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Matthew E Peters
Johns Hopkins Medicine
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EDITORIAL
Received October 13, 2014; accepted October 13, 2014. From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview
and Johns Hopkins University School of Medicine, Baltimore, MD. Send correspondence and reprint requests to Constantine G. Lyketsos,
M.D., M.H.S., Department of Psychiatry, Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Blvd., Baltimore, MD 21224. e-mail:
kostas@jhmi.edu
! 2015 American Association for Geriatric Psychiatry
http://dx.doi.org/10.1016/j.jagp.2014.11.002
115
Editorial
and persistent 5 years later) was not. The association
with rst-ever depression lends support to the
symptom hypothesis. Of note, the authors use a
competing risk model in studying depression as a
risk factor for AD because death may prevent (i.e.,
compete with) the occurrence of AD in the aged
population. This is a novel analytic method that
future studies on this topic should consider.
In an international study of memory clinics in the
United States and France, Zahodne et al.8 characterize cross-sectional and longitudinal relationships
between three NPS (psychosis, depressed mood,
agitation/aggression) and dementia progression (as
measured by cognition and dependence) to better
understand their interplay over time. Impact of individual NPS on patient care needs are indexed by
patient dependence, as opposed to nursing home
placement used in some other studies. Both psychosis
and depressed mood at entry were associated with
worse subsequent cognitive decline. Independent of
cognitive decline, initial psychosis was associated
with worse subsequent increase in dependence. Rates
of increase in agitation/aggression separately correlated with rates of decline in both outcomes. This is
consistent with recent work from our group in the
Cache County Dementia Progression Study,9 where
psychosis, agitation/aggression, and any one clinically signicant NPS were associated with more
rapid progression from dementia onset to severe
dementia. Psychosis, affective symptoms, agitation/
aggression, and mildly symptomatic/clinically signicant NPS were associated with earlier death. It is
increasingly clear that NPS are risk factors for dementia progression, as they are for dementia onset.
However, it could be that these NPS signify worse or
more widely distributed AD pathology.
Beyond epidemiology, Whiteld et al.10 examine
the molecular basis of depression in dementia. Current antidepressants, effective in treating depression
in people without dementia, have limited effectiveness for depression in dementia patients,11 suggesting a different pathology. Using postmortem
examination of the brains of individuals with AD,
Parkinson disease dementia, and dementia with
Lewy bodies, the researchers investigated the relationship between synaptic zinc regulation (specifically zinc transporter 3 levels) and depression. This
follows research in rodents, where zinc deciency
results in the display of depressive-like symptoms. In
116
References
1. Alzheimers Disease International: World alzheimer report 2014.
London, 2014. Available at: http://www.alz.co.uk/research/
world-report-2014
2. Steinberg M, Shao H, Zandi P, et al: Point and 5-year period
prevalence of neuropsychiatric symptoms in dementia: the
Cache County Study. Int J Geriatr Psychiatry 2008; 23:170e177
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Editorial
5. Geda YE, Schneider LS, Gitlin LN, et al: Neuropsychiatric symptoms in Alzheimers disease: past progress and anticipation of the
future. Alzheim Dement 2013; 9:602e608
6. Cohen-Manseld J: Theoretical frameworks for behavioral problems in dementia. Alzheim Care Today 2000; 1:8e21
7. Gracia-Garcia P, de-la-Camara C, Santabarbara J, et al: Depression
and incident Alzheimers disease: the impact of depression
severity. Am J Geriatr Psychiatry 2015; 23:119e129
8. Zahodne L, Ornstein K, Cosentino S, et al: Longitudinal relationships between Alzheimers disease progression and psychosis,
depressed mood and agitation/aggression. Am J Geriatr Psychiatry 2015; 23:130e140
9. Peters ME, Schwartz SS, Han D, et al: Neuropsychiatric
symptoms as predictors of progression to severe Alzheimers
dementia and death: The Cache County Dementia Progression Study. Am J Geriatr Psychiatry 2014; 22:3(suppl 1):
S65eS66
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