Providentia

Identifying individuals with subtle cognitive decline

Dementia is a devastating neurological disease that may be better managed if diagnosed earlier when subclinical neurodegenerative changes are already present, including subtle cognitive decline and mild cognitive impairment. In a new study published in the journal Neuropsychology, researchers used item-level performance on the Montreal Cognitive Assessment (MoCA) to identify individuals with subtle cognitive decline. Method: Individual MoCA item data from the Alzheimer’s Disease Neuroimaging Initiative was grouped using k-modes cluster analysis. These clusters were validated and examined for association with convergent neuropsychological tests. The clusters were then compared and characterized using multinomial logistic regression. Results: A three-cluster solution had 77.3% precision, with Cluster 1 (high performing) displaying no deficits in performance, Cluster 2 (memory deficits) displaying lower memory performance, and Cluster 3 (compound deficits) displaying lower performance on memory and executive function. Age at MoCA (older in compound deficits), gender (more females in memory deficits), and marital status (fewer married in compound deficits) were significantly different among clusters. Age was not associated with increased odds of membership in the high-performing cluster compared to the others. Conclusions: We identified three clusters of individuals classified as cognitively unimpaired using cluster analysis. Individuals in the compound deficits cluster performed lower on the MoCA and were older and less often married than individuals in other clusters. Demographic analyses suggest that cluster identity was due to a combination of both cognitive and clinical factors. Identifying individuals at risk for future cognitive decline using the MoCA could help them receive earlier evidence-based interventions to slow further cognitive decline. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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When Autistic People Camouflage

Camouflaging includes strategies used by individuals to mask or hide autistic traits. Research has shown that both autistic and neurotypical individuals engage in camouflaging and that there may be sex differences in the reasons for camouflaging in autistic adults. A qualitative study recently published in the Journal of Autism and Developmental Disorders extends previous research on the lived experience of camouflaging through exploring camouflaging motivations and consequences in autistic and neurotypical adolescents through both questionnaires (n = 132) and semi-structured interviews (n = 19). Results revealed trends in camouflaging motivations and consequences by diagnosis and sex, as well as by sex within the autistic group. These findings further inform our understanding of camouflaging and why it may be reported as particularly detrimental for autistic females. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Dementia Linked to Two Murder-Suicides in Iowa

When deputies in Iowa's Pottawattamie County on November 7 of this year, they were told that a domestic disturbance was in progress.  They were also warned that 86-year-old Harvey Rankin was suffering from dementia and family members worried about his welfare as well as that of his wife, 83-year-old Bonnie Rankin.   Upon arriving, they discovered that Harvey Rankin had shot and killed his wife and, despite pleas from the deputies for him to give himself up, shot himself as well.   Despite being transported to a local hospital, he died on November 16.

"All the evidence so far leads to an apparent murder-suicide,” said Sgt. Jim Doty, Pottawattamie County Sheriff's Office. "Going to the scene and seeing that it’s an elderly couple and hearing the reports of dementia, it was heartbreaking, because you can't believe that he was in his right mind to do something that horrific,” Doty added. 

The case bears a striking resemblance to an earlier murder that occurred in Lincoln, Nebraska in June of this year.  On June 20, 80-year-0ld JohnKotopka shot and killed his 78-year-old wife, Janet.  Now facing a first-degree murder charge, Kotopka told authorities that he killed his wife of 57 years due to the exhaustion of caring for.   She had been diagnosed with dementia two years earlier and he had been acting as her primary caregiver with little real relief.  

While caregiver stress remains a major problem for spouses of dementia patients, Nebraska Alzheimer’s Association executive director Julie Chytil said there is help available for people in need.  "Knowledge is going to be your friend in this situation so you know what’s coming and how to prepare,” she said. “Your loved one will change, and the way you used to communicate with them must also change. Learning how to care for them can help you plan.”  Many organizations for dementia sufferers have extensive online and local resources which can be invaluable in avoiding tragedies such as these.

 

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Australian Psychiatrist Goes to Court For Right to Treat Patient with MDMA

Melbourne psychiatrist Eli Kotler has launched a court battle against the state of Victoria for permission to treat a severely ill patient with MDMA (better known as "ecstasy").   According to Dr. Kotler, his patient (who cannot be named) suffers from numerous mental health issues for which conventional psychiatric medication have been ineffective.    Since MDMA is listed as a prohibited substance in Australia, it can only be administered for medical or scientific research.  Earlier this year, the Victorian health department rejected Dr. Kotler's application to use the drug for treating his patient.  A letter sent at the time by Stefan Tulloch, the acting chief officer of medicines and poisons regulation at the Department of Health,  informed the psychiatrist that ""There is insufficient data to establish the safety and efficacy … with regards to the safe use of a Schedule 9 poison in clinical practice."

As a result, Dr. Kotler has gone forward with a court challenge that sets a legal precedent in Australia.  While Australia's  Therapeutic Goods Administration, which regulates medicines, is considering making MDMA a controlled drug, it is still unclear how long this will take and whether it will resolve Dr. Kotler's challenge.  In the meantime, both sides are gearing up for what is expected to be a protracted legal battle with expert witnesses being called in from California and the United Kingdom where MDMA has already been used successfully in medical treatment.

Despite the controversy surrounding MDMA-assisted therapy in many places, research has already suggested that MDMA-assisted psychotherapy may be beneficial in treating posttraumatic stress disorder (PTSD), and depression though most researchers call for more studies given the potential dangers associated with its use.

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Remembering Sexual Assaults

Trauma survivors often report trauma events inconsistently over time. Many studies, for example, have found that people report having experienced trauma events that they initially failed to report or remember, a phenomenon called “memory amplification.” Other studies have found the opposite: people report experiencing fewer events over time. Nahleen, Nixon, and Takarangi (2019) asked participants at two time-points, with a six-month delay, whether they had experienced 19 sexual assault events on a yes/no scale. Participants reported fewer events over time, that is, memory for sexual assault did not amplify overall. In a new study published in the Journal of Behavior Therapy and Experimental Psychiatry, we assessed whether inconsistency in reports of trauma exposure over time may be attributed to changes in participants’ belief that certain events were experienced. We replicated Nahleen et al. (2019), but rather than respond to a yes/no trauma exposure scale, participants were required to rate the likelihood that each trauma event occurred on an 8-point scale (1 = definitely did not happen; 8 = definitely did happen). Results showed that participants believed that they were less likely to have experienced the sexual assault events at follow-up compared to the initial assessment.   We could not corroborate trauma experiences or determine causality with our design which limited our findings Further, not all of our findings were consistent with Nahleen et al. (2019). Conclusions: Sexual assault memories did not amplify over time, perhaps because, compared to other types of trauma, the idea of experiencing additional sexual assault events that were not actually experienced is less believable. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Will Pellagra Make a Comeback?

Pellagra is a vitamin deficiency disease that is often reported in Africa, Central America, and South-east Asia. Caused by tryptophan and niacin-poor diets, it has also been identified in marginalized individuals in industrial societies (especially homeless, chronic alcoholic, and psychiatric patients who refuse food). Symptoms of pellagra include light sensitivity, dementia, diarrhea, and dermatitis. In advanced cases, pellagra can lead to psychotic delusions. Left untreated, pellagra cases die after several years without proper nutrition.

While first identified in Spain in the 18th century, it received its name from an epidemic in Italy ("pelle agra" means bitter skin in Italian). Pellagra was epidemic in parts of the US in the early 1900s before the nutritional basis for the disease was identified and niacin supplements made treatment possible. While easy to diagnose and treat, physicians often miss vital clues, especially in industrialized societies where pellagra is less likely to be encountered. Even in non-industrialized countries, improved standard of living and greater diversity in dietary sources have made pellagra less common.

But an article published a few years back in the American Journal of Therapeutics discussed the possible resurgence of pellagra in HIV patients and anorexia nervosa patients who neglect proper nutrition. The authors also reviewed a case f pellagra identified through the warning triad of "dermatosis, diarrhea, and dementia" and properly treated.   In the twelve years since that particular study was published,   there has been an upswing in new pellagra cases which have been largely linked to the popularity of certain restricted diets such as extreme veganism.   A 2021 article reviews a case of pellagra involving a strict vegan who was diagnosed and treated for pellagra and warns health professionals of the need to stay aware of how easily such a patient might be misdiagnosed.     

For all that it is considered extinct in affluent countries, pellagra has never completely gone away.    Something to think about if you are considering a new fad diet...

Infidelity and the Capgras Delusion

Remembering back to a fascinating case study described in the June 2008 issue of Clinical Neurophysiology.  The study concerns a patient who presented visual hallucinations and identification disorders associated with a Capgras syndrome. During his Capgras episodes, the patient not only misidentified his wife's face, but also perceived her as being an entirely different sexual partner. He then had sexual intercourse with his wife's "double" without having the slightest recollection of any familiarity with her and even changed his sexual habits. According to the authors, he is the only known neurological patient that made his wife a mistress. In discussing the case, the authors discuss the mechanism of Capgras delusion with reference to the processes involved in face recognition. The complete loss of familiarity not only with the face but also with all aspects of sexual intimacy suggests a specific disconnection between the neural pathways linked to face identification and the systems involved in emotional and episodic memory.

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Charting Cognitive Functioning in Seniors Across Europe

With ageing mental health issues, as age-related cognitive decline, increase. A study recently published in the journal Aging, Neuropsychology, and Cognition aims to evaluate the prevalence of cognitive impairment among older European adults and to evaluate its association with clinical and sociodemographic variables, using SHARE. Numeracy, temporal orientation, verbal fluency, and memory were the measures used to evaluate cognitive performance. From 44 963 individuals included, mean age was 70.0 ± 9.0 years old and 56.3% were female. Overall prevalence of impairment was of 13.0% (temporal orientation), 24.8% (numeracy), 27.6% (verbal fluency) and 50.5% (memory). Men showed higher impairment prevalence in temporal orientation and memory and lower in numeracy and verbal fluency. Age, fewer years of education, difficulties performing iADLs, physical inactivity, and poor self-perceived health were independently associated with impairment in all cognitive abilities. These results showed the burden of cognitive impairment across Europe. Factors identified as associated should be taken in consideration to develop effective interventions to prevent cognitive decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

 

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Seeing the Little People

Lilliputian hallucinations concern hallucinated human, animal or fantasy entities of minute size. Having been famously described by the French psychiatrist Raoul Leroy in 1909, who wrote from personal experience, to date they are mentioned almost routinely in textbooks of psychiatry, albeit with little in-depth knowledge. A paper recently published in the journal Neuroscience and Biobehavioral Reviews systematically reviewed 145 case reports and case series comprising 226 case descriptions, concluding that lilliputian hallucinations are visual (61 %) or multimodal (39 %) in nature. In 97 % of the cases, they are perceived as grounded in the actual environment, thus indicating involvement of higher-level regions of the perceptual network subserving the fusion of sensory and hallucinatory content. Perceptual release and deafferentiation are the most likely underlying mechanisms. Etiology is extremely diverse, with schizophrenia spectrum disorder, alcohol use disorder and loss of vision accounting for 50 % of the cases and neurological disease for 36 %. Recovery was obtained in 62 % of the cases, whereas 18 % of the cases ended in chronicity and 8 % in death. Recommendations are made for clinical practice and future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

 

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Is Brain Resilience Heritable?

Resilience is the capacity of complex systems to persist in the face of external perturbations and retain their functional properties and performance. In a new study published in the journal Neuroimage, researchers investigated how individual variations in brain resilience, which might influence response to stress, aging and disease, are influenced by genetics and/or the environment, with potential implications for the implementation of resilience-boosting interventions. Resilience estimates were derived from in silico lesioning of either brain regions or functional connections constituting the connectome of healthy individuals belonging to two different large and unique datasets of twins, specifically: 463 individual twins from the Human Connectome Project and 453 individual twins from the Colorado Longitudinal Twin Study. As has been reported previously, moderate heritability was found for several topological indexes of brain efficiency and modularity. Importantly, evidence of heritability was found for resilience measures based on removal of brain connections rather than specific single regions, suggesting that genetic influences on resilience are preferentially directed toward region-to-region communication rather than local brain activity. Specifically, the strongest genetic influence was observed for moderately weak, long-range connections between a specific subset of functional brain networks: the Default Mode, Visual and Sensorimotor networks. These findings may help identify a link between brain resilience and network-level alterations observed in neurological and psychiatric diseases, as well as inform future studies investigating brain shielding interventions against physiological and pathological perturbations. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Hazy memories in the courtroom: A review of alcohol and other drug effects on false memory and suggestibility.

Alcohol and other psychoactive drugs are oftentimes implicated in legal cases. A pertinent question herein is whether such substances might adversely affect testimonies of victims, eyewitnesses, or suspects by propelling the formation of false memory and increasing susceptibility to suggestion. In a new review published in Neuroscience and Biobehavioral Reviews, researchers amassed all available evidence on the effects of intoxication on false memory formation and suggestibility, including the substances alcohol, benzodiazepines, cannabis, stimulants, hallucinogens, and antipsychotics. The review indicated that alcohol and cannabis under certain conditions increased the susceptibility to false memories and/or suggestion with effect sizes ranging from medium to large. When intoxicated during an event, alcohol is most likely to increase this susceptibility at high intoxication levels or after a delay, whereas cannabis exerts detrimental effects during acute intoxication but not necessarily once sober. For other substances, ecologically valid research separating different memory phases is needed. Overall, differences between substances regarding false memory effects exist, suggesting that a nuanced approach is needed when dealing with intoxicated individuals in a legal context. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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