other settings is necessary to evaluate the distinctiveness of the neurobehavioural profile of closed head injury as compared with other aetiologies of brain damage.
Annals of Internal MedicineAn Atlas of the Human Brain for Computerized Tomography.
467 Citations1978Takayoshi Matsui
American Journal of PsychiatryLeft prefrontal glucose hypometabolism in the depressed state: a confirmation
465 Citations1990Jean‐Luc Martinot, P. Hardy +6 more
The resting-state cerebral metabolic rates for glucose of severely depressed patients were compared, before and after treatment with tricyclic antidepressants, to those of 10 control subjects of similar age by means of positron emission tomography and the fluorodeoxyglucose method.
Annals of NeurologyThe neuropathology of aminergic nuclei in Alzheimer's disease
441 Citations1988Richard M. Zweig, Christopher A. Ross +6 more
Archives of NeurologyNeuropsychiatric Aspects of Multi-infarct Dementia and Dementia of the Alzheimer Type
428 Citations1987Jeffrey L. Cummings, Bruce L. Miller +2 more
Depression and delusions were not deducted in patients with severe dementia, and hallucinations occurred in both diagnostic groups but were not common: one patient with DAT and one with MID had auditory hallucinations, and three patients with MIDHad visual hallucinations.
Annals of NeurologySelective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson's disease
421 Citations1990Helen S. Mayberg, Sergio Starkstein +6 more
It is suggested that depression in PD is associated with dysfunction in the caudate and orbital‐inferior area of the frontal lobe, and this metabolic pattern is unlike that seen in patients with PD who have other behavioral deficits such as dementia, and suggests that disruption of basal ganglia circuits involving the inferior region ofThe frontal lobe may affect the regulation of mood.
The British Journal of PsychiatryPsychiatric Phenomena in Alzheimer's Disease. IV: Disorders of Behaviour
394 Citations1990Alastair Burns, Robin Jacoby +1 more
Out of a sample of 178 patients with AD, aggression was present in 20%, wandering in 19%, binge-eating in 10%, hyperorality in 6%, urinary incontinence in 48%, and sexual disinhibition in 7%.
NeurologyPredictors of cognitive and functional progression in patients with probable Alzheimer's disease
322 Citations1992James A. Mortimer, Brenda Ebbitt +2 more
Faster functional progression was predicted by paranoid behavior, hallucinations, and activity disturbances during the first year and the presence of extrapyramidal signs and lower scores on nonverbal neuropsychological tests at the time of entry into the study.
Archives of NeurologyLongitudinal Study of Cerebral Metabolic Asymmetries and Associated Neuropsychological Patterns in Early Dementia of the Alzheimer Type
314 Citations1990James V. Haxby, C. L. Grady +6 more
It is demonstrated that heterogeneous nonmemory language and visuospatial impairments in early DAT are related to and predicted by the earlier-appearing distribution of metabolic reductions in the association neocortex.
Archives of NeurologyNeuropathologic and Neurochemical Correlates of Psychosis in Primary Dementia
276 Citations1991George S. Zubenko, John Moossy +5 more
The profile of neuropathologic and neurochemical changes associated with psychosis is distinct from that previously reported for major depression in the context of primary dementia.
American Journal of PsychiatryThe relationship between dementia and elder abuse
275 Citations1993Andrew C. Coyne, William E. Reichman +1 more
The hypothesis that abuse involving cognitively impaired older adults and their caregivers may be associated with the relatively high psychological and physical demands placed on family members who care for relatives with dementia is supported.
Archives of NeurologyMajor Depression in Primary Dementia
248 Citations1988George S. Zubenko
The results indicate that the development of major depression in patients with primary dementia is associated with the degeneration of the locus ceruleus and substantia nigra.
Journal of Neurology Neurosurgery & PsychiatrySingle photon emission tomography using 99mTc-HM-PAO in the investigation of dementia.
238 Citations1987David Neary, Julie S. Snowden +6 more
Single photon emission tomographic imaging of the brain using 99mTc HM-PAO was carried out in patients with a clinical diagnosis of Alzheimer's disease, non-Alzheimer frontal-lobe dementia, and progressive supranuclear palsy, and the findings were consistent with observed patterns of mental impairment.
Archives of NeurologyNeurochemical Correlates of Major Depression in Primary Dementia
234 Citations1990George S. Zubenko, John Moossy +1 more
American Journal of PsychiatryPsychosis and physical aggression in probable Alzheimer's disease
227 Citations1991Lynn H. Deutsch, Frederick W. Bylsma +3 more
This study suggests that delusions are a risk factor for physical aggression in patients with probable Alzheimer's disease who have moderate to severe cognitive impairment.
American Journal of PsychiatryPhenomenological correlates of metabolic activity in 18 patients with chronic schizophrenia
214 Citations1987Nora D. Volkow, A Wolf +5 more
Findings suggest that cerebral metabolic patterns reflect clinical characteristics of schizophrenic patients, and patients with more negative symptoms showed lower global metabolic rates and more severe hypofrontality.
American Journal of PsychiatryCognitive deficits of patients with Alzheimer's disease with and without delusions
211 Citations1992D. V. Jeste, R E Wragg +3 more
The presence of psychotic symptoms in Alzheimer's disease was associated with greater cognitive impairment, especially frontal/temporal dysfunction, and possibly with a more rapidly progressive dementia.
American Journal of PsychiatryA comparison of psychiatric symptoms in vascular dementia and Alzheimer's disease
206 Citations1993David L. Sultzer, H S Levin +3 more
Patients with vascular dementia have more severe behavioral retardation, depression, and anxiety than those with Alzheimer's disease when the groups have similar levels of cognitive impairment, probably reflects the contrasting brain regions typically involved in the two disorders.
NeurologyParalimbic frontal lobe hypometabolism in depression associated with Huntington's disease
197 Citations1992Helen S. Mayberg, Sergio Starkstein +4 more
The metabolic pattern in patients with early Huntington's disease is similar to that in depression associated with Parkinson's disease, suggesting that the integrity of pathways linking paralimbic frontal cortex and the basal ganglia may be integral to the normal regulation of mood.
Annals of NeurologyPossible neurotransmitter basis of behavioral changes in alzheimer's disease
196 Citations1988Alan M. Palmer, Gary C. Stratmann +2 more
It is argued that the large loss of indoleamines from the frontal lobe (to 50–63% of control values) is rather unexpected based on other biochemical measurements and may relate to behavioral changes.
Journal of the American Geriatrics SocietyRelation of Cognitive Status and Abnormal Behaviors in Alzheimer's Disease
196 Citations1990James K. Cooper, Dan Mungas +1 more
Data support the general notion that five of the six abnormal behaviors studied are more likely to occur with increasing cognitive loss, but correlations are small and it is suggested that other as yet unproven factors may play an as large or greater role than MMSE score in predicting such behaviors.
Archives of NeurologyTopography of Cross-sectional and Longitudinal Glucose Metabolic Deficits in Alzheimer's Disease
178 Citations1992Gwenn S. Smith
The brain regions that show glucose metabolic deficits cross-sectionally over the stages of AD also show further deficits longitudinally within the same AD subjects, which is greater than would be expected from the degree of brain atrophy.
StrokeEffects of capsular or thalamic stroke on metabolism in the cortex and cerebellum: a positron tomography study.
170 Citations1990Sabina Pappatà, Bernard Mazoyer +4 more
The data suggest that damage to the thalamus or the thalamocortical projections is important in the development of ipsilateral cortical hypometabolism and that the latter may underlie the associated neuropsychological impairment.
Journal of GerontologyCognitive Deterioration in Alzheimer's Disease Behavioral and Health Factors
166 Citations1990Linda Teri, John P. Hughes +1 more
Results indicate that the rate of cognitive decline in Alzheimer's disease is quite variable, and patients with various health and behavioral problems declined at a rate between 1.4 and 5 times faster than patients without such problems.
The British Journal of PsychiatryMood Changes After Right-Hemisphere Lesions
165 Citations1989Sergio Starkstein, Robert G. Robinson +4 more
Patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions.
NeurologyAlzheimer's disease with delusions and hallucinations
157 Citations1991Oscar L. López, James T. Becker +4 more
It is demonstrated that AD patients with delusions and hallucinations have a greater degree of cerebral dysfunction and a relatively focal neuropsychological defect, which may indicate a localized pathologic abnormality.
PubMedHigh-resolution PET studies in Alzheimer's disease.
153 Citations1991Anand Kumar, M. B. Schapiro +6 more
Widespread metabolic disturbances, particularly in the association areas, relatively early in Alzheimer's disease, and more profound involvement with disease progression are demonstrated.
Archives of NeurologyCortical Abnormalities Associated With Subcortical Lesions in Vascular Dementia
142 Citations1995David L. Sultzer
Cortical metabolic dysfunction is related to ischemic subcortical lesions in patients with vascular dementia and anxiety, depression, and the overall severity of neuropsychiatric symptoms in vascular dementia are associated with the extent of white matter ischemia.
Journal of NeuropsychiatrySubgroups in dementia of the Alzheimer type identified using positron emission tomography
133 Citations1990C. L. Grady, James V. Haxby +6 more
These metabolic subgroups could not be explained on the basis of dementia severity, illness duration, or age, but were most likely related to an underlying pathology with a variable regional distribution.
Journal of the American Geriatrics SocietyCorrelates of Depression and Burden for Informal Caregivers of Patients in a Geriatrics Referral Clinic
127 Citations1987Theresa J. K. Drinka, J. Carson Smith +1 more
The hypothesis that caregiver burden and depression are related to patient cognitive impairment is tested and it is shown that there was a high prevalence of dementia and depression in elderly male patients from a Veterans hospital geriatrics referral clinic.
NeurologyA SPECT study of delusions in Alzheimer's disease
124 Citations1994Sergio Starkstein, Silvia Vázquez +5 more
Journal of the American Geriatrics SocietyAssessment of Cognitive, Psychiatric, and Behavioral Disturbances in Patients with Dementia: The Neurobehavioral Rating Scale
123 Citations1992David L. Sultzer, Harvey S. Levin +3 more
To assess the validity of the Neurobehavioral Rating Scale (NRS) in patients with Alzheimer's disease (AD) or multi‐infarct dementia (MID) and to characterize the cognitive, psychiatric, and behavioral disturbances that occur in these patients.
Alzheimer Disease & Associated DisordersManagement of Behavior Disturbance in Alzheimer Disease
121 Citations1992Linda Teri, Peter V. Rabins +6 more
The current thinking on five areas of prime importance to patients, care providers, and health care professionals: agitation, assault/aggression, screaming, wandering, and depression/apathy/withdrawal are summarized.
Neurobiology of AgingDifferences of regional cerebral glucose metabolism between presenile and senile dementia of Alzheimer type
115 Citations1992R. Mielke, Karl Herholz +3 more
A more generalized disorder in senile dementia impairing metabolism globally in addition to the more localized changes that are typical for DAT is suggested.
NeuropsychologiaImpaired metabolic activation in Alzheimer's disease: A pet study during continuous visual recognition
95 Citations1991Josef Kessler, Karl Herholz +2 more
It can be concluded that metabolic rate at rest reflects the extent of morphologic damage, while PET studies during activation indicate the brain's reserve capacity to respond to functional tasks.
American Journal of PsychiatryImpact of psychiatric hospitalization on behavioral complications of Alzheimer's disease
81 Citations1992George S. Zubenko, Jules Rosen +3 more
Short-term psychiatric hospitalization is effective and efficient for achieving the goal of returning patients to their homes and for safely implementing specific treatments in this frail population, and it may reduce the need for institutionalization.
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques<sup>18</sup>Fluorodeoxyglucose Positron Emission Tomography Studies in Presumed Alzheimer Cases, Including 13 Serial Scans
77 Citations1990Edith G. McGeer, R.P. Peppard +8 more
Journal of Neurology Neurosurgery & PsychiatryBrain metabolism in Alzheimer's dementia: studies of 11C-deoxyglucose accumulation, CSF monoamine metabolites and neuropsychological test performance in patients and healthy subjects.
63 Citations1991Henrik Nybäck, Håkan Nyman +3 more
Verbal and memory performances were associated with greater left hemisphere metabolism in the patients, but not in the controls, whereas non-verbal abilities tended to be associated with right hemisphere metabolic dominance.
Journal of clinical and experimental neuropsychologyVisuoconstructive performance and regional cerebral glucose metabolism in alzheimer's disease
63 Citations1991Beth A. Ober, William J. Jagust +3 more
Findings are suggestive of a posterior-anterior differentiation, but no left-right hemisphere differentiation, in the relationship between drawing performance and cerebral metabolism in AD, which cannot be accounted for by overall dementia severity.
Journal of Psychiatric ResearchCerebral metabolic and cognitive studies in dementia with frontal lobe behavioral features
55 Citations1990Anand Kumar, Mark B. Schapiro +3 more
Archives of General PsychiatryAn In Vivo Study of Phosphorus and Glucose Metabolism in Alzheimer's Disease Using Magnetic Resonance Spectroscopy and PET
51 Citations1993Declan Murphy
Altered high-energy phosphate levels are not a consequence of reduced glucose metabolism in DAT, and do not play a major role in the pathophysiology of the disorder, at least in whole-brain sections.
Neuropsychiatry, neuropsychology, and behavioral neurologyDifferential Diagnosis of Primary and Secondary Capgras Delusions
50 Citations1992Paul Malloy, Cynthia R. Cimino +1 more
In MC patients, IFN-free regimens are effective and well tolerated, and RBV seems to significantly increase the immunological response and promote a decline in cryocrit.
Archives of Gerontology and GeriatricsCortical glucose utilization patterns in primary degenerative dementias of the anterior and posterior type
46 Citations1987Thomas N. Chase, Gillian Burrows +1 more
The results indicate that the primary degenerative dementias may reflect a selective abnormality of the frontal and parietal association corticies and suggests that diagnostic entities as neuropathologically distinct as Alzheimer's disease and Pick's disease could share a common pathophysiology.
American Journal of PsychiatryAgitation and postdexamethasone cortisol levels in Alzheimer's disease
36 Citations1992Brian Lawlor, Gabriel Tsuboyama +6 more
The clinical correlates of hypothalamic-pituitary-adrenal (HPA) functioning were examined in 29 patients with probable Alzheimer's disease and postdexamethasone cortisol levels were highly correlated with higher agitation scores but not with the degree of depressed mood or memory impairment.
American Journal of PsychiatryPsychopathology in younger versus older persons with very mild and mild dementia of the Alzheimer type
29 Citations1993Eugene H. Rubin, Dorothy A. Kinscherf +1 more
Similar patterns of psychopathology in younger and more elderly persons with dementia of the Alzheimer type support the suggestion that these changes are direct effects of the illness on the CNS.
Comprehensive PsychiatryAspects of the behavior of psychiatric inpatients with frontal lobe damage: Some implications for diagnosis and treatment
20 Citations1987Thomas W. McAllister, Trevor R. P. Price
A series of 20 consecutive psychiatric inpatients with clear-cut evidence of frontal lobe disease and a variety of behavioral disturbances are described, highlighting some diagnostic issues that the clinician commonly faces with such patients.
Psychiatric Clinics of North AmericaNeuroimaging in Alzheimer's Disease
9 Citations1991Marilyn S. Albert, Ginette Lafleche
This article reviews the recent neuroimaging studies of patients with Alzheimer's disease and discusses computerized tomography, magnetic resonance imaging, positron emission tomographic procedures, and single-photon emission computerize tomography.