Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-19T21:46:51.749Z Has data issue: false hasContentIssue false
  • English
  • Français

Case series of mild behavioral impairment: toward an understanding of the early stages of neurodegenerative diseases affecting behavior and cognition

Published online by Cambridge University Press:  11 October 2017

Alicja Cieslak ,
Eric E. Smith ,
John Lysack  and
Zahinoor Ismail Open the ORCID record for Zahinoor Ismail [Opens in a new window]
Alicja Cieslak
Affiliation:
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
Eric E. Smith
Affiliation:
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
John Lysack
Affiliation:
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada Division of Neuroradiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
Zahinoor Ismail*
Affiliation:
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada Department of Psychiatry, Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
*
Correspondence should be addressed to: Zahinoor Ismail, 3280 Hospital Dr. NW, TRW Building First Floor, Mathison Centre, Calgary AB, T2N 2Z6, Canada. Phone: +1 403 210 6900. Email: zahinoor@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Mild behavioral impairment (MBI) is characterized by later life acquired, sustained, and impactful neuropsychiatric symptoms (NPS) of any severity that cannot be better accounted for by other formal medical and psychiatric nosology. MBI is an “at risk” state for incident cognitive decline and dementia, and for some, MBI is the index manifestation of neurodegeneration, observed in advance of cognitive impairment. Initially described in Frontotemporal Dementia (FTD), MBI evolved to describe a preclinical stage of all cause dementia, and has been operationalized in the International Society to Advance Alzheimer's Research and Treatment-Alzheimer's Association (ISTAART-AA) proposed research diagnostic criteria. Here, we describe three cases in which patients diagnosed with a variety of dementing conditions initially presented with NPS to the Cognitive Neurosciences Clinic at the University of Calgary, Canada. All patients described in our series were given a final diagnosis of dementia; the etiology supported by clinical, cognitive, and neuroimaging findings. In all three cases, the progression to dementia was preceded by NPS that meet criteria for MBI. With these examples, we are able to illustrate that MBI can represent a premonitory stage of dementia of different etiologies. These cases demonstrate early use of the MBI checklist (MBI-C). The cases presented in this series serve as examples of NPS as early manifestations of dementia. Our case examples include both FTD and AD, and demonstrate that before a diagnosis of a neurodegenerative disease is considered, often patients will be diagnosed with and treated for a psychiatric condition. These early NPS can be characterized within the domains outlined in the ISTAART-AA MBI criteria, and detected with the MBI-C, which may help clinicians consider neurodegenerative disease in the differential diagnosis of later life onset psychiatric symptomatology.

Keywords

mild behavioral impairmentneuropsychiatric symptomsfrontotemporal dementiaAlzheimer's diseasepreclinical dementiaprodromal dementia
Type
Case Report
Information
International Psychogeriatrics , Volume 30 , Special Issue 2: Mild Behavioral Impairment , February 2018 , pp. 273 - 280
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Almeida, O., Hankey, G., Yeap, B., Golledge, J. and Flicker, L. (2017). Depression as a modifiable factor to decrease the risk of dementia. Translational Psychiatry, 7, e1117.Google Scholar
Fischer, C. E., Ismail, Z. and Schweizer, T. A. (2012). Delusions increase functional impairment in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 33, 393–399.Google Scholar
Geda, Y. E. et al. (2013). Neuropsychiatric symptoms in Alzheimer's disease: past progress and anticipation of the future. Alzheimer's & Dementia, 9, 602–608.Google Scholar
Ismail, Z. and Mortby, M. E. (2017). Cognitive and neuropsychiatric screening tests in older adults. In Chiu, H. and Shulman, K. (eds.), Mental Health and Illness of the Elderly. New Delhi: Springer.Google Scholar
Ismail, Z. et al. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimer's & Dementia, 12, 195–202.Google Scholar
Ismail, Z. et al. (2017). The mild behavioral impairment checklist (MBI-C): a rating scale for neuropsychiatric symptoms in pre-dementia populations. Journal of Alzheimer's disease, 56, 929–938.Google Scholar
Jalal, H., Ganesh, A., Lau, R., Lysack, J. and Ismail, Z. (2014). Cholinesterase-inhibitor associated mania: a case report and literature review. The Canadian Journal of Neurological Sciences, 41, 278–280.CrossRefGoogle Scholar
Lanctôt, K. L. et al. (2017). Apathy associated with neurocognitive disorders: recent progress and future directions. Alzheimer's & Dementia, 13, 84–100.Google Scholar
McKhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 263–269.Google Scholar
Petersen, R. C., Stevens, J. C., Ganguli, M., Tangalos, E. G., Cummings, J. L. and DeKosky, S. T. (2001). Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the quality standards subcommittee of the American academy of neurology. Neurology, 56, 1133–1142.Google Scholar
Rascovsky, K. et al. (2011). Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain, 134, 2456–2477.Google Scholar
Rosenberg, P. B., Nowrangi, M. A. and Lyketsos, C. G. (2015). Neuropsychiatric symptoms in Alzheimer's disease: what might be associated brain circuits? Molecular aspects of medicine, 43, 25–37.Google Scholar
Singh-Manoux, A. et al. (2017). Trajectories of depressive symptoms before diagnosis of dementia: a 28-year follow-up study. JAMA Psychiatry, 74, 712–718.CrossRefGoogle ScholarPubMed
Tapiainen, V., Hartikainen, S., Taipale, H., Tiihonen, J. and Tolppanen, A.-M. (2017). Hospital-treated mental and behavioral disorders and risk of Alzheimer's disease: a nationwide nested case-control study. European Psychiatry, 43, 92–98.CrossRefGoogle ScholarPubMed
Taragano, F. E., Allegri, R. F., Krupitzki, H., Sarasola, D., Serrano, C. and Lyketsos, C. (2009). Mild behavioral impairment. Journal of Clinical Psychiatry, 70, 584–592.CrossRefGoogle ScholarPubMed
Woolley, J. D., Khan, B. K., Murthy, N. K., Miller, B. L. and Rankin, K. P. (2011). The diagnostic challenge of psychiatric symptoms in neurodegenerative disease: rates of and risk factors for prior psychiatric diagnosis in patients with early neurodegenerative disease. Journal of Clinical Psychiatry, 72, 126–133.CrossRefGoogle ScholarPubMed